Artikel
Results of transsylvian amygdalohippocampectomy in patients with drug-refractory non-lesional mesial temporal lobe epilepsy (MTLE)
Ergebnisse der transsylvischen Amygdalohippocampektomie bei Patienten mit medikamentenrefraktärer mesialer Schläfenlappenepilepsie
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Autoren
Veröffentlicht: | 23. April 2004 |
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Gliederung
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Objective
Presentation of epileptological results in a consecutive series of patients with drug refractory temporal lobe epilepsy and ammons horn sclerosis. All patients underwent a transsylvian resection of mesial temporal lobe structures after noninvasive phase I studies.
Methods
Thirty-eight patients with drug-refractory MTLE were evaluated at least 6 months after undergoing transsylvian amygdalohippocampectomy as described by Yasargil and further modified by Schramm and colleagues. All patients underwent preoperative evaluation including video EEG, high resolution MRI, neuropsychological evaluation, Wada testing and SPECT/PET. Data were entered prospectively in a database. All patients had Ammons horn sclerosis confirmed by neuropathological evaluation. Outcome was classified according to Engel (1993) in classes 1 (absence of disabling seizures) to 4 (no improvement) by an independent observer.
Results
Epilepsy was improved in all patients at follow-up. Outcome was n=27 class 1A, n=1 class 1C, n=2 class 1D, n= 7 class 2B, n=1 class 3A. Mortality was zero, one patient experienced a permanent disability (speech disturbance) due to delayed ischemia.
Conclusions
About 80% (30/38) of patients with drug refractory MTLE were free or almost seizure free after noninvasive evaluation and transsylvian removal of mesial temporal lobe structures. These results are obtainable with low morbidity in a dedicated, young epilepsy surgery program where selective approaches are considered the first choice in the treatment of nonlesional MTLE.