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Analysis of Patients Undergoing Anterior Temporal Lobectomy for Drug-Resistant Mesial Temporal Lobe Epilepsy: A
Tural Ahmadov1, Tugrul Cem Unal, Ilyas Dolas
1Istanbul University, Istanbul Faculty of Medicine, Department of Neurosurgery, Istanbul, Türkiye.
Aim:
To analyze the epidemiologic, clinical, neuroradiological, and histopathological data of patients who have undergone anterior temporal lobectomy (ATL) for drug-resistant mesial temporal lobe epilepsy (MTLE).
Material And Methods:
The study included patients who were diagnosed with MTLE refractory to medical treatment, underwent anterior temporal lobectomy at our institution between 2010 and 2020 and had postoperative clinical follow-up data. The epidemiologic, clinical, neuroradiological, and histopathological data of the patients were collected.
Results:
Fourteen patients were male, and thirty were female. The mean age at seizure onset was 15.3 years. Video electroencephalographic monitoring (VEM), magnetic resonance imaging (MRI), and positron emission tomography (PET) revealed lateralization in 37, 36, and 31 patients, respectively. The cranial MRI and PET were inconclusive in eight patients in whom the diagnosis was verified via invasive monitoring. Thirty-six (81.8%) patients were seizure-free postoperatively. The number and dosage of antiepileptic drugs used were reduced in 35 (79.5%) and 26 (78.8%) patients, respectively. Only six patients developed complications (cerebrospinal fluid fistula, n = 3; central nervous system infection, n = 2; and epidural hematoma, n = 1).
Conclusion:
Epilepsy is a significant cause of morbidity for patients, and surgery plays a vital role in treating mesial temporal sclerosis, an etiology of epilepsy. Patients can be diagnosed using various tests such as cranial MRI, electroencephalography, VEM, PET, single-photon emission computerized tomography, neuropsychological tests, and invasive monitoring at advanced epilepsy centers. Surgical treatment is highly effective and safe in these patients.
Insights
Anterior temporal lobectomy (ATL) is a highly effective surgery for drug-resistant mesial temporal lobe epilepsy (MTLE). Most patients achieve seizure freedom and reduced medication needs with minimal complications.
Area of Science:
- Neurology
- Neurosurgery
- Epileptology
Background:
- Mesial temporal lobe epilepsy (MTLE) is a common cause of intractable epilepsy.
- Drug-resistant MTLE significantly impacts patient quality of life and carries substantial morbidity.
- Anterior temporal lobectomy (ATL) is a surgical option for select patients with refractory epilepsy.
Purpose of the Study:
- To analyze the outcomes of anterior temporal lobectomy (ATL) in patients with drug-resistant mesial temporal lobe epilepsy (MTLE).
- To evaluate the epidemiologic, clinical, neuroradiological, and histopathological characteristics of patients undergoing ATL.
- To assess the efficacy and safety of ATL for treating refractory MTLE.
Main Methods:
- Retrospective analysis of patients with MTLE refractory to medical treatment who underwent ATL between 2010 and 2020.
- Collection and review of epidemiologic, clinical, neuroradiological (MRI, PET), and histopathological data.
- Postoperative clinical follow-up to assess seizure control and medication reduction.
Main Results:
- 81.8% of patients achieved postoperative seizure freedom.
- Significant reduction in antiepileptic drug (AED) number and dosage was observed in most patients.
- Complications were infrequent, with only six patients experiencing adverse events.
Conclusions:
- Anterior temporal lobectomy (ATL) is a safe and highly effective surgical treatment for drug-resistant mesial temporal lobe epilepsy (MTLE).
- Comprehensive diagnostic evaluations including neuroimaging and invasive monitoring are crucial for patient selection.
- Surgery offers a vital therapeutic option for improving seizure control and quality of life in patients with mesial temporal sclerosis.
