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73. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
Joint Meeting mit der Griechischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

29.05. - 01.06.2022, Köln

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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

Meeting Abstract

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  • presenting/speaker Valeri Borger - Universitätsklinikum Bonn, Klinik und Poliklinik für Neurochirurgie, Bonn, Deutschland
  • Majd Bahna - Universitätsklinikum Bonn, Klinik und Poliklinik für Neurochirurgie, Bonn, Deutschland
  • Motaz Hamed - Universitätsklinikum Bonn, Klinik und Poliklinik für Neurochirurgie, Bonn, Deutschland
  • Attila Racz - Universitätsklinikum Bonn, Klinik und Poliklinik für Epileptologie, Bonn, Deutschland
  • Tobias Baumgartner - Universitätsklinikum Bonn, Klinik und Poliklinik für Epileptologie, Bonn, Deutschland
  • Anna-Laura Potthoff - Universitätsklinikum Bonn, Klinik und Poliklinik für Neurochirurgie, Bonn, Deutschland
  • Inja Ilic - Universitätsklinikum Bonn, Klinik und Poliklinik für Neurochirurgie, Bonn, Deutschland
  • Albert Becker - Universitätsklinikum Bonn, Institut für Neuropathologie, Bonn, Deutschland
  • Florian Mormann - Universitätsklinikum Bonn, Klinik und Poliklinik für Epileptologie, Bonn, Deutschland
  • Rainer Surges - Universitätsklinikum Bonn, Klinik und Poliklinik für Epileptologie, Bonn, Deutschland
  • Hartmut Vatter - Universitätsklinikum Bonn, Klinik und Poliklinik für Neurochirurgie, Bonn, Deutschland
  • Matthias Schneider - Universitätsklinikum Bonn, Klinik und Poliklinik für Neurochirurgie, Bonn, Deutschland

Deutsche Gesellschaft für Neurochirurgie. 73. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Griechischen Gesellschaft für Neurochirurgie. Köln, 29.05.-01.06.2022. Düsseldorf: German Medical Science GMS Publishing House; 2022. DocV157

doi: 10.3205/22dgnc155, urn:nbn:de:0183-22dgnc1550

Published: May 25, 2022

© 2022 Borger et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

Text

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.