Epilepsy surgery
Michael Y. Wang, Andrea L. Strayer, Odette A. Harris, Cathy M. Rosenberg, Praveen V. Mummaneni in Handbook of Neurosurgery, Neurology, and Spinal Medicine for Nurses and Advanced Practice Health Professionals, 2017
Often epilepsy surgery is performed to treat mesial temporal sclerosis. In these cases, the medial structures of the temporal lobe, the hippocampus, and to some degree the amygdala, are thought to be epileptogenic. In some cases, the lateral temporal cortex may also be a focus of epilepsy. When the temporal lobe is viewed laterally, the superior, middle, and inferior temporal gyri are evident. Viewed medially, the uncus and parahippocampal gyrus are evident (Figure 40.2 and 40.3). A coronal section of the anterior temporal lobe demonstrates the hippocampus, temporal horn, optic tract, and parahippocampal gyrus (Figure 40.4). Traditionally, a portion of the lateral temporal cortex is removed with the hippocampus and amygdala (anterior temporal lobectomy); however, there are procedures that preserve the lateral temporal cortex and only remove the medial temporal lobe structures (selective amygdalohippocampectomy). On the dominant side, the left brain for most people, the surgeon may choose to limit the posterior extent of resection of the temporal lobe to avoid creating language deficits (taking the resection back to only 3.5–4 cm from the temporal pole on the dominant side as opposed to 5–5.5 cm from the temporal pole on the nondominant side) (Van Hoesen, 1995).
Neurology
Stephan Strobel, Lewis Spitz, Stephen D. Marks in Great Ormond Street Handbook of Paediatrics, 2019
Surgery: Resection for focal lesions (e.g. temporal lobectomy or amygdalohippocampectomy to remove dysplastic and/or scarred tissue, removal of cortical dysembryoplastic neuroectodermal tumour, hemispherectomy).Vagal nerve stimulation.Corpus callosotomy is usually reserved for intractable drop attacks.
Cranial Neurosurgery
Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie in Bailey & Love's Short Practice of Surgery, 2018
Mesial temporal epilepsy is commonly medically refractory and can be addressed surgically by amygdalohippocampectomy or resection of the temporal lobe including the mesial structures. The extent of resection is limited by the potential for damage to the optic tracts and to speech areas in the dominant hemisphere. With careful patient selection, cure rates of up to 70% or greater can be achieved.
Laser thermal ablation in epilepsy
Published in Expert Review of Neurotherapeutics, 2019
Sanjeet S. Grewal, William O. Tatum
Many different types of surgical procedures are available for patients with drug-resistant epilepsy [Table 1] [1,2]. Temporal lobectomy is the most common surgical procedure performed for patients with drug-resistant epilepsy. Despite Class I evidence and practice guidelines by the American Academy of Neurology, utilization of epilepsy surgery has remained static with less than 5% of potential candidates operated [3]. Resection of the anterior temporal lobe is the target in 70% of epilepsy surgeries (amygdala, hippocampus, parahippocampal gyrus) [4]. Seizure-free outcomes result in 60–80% of selected patients but with the risk of cognitive and neurological adverse outcome [5]. Patients who undergo anterior temporal lobectomy may experience category-related object recognition and naming when the white matter of the temporal stem is involved. Collateral damage may decouple the core of language, visual function, and semantic memory. However, overall, quality of life after epilepsy surgery is improved when compared with that of best medical practice [4,5]. Direct costs are lower in 3 years for seizure-free patients and reach cost-effectiveness in 9 years [6]. Selective amygdalohippocampectomy reduces seizure-free outcome by a mean of 8% [7]. Visual field deficits and verbal memory deficits with anterior temporal lobectomy appear greater than selective amygdalohippocampectomy in one study (43.4% v 30.9%) [8]. The potential for effectiveness balances seizure-freedom with the risk of ‘collateral damage’ incurred by larger resection of the anterior temporal lobe [9].
Withdrawal of antiseizure medications – for whom, when, and how?
Published in Expert Review of Neurotherapeutics, 2023
Francesco Brigo, Serena Broggi, Simona Lattanzi
Resective surgery is an effective option for the treatment of drug-resistant epilepsies, especially for mesial temporal lobe epilepsy [34]. After surgery, 64% to 70% of patients with drug-resistant temporal lobe epilepsy can achieve seizure freedom maintaining ASMs after the procedure, often with a substantially lower dose compared to baseline/pre-surgical status [35]. Data on seizure freedom after ASMs withdrawal in these patients have been accumulated in recent years. The best evidence available so far comes from non-randomized retrospective and prospective studies conducted on relatively homogeneous cohorts of patients undergoing temporal lobe surgery (anterior temporal lobe lobectomy, amygdalohippocampectomy, and lesionectomy) [36]. In clinical practice, ASMs withdrawal in postsurgical patients is not considered before at least one year of seizure freedom after surgical intervention [37,38]. However, in pediatric clinical practice, postoperative ASM withdrawal is usually considered much earlier than 1 year after surgery [39].
Contemporary surgical management of drug-resistant focal epilepsy
Published in Expert Review of Neurotherapeutics, 2020
Jasmina R. Milovanović, Slobodan M. Janković, Dragan Milovanović, Dejana Ružić Zečević, Marko Folić, Marina Kostić, Goran Ranković, Srđan Stefanović
Frequent problem after dominant temporal lobe resection is impairment of both verbal and visual memory, which is much more pronounced than after non-dominant temporal lobe resection. The patients with dominant temporal lobe resection have 51% lower scores on verbal memory tests and 27% lower scores on visual memory tests after the operation in comparison to preoperative results, while those with non-dominant temporal lobe resections have only 32% loss of verbal memory and negligible loss of visual memory [125]. In patients with mesial temporal lobe epilepsy and hippocampal sclerosis loss of both verbal and visual memory may be mitigated if more selective operation of amygdalohippocampectomy is performed instead of anterior temporal lobe resection [61].