Burr hole microsurgical subtemporal selective amygdalohippocampectomy

Area of Science:

• Neurosurgery
• Epilepsy Treatment
• Microsurgery

Background:

• Drug-resistant mesial temporal lobe epilepsy (TLE) poses a significant clinical challenge.
• Selective amygdalohippocampectomy (SAH) is an established surgical option for TLE.
• Ongoing debate exists regarding the optimal SAH approach and its associated risks.

Purpose of the Study:

• To evaluate the efficacy and safety of burr hole microsurgical subtemporal SAH for drug-resistant TLE.
• To compare the outcomes of preauricular versus supra-auricular SAH approaches.
• To assess the impact of SAH on seizure control, visual fields, and memory function.

Main Methods:

• A consecutive series of 43 adult patients with drug-resistant TLE underwent subtemporal SAH.
• Two surgical approaches were utilized: preauricular (25 patients) and supra-auricular (18 patients).
• Patients were followed for a median of 59 months, with outcomes assessed using the Engel classification.

Main Results:

• 80.9% of patients achieved Engel I outcome (seizure freedom) by the third year post-surgery.
• Verbal and delayed verbal memory deficits were observed in 38.5% and 46.1% of patients, respectively.
• The supra-auricular approach was associated with a lower incidence of verbal memory impairment and upper quadrant visual field defects compared to the preauricular approach.

Conclusions:

• Burr hole microsurgical subtemporal SAH is an effective treatment for drug-resistant TLE with minimal risk of visual field loss.
• The supra-auricular approach offers advantages over the preauricular approach, including reduced risk of hemianopia and verbal memory impairment.
• SAH can lead to significant seizure reduction, with potential for medication discontinuation or dose reduction.