Lobectomy vs. MRgLITT in Temporal Lobe Epilepsy (TLE): A Pilot Study Investigating Vestibulo-Spatial Functions

Background: About 65 million people worldwide are affected by epilepsy, with temporal lobe epilepsy being the most common type resistant to drugs and often requiring surgical treatment. Although open surgical approaches, such as temporal lobectomy, have been the method of choice for decades, minimally invasive MRgLITT has demonstrated promising results. However, it remains unknown whether patients who underwent one of these two approaches would show better performance on vestibulo-spatial tasks. Methods: Twenty-seven patients were included in three different groups: (1) MRgLITT (37.0 ± 15.1 years, two females), (2) R-OP (44 ± 15.7 years, five females) and (3) No-OP (43 ± 11.2 years, three females)-with no significant differences in age, disease duration and number of medications. Groups were compared on their performance in three vestibular-dependent tests: (1) clinical balance test (CBT), (2) triangle completion test (TCT) and (3) rotational memory (RM) test. Results: Significantly better performance of MRgLITT patients, in comparison to the other two groups (R-OP and No-OP), was found for the TCT. The other tests revealed no significant differences between the groups. Conclusions: Patients who underwent MRgLITT performed significantly better on the vestibular-dependent spatial orientation task (TCT) compared to those who underwent temporal lobectomy (R-OP) and non-operated patients. Speculations about reasons for such an effect-including minimal invasiveness with less "collateral damage", influence of operated side, timing of surgery, sample heterogeneity and others-need to be assessed in detail in larger-scale, prospective longitudinal studies.