Visual field defects following different resective procedures for mesiotemporal lobe epilepsy

Area of Science:

• Neurosurgery
• Ophthalmology
• Epilepsy Research

Background:

• Mesiotemporal lobe resection for epilepsy can cause visual field defects (VFD).
• Extended VFD can impact daily activities and driving eligibility.
• Understanding VFD frequency and severity across surgical approaches is crucial.

Purpose of the Study:

• To evaluate the frequency and extent of VFD after different mesiotemporal lobe resection surgical approaches.
• To assess the impact of VFD on driving ability based on surgical technique.

Main Methods:

• A consecutive series of 366 patients with intractable mesiotemporal lobe epilepsy were analyzed.
• Surgical approaches included anterior temporal lobectomy (ATL), keyhole resection (KH), and selective amygdalohippocampectomy (tsAHE and ssAHE).
• Postoperative VFD were assessed and classified as driving-relevant or irrelevant based on German driving guidelines.

Main Results:

• 73% of patients developed VFD post-surgery.
• 48% of VFD were classified as driving-relevant.
• Subtemporal selective amygdalohippocampectomy (ssAHE) showed significantly fewer driving-relevant VFD compared to other temporal resections (p<0.05).

Conclusions:

• Subtemporal selective amygdalohippocampectomy (ssAHE) leads to significantly less frequent and less severe driving-relevant VFD.
• This approach appears safer regarding visual field preservation compared to other temporal lobe resection methods.
• ssAHE may be a preferred surgical option for patients where minimizing VFD impact on driving is a priority.