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Updated: Feb 21, 2026
Anteromesial Temporal Lobectomy for Medically Intractable Temporal Lobe Epilepsy: An Operative Study
Published on: August 15, 2025
Temporal lobe surgery for intractable epilepsy in children: What to do with the hippocampus?
Mony Benifla1, Odeya Bennet-Back2, Zamir Shorer3
1The Neurosurgical Pediatric Unit, Rambam Health Care Campus, Haifa, Israel.
Insights
Preserving the hippocampus during epilepsy surgery in children with temporal lobe epilepsy (TLE) is achievable. This approach leads to excellent seizure control and better quality of life, avoiding memory decline.
Area of Science:
- Pediatric Neurology
- Neurosurgery
- Epileptology
Background:
- Hippocampal resection in pediatric epilepsy surgery can lead to verbal memory deficits.
- Preserving the hippocampus is vital for maintaining quality of life in children with intractable temporal lobe epilepsy (TLE).
Purpose of the Study:
- To investigate techniques for identifying the epileptogenic zone in relation to the hippocampus.
- To evaluate outcomes of pediatric epilepsy surgery focused on sparing the hippocampus.
Main Methods:
- Retrospective analysis of pediatric patients with medically refractory TLE and normal hippocampal MRI.
- Intraoperative techniques included electrocorticography and long-term invasive monitoring to guide epilepsy surgery.
- Seizure control was assessed using the Engel classification system.
Main Results:
- The hippocampus was preserved in 73% of patients (16/22).
- Patients who underwent epilepsy surgery sparing the hippocampus achieved 94% seizure freedom (Engel I).
- In contrast, 50% seizure freedom was observed in patients who underwent hippocampectomy.
Conclusions:
- Surgical preservation of the hippocampus in pediatric TLE is feasible.
- Employing appropriate intraoperative techniques ensures excellent seizure outcomes.
- Sparing the hippocampus can be achieved without compromising seizure control.
Purpose:
Resection of the hippocampus can cause verbal memory decline, especially in the pediatric population. Thus, preservation of the hippocampus can be crucial for the quality of life of children with intractable temporal lobe epilepsy (TLE) who are candidates for epilepsy surgery. We investigated techniques that determine whether the hippocampus is part of the epileptogenic zone and the outcomes of pediatric surgery aimed to spare the hippocampus.
Methods:
We accessed data of children with normal hippocampus on MRI, who underwent surgery for medically refractory TLE. To identify epileptogenic areas, electrocorticography was performed in patients with space occupying lesions adjacent to the hippocampus, and long term invasive monitoring in patients with nonlesional TLE. Postoperative seizure control was classified according to Engel I-IV; Class I indicates seizure-free.
Results:
Eleven females and 11 males met study inclusion criteria; the mean age at surgery was 11.3 years. Cortical and hippocampal electrocorticography was performed in 15 patients and long term invasive hippocampal monitoring in seven. The hippocampus was preserved in 16 patients (73%) while hippocampectomy was performed in 6 (27%). At the end of a mean follow-up of 3.5 years, 94% (15/16) of the patients who did not undergo hippocampectomy were classified as Engel I, compared to 50% (3/6) who underwent hippocampectomy.
Conclusion:
Sparing the hippocampus in temporal lobe epilepsy surgery is possible with excellent seizure outcome, while using the proper intraoperative technique.
