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Selective amygdalohippocampectomy: surgical outcome in children versus adults
A Datta1, D Barry Sinclair, M Wheatley
1Comprehensive Epilepsy Program, University of Alberta, Edmonton, Alberta, Canada.
Insights
Selective amygdalohippocampectomy (SAH) shows excellent seizure control in adults with refractory temporal lobe epilepsy. However, outcomes are less favorable in children, suggesting anterior temporal lobe resection may be a better option for pediatric patients.
Area of Science:
- Neurosurgery
- Epileptology
- Pediatric Neurology
Background:
- Intractable temporal lobe epilepsy (TLE) poses significant challenges in both pediatric and adult populations.
- Selective amygdalohippocampectomy (SAH) is a surgical option for refractory TLE.
- Understanding the efficacy of SAH across different age groups is crucial for treatment planning.
Purpose of the Study:
- To review the surgical outcomes of selective amygdalohippocampectomy (SAH) in children and adults with intractable temporal lobe epilepsy.
- To compare the effectiveness of SAH between pediatric and adult patient cohorts.
- To identify potential factors influencing surgical success in different age groups.
Main Methods:
- A retrospective case series design was employed at a tertiary care epilepsy center.
- Data from 23 patients (9 children, 14 adults) who underwent SAH and had at least one year of follow-up were analyzed.
- Outcomes were stratified and compared between the pediatric and adult groups using seizure-free status (Engel Class I-IV).
Main Results:
- Surgical outcomes for SAH varied between children and adults.
- In children, 33% were seizure-free (Engel Class I), while 32% required re-operation.
- Adults demonstrated superior outcomes, with 71% achieving seizure freedom (Engel Class I) and 29% experiencing rare seizures (Engel Class II).
Conclusions:
- Selective amygdalohippocampectomy (SAH) is highly effective for achieving seizure freedom in adults with refractory temporal lobe epilepsy.
- Preliminary findings suggest SAH yields less favorable outcomes in pediatric patients compared to adults.
- Differences in underlying pathology may account for the varied results, indicating that anterior temporal lobe resection might be a more suitable surgical approach for children with intractable TLE.
Introduction:
The objective of the study was to review our experience with selective amygdalohippocampectomy (SAH) in children and adults with intractable temporal lobe epilepsy.
Methods:
A retrospective case series was used in the setting of a tertiary care hospital which provides epilepsy care to both children and adults. All patients underwent a selective amygdalohippocampectomy procedure and had at least one year of follow-up. Adults and children were divided into two groups and the data was compared between children and adults.
Results:
Twenty three patients, 9 children and 14 adults were studied. Age of surgery varied from 6 to 58 years. Surgical outcome was variable between the two groups. Amongst the children, three patients (33%) were seizure-free (Engel Class I), two patients (22%) had rare seizures (Engel Class II), one patient (11%) had a worthwhile decrease in seizures (Engel class III) and three patients (32%) had refractory seizures that required re-operation with an anterior temporal lobectomy. This differed from the adults, who all had a good outcome. Ten patients (71%) were seizure-free (Engel Class I) and the remainder (29%) had rare seizures (Engel Class II).
Conclusion:
Selective amygdalohippocampectomy can lead to excellent seizure surgical outcome in adults with refractory temporal lobe epilepsy. However, preliminary results show less favorable results in children. The difference is probably related to the different pathology between the two groups. Anterior temporal lobe resection may prove to be a more successful operation than SAH in children with intractable temporal lobe epilepsy.
