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65th Annual Meeting of the German Society of Neurosurgery (DGNC)

German Society of Neurosurgery (DGNC)

11 - 14 May 2014, Dresden

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Procedure-related adjacent temporal infarctions after transsylvian selective amygdalohippocampectomy have an impact on epilepsy outcome

Meeting Abstract

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  • Tobias Martens - Klinik für Neurochirurgie, Universitätsklinikum Hamburg-Eppendorf
  • Matthias Merkel - Abteilung für Epileptologie, Epilepsiezentrum Hamburg-Alsterdorf
  • Brigitte Holst - Klinik für neuroradiologische Diagnostik und Intervention, Universitätsklinikum Hamburg-Eppendorf
  • Matthias Lindenau - Abteilung für Epileptologie, Epilepsiezentrum Hamburg-Alsterdorf
  • Manfred Westphal - Klinik für Neurochirurgie, Universitätsklinikum Hamburg-Eppendorf
  • Oliver Heese - Klinik für Neurochirurgie, Universitätsklinikum Hamburg-Eppendorf; Klinik für Neuro- und Wirbelsäulenchirurgie, Helios Kliniken Schwerin

Deutsche Gesellschaft für Neurochirurgie. 65. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC). Dresden, 11.-14.05.2014. Düsseldorf: German Medical Science GMS Publishing House; 2014. DocMI.16.01

doi: 10.3205/14dgnc360, urn:nbn:de:0183-14dgnc3606

Published: May 13, 2014

© 2014 Martens et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.

Outline

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Objective: Epilepsy surgery is a standard treatment option of medically intractable temporal lobe epilepsy. Selective amygdalohippocampectomy (SAH) and anterior temporal lobectomy (ATL) are two of the standard surgical procedures in these cases. We conducted a retrospective analysis of patients treated with SAH via a modified transsylvian approach in our epilepsy centre between 2008 and 2011 and analysed the impact of adjacent procedure-related infarctions on seizure outcome in these patients.

Method: Infarctions were detected by magnetic resonance imaging (MRI) within the first week postoperatively and by a second MRI nine months after surgical intervention. Neuropsychological testing was performed preoperatively. Evaluation of seizure outcome and postoperative neuropsychological testing were conducted approximately one year after epilepsy surgery. Correlative clinical data were analysed by retrospective chart review.

Results: The postoperative MRI revealed temporal infarctions in 47.9% (n=23/48) and frontal infarctions in 10.4% (n=5/48) of the patients. These vascular events were asymptomatic in terms of focal neurological deficits (pareses, cranial nerve palsies or dysphasia). Of the patients, 68.5% (n=37/54) were free of disabling seizures (Engel Class 1) one year after the procedure. Patients with temporal infarctions were significantly more often free of disabling seizures (Engel Class 1, p=0.046) than patients without temporal infarctions. Neuropsychological testing indicated a deterioration in verbal memory after SAH in patients with infarctions on the language-lateralised hemisphere compared to patients without infarction (p=0.011). All other tested neuropsychological categories showed no significant differences between patients with or without infarctions.

Conclusions: Our results indicate a surprisingly high number of procedure-related temporal infarctions after transsylvian SAH. Hence, the volume of non-functional “eliminated” tissue is enlarged unintentionally, which is a possible explanation for better seizure outcome in these patients. This result supports the notion that ATL is the favourable procedure for temporal lobe epilepsy compared to SAH on the non-dominant hemisphere, as neuropsychological deficits are scarcely to be expected.