Visual field defects after selective amygdalohippocampectomy and standard temporal lobectomy

Area of Science:

• Neurosurgery
• Ophthalmology
• Epileptology

Background:

• Mesial temporal lobe epilepsy with hippocampal sclerosis is often treated with selective amygdalohippocampectomy (SelAH) or standard temporal lobectomy (StTL).
• Postoperative visual field defects are a known complication of these epilepsy surgeries.
• Comparing visual field outcomes between SelAH and StTL is crucial for surgical decision-making.

Purpose of the Study:

• To compare the severity of visual field defects after SelAH versus StTL.
• To determine if SelAH offers better visual field preservation than StTL.

Main Methods:

• Retrospective analysis of Humphrey visual field data from 18 SelAH and 33 StTL patients.
• Quantitative visual field analysis using pattern deviation, with specific criteria for clinically significant defects.
• Assessment of defect severity and location, particularly near the vertical and horizontal meridians.

Main Results:

• Homonymous superior quadrantic visual field defects were common after both procedures.
• SelAH resulted in significantly less pronounced visual field defects compared to StTL.
• Visual field coordinates near the horizontal meridian were relatively spared after SelAH.

Conclusions:

• Visual field defects are frequent after SelAH but are less severe than those following StTL.
• SelAH demonstrates superior preservation of visual fields, especially near the horizontal meridian, compared to StTL.
• These findings support SelAH as a potentially vision-sparing surgical option for mesial temporal lobe epilepsy.