Artikel
Long-term outcome following selective amygdalo-hippocampectomy in temporal lobe epilepsy – piriform cortex resection reveals superior seisure control rates
Resektionsausmaß des piriformen Cortex ist entscheidend für das Langzeit Anfallsoutcome nach einer selektiven Amygdalohippocampektomie bei Temporallappenepilepsie
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Veröffentlicht: | 25. Mai 2022 |
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Objective: Transsylvian selective amygdalo-hippocampectomy (tsSAHE) is a valid surgical treatment option for drug-resistant mesial temporal lobe epilepsy (mTLE) with seizure freedom rates of about 70% following tsSAHE. In a recently published study, we showed that resection of at least 27% of piriform cortex strongly correlated with seizure freedom one year following tsSAHE. However, the impact of piriform cortex resection on long-term seizure outcome is currently unknown. The aim of this study was to evaluate the impact of piriform cortex resection on long-term seizure outcome after tsSAHE in patients with mTLE.
Methods: Long-term follow-up (FU) was defined as at least two years postoperatively. Between 2012 and 2017, 64 patients with mTLE who had undergone tsSAHE at our center with a completed dataset for long-term FU were included in the analysis. Seizure outcome at the last available follow-up was assessed according to the International League against Epilepsy (ILAE). Patients were stratified according to favorable (ILAE class 1) and unfavorable (ILAE class 2-6) seizure outcome and resected proportions of hippocampus, amygdala and piriform cortex were volumetrically assessed.
Results: In the whole cohort, the mean follow-up duration was 3.75 years (yrs) with the range of 2–9yrs. Patients with favorable long-term seizure outcome revealed a significantly larger proportion of resected piriform cortex compared to patients with unfavorable seizure outcome (mean resected proportion was 42% versus (vs.) 22%, p=0.0011). Resected proportions of hippocampus and amygdala did not significantly differ for these groups. Among those patients with at least 27% resected proportion of piriform cortex, there were significantly more patients with seizure freedom at the last FU compared to the patients with less than 27% resected proportion of piriform cortex (83% vs. 39%, p=0.0007).
Conclusion: Our results show a strong impact of the extent of piriform cortex resection on long-term seizure outcome following tsSAHE in mTLE. Therefore, we suggest the piriform cortex to constitute a key target volume in tsSAHE to achieve seizure freedom in the long-term.