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Extended resection of piriform cortex predicts post-operative seizure freedom following selective amygdalo-hippocampectomy
Erweiterte Resektion des piriformen Cortex ist entscheidend für die post-operative Anfallsfreiheit nach einer selektiven Amygdalohippocampektomie
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Veröffentlicht: | 26. Juni 2020 |
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Objective: Transsylvian selective amygdalo-hippocampectomy (tsSAHE) represents a valid surgical procedure for drug-resistant mesial temporal lobe epilepsy (mTLE). However, although postoperative seizure freedom can be achieved in about 70% of tsSAHE, there is a considerable amount of patients with persisting postoperative seizures. This might partly be reasoned in differing extents of resection of various tsSAHE target volumes. In the present study we therefore analyzed the resected proportions of hippocampus, amygdala as well as piriform cortex in regard of postoperative seizure outcome.
Methods: Between 2012 and 2017, 82 of 103 patients with mTLE who underwent tsSAHE at our center were included in the analysis. Patients were stratified according to favorable (International League against Epilepsy (ILAE) class 1) and unfavorable (ILAE class 2-6) seizure outcome and resected proportions of hippocampus, amygdala and piriform cortex as target structures of tsSAHE were volumetrically assessed.
Results: Patients with favorable seizure outcome revealed a significantly larger proportion of resected piriform cortex volumes compared to patients with unfavorable seizure outcome (mean resected proportion was 45% versus (vs.) 12%, p=0.0001). Resected proportions of hippocamus and amygdala did not significantly differ for these groups [hippocampus: 80% vs. 82% (p=0.58); amygdala: 99% vs. 98% (p=0.7)]. Resection of at least 27% of preoperative piriform cortex volumes was associated with a 78-fold increase in the probability of becoming seizure-free (95% CI, p=0.001).
Conclusion: These results strongly suggest piriform cortex to constitute a key target volume in respect of acquiring postoperative seizure freedom following tsSAHE.