gms | German Medical Science

Objective: The goal of this study was to analyse the efficacy and safety of different surgical approaches in patients with pharmacoresistant mesiotemporal lobe epilepsy (MTLE).

Method: This study is based on a consecutive series of 508 surgical procedures in a total of 500 patients with medically refractory mesiotemporal lobe epilepsy operated at the Epilepsy Center Freiburg during 1998–2012. Clinical, neuroradiological and histopathological findings were evaluated. Mean duration of postoperative follow-up was 28 months.

Results: The following procedures were performed: Standard anterior temporal lobectomy with amygdalohippocampectomy (N=184, 36.2%), keyhole resections with amygdalohippocampectomy (N=48, 9.4%), lesionectomy with amygdalohippocampectomy (N=62, 12.2%), transsylvian selective amygdalohippocampectomy (N=189, 37.2%) and subtemporal selective amygladohippocampectomy (N=25, 4.9%). Overall, 270 of 387 patients (69.7%) remained seizure free (Engel I) at one year after operation and 340 (87.7%) had a worthwhile improvement (Engel I-III). We did not observe significant differences in epileptological outcome in relation to the surgical approach used. There was no death in our series. Transient morbidity including surgical and neurological complications was encountered in 93 patients (18.6%) and permanent morbidity in 20 patients (4.0%). There were no significantly differences in complications in relation to the surgical approach performed.

Conclusions: Different surgical approaches for mesiotemporal epilepsy used in this series resulted in equally favorable seizure control and surgical outcome.