Surgery of Temporal Lobe Epilepsy: Modalities, Advantages, Disadvantages and Outcomes

Abstract

From the standard anterior temporal to selective resections, several modalities have evolved in the surgical treatment of temporal lobe epilepsy. In this review, the various surgical approaches, their advantages and disadvantages are discussed from the standpoint of results on seizure tendency, cognitive function, quality of life and technical aspects. Numerous studies, including our own with intracranial recording and reoperations, have provided evidence that the vast majority of temporal lobe seizures arise within the mesial structures. As a result, more and more selective procedures are being carried out directed at the amygdala and hippocampal formation. However, there is still no clear evidence that one selective approach is superior to the more standard temporal resection, which entails removal of the anterior temporal cortex, amygdala and hippocampus, or to any other so-called selective approach in terms of seizure control, cognitive function and quality of life. Technically, in our hands, the transcortical transventricular approach combined with neuronavigation has proven to be safe and less invasive compared with anterior temporal resection. Our experience suggests that the type of resection should be chosen case by case, on an individual basis, determined mainly by symptomatology, imaging, intracranial recording, neuropsychological findings and, at times, by the surgeon‘s experience.

Keywords:

• anterior temporal lobectomy
• cortico-amygdalo-hippocampectomy
• epilepsy
• epilepsy surgery
• hippocampal sclerosis
• limbic structures
• mesial temporal lobe
• seizure outcome
• selective amygdalohippocampectomy
• temporal lobe epilepsy

Financial & competing interests disclosure

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

No writing assistance was utilized in the production of this manuscript.