[Visual field disorder after surgery of temporal lobe epilepsy associated to hippocampus sclerosis]

Assessment of frequency and severity of visual field disorders after neurosurgical operations at patients with pharmacoresistant form of epilepsy in hippocampus sclerosis.

The study included 48 patients having surgical operations for a pharmacoresistant form of temporal lobe epilepsy due to hippocampus sclerosis. Anterior lobectomy with amygdalohippocampectomy (LE + AHE) was performed in 25 patients; Selective amygdalohippocampectomy (SAHE) was performed in 23 patients. We evaluated both the frequency of cases of homonymous visual field disorders and their severity.

After surgery the normal visual field was preserved at 7 (14.6%) patients. The appearance of visual field disorder by the type of homonymous hemianopsia was observed at 41 (85.4%) patients. When assessing the severity of visual field disorder, the smallest disorder was at patients who underwent sub-temporal access of SAHE: a statistically significant difference in the frequency of severe visual field disorder was revealed when comparing this group with patients having LE + AHE (p<0.02), as well as with patients having SAHE with access through sylvian gap (p<0.02).

SAHE with sub-temporal access allows maintaining or minimally injuring the central optic neuron fibers, including the Meyer loop at patients operated for symptomatic temporal lobe epilepsy.