Apical temporal lobe resection; "tailored" hippocampus-sparing resection based on presurgical evaluation data

Area of Science:

• Neurosurgery
• Epileptology
• Neurology

Background:

• Epilepsy surgery aims to resect both the lesion and the epileptogenic zone in patients with lesional epilepsy.
• A modified apical temporal lobe resection (aTLR) technique spares the hippocampal formation, targeting lesions in the anterior temporal lobe.
• This technique involves tailored lesionectomy, amygdalectomy, and resection of mesial structures only at the temporal lobe apex.

Purpose of the Study:

• To present the surgical technical details of the apical temporal lobe resection (aTLR).
• To evaluate the outcomes of aTLR in patients with epilepsy caused by lesions in the anterior temporal lobe.
• To assess the long-term seizure control and safety of this modified temporal resection technique.

Main Methods:

• The study included 61 patients who underwent aTLR between 2001 and 2008.
• Patients had lesions in the temporal lobe apex, normal hippocampi on MRI, and intact memory function.
• Presurgical evaluation included video-EEG, MRI, and neuropsychological testing, with a mean follow-up of 2.1 years.

Main Results:

• 88.5% of patients achieved Engel Class 1 seizure outcome at 6 months, with sustained results at 2 and 5 years.
• Histopathology revealed various lesions including tumors (31), FCD (10), and amygdala sclerosis (7).
• Complications were infrequent (4 patients), and 82% of resections were complete. Memory function remained stable or improved in most patients.

Conclusions:

• Apical temporal resection (aTLR) is an effective surgical option for refractory epilepsy.
• The procedure offers good long-term seizure outcomes for lesions confined to the apex of the temporal lobe.
• Sparing mesial temporal structures during aTLR maintains favorable neurological function.