Neuropsychology outcomes following trephine epilepsy surgery: The inferior temporal gyrus approach for amygdalohippocampectomy in medically refractory mesial temporal lobe epilepsy

Mike R. Schoenberg; William E. Clifton; Ryan W. Sever; Fernando L. Vale

doi:10.1093/neuros/nyx302

Neuropsychology outcomes following trephine epilepsy surgery: The inferior temporal gyrus approach for amygdalohippocampectomy in medically refractory mesial temporal lobe epilepsy

Mike R. Schoenberg, William E. Clifton, Ryan W. Sever, Fernando L. Vale

Research output: Contribution to journal › Article › peer-review

17 Scopus citations

Abstract

BACKGROUND: Surgery is indicated in cases of mesial temporal lobe epilepsy(MTLE)that are refractory to medical management. The inferior temporal gyrus (ITG) approachprovides access to the mesial temporal lobe (MTL) structures with minimal tissuedisruption. Reported neuropsychology outcomes following this approach are limited.OBJECTIVE: To report neuropsychological outcomes using an ITG approach to amygdalohippocampectomy (AH) in patients with medically refractory MTLE based on a prospectivedesign.METHODS: Fifty-four participants had Engel class I/II outcome following resection of MTLusing the ITG approach. All participants had localization-related epilepsy confrmed bylong-term surface video-electroencephalography and completed pre/postsurgical evaluations that included magnetic resonance imaging (MRI), Wada test or functional MRI, andneuropsychology assessment.RESULTS: Clinical semiology/video-electroencephalography indicated that of the 54patients, 28 (52%) had left MTLE and 26 (48%) had right MTLE. Dominant hemisphere resections were performed on 23 patients (43%), nondominant on 31(57%). Twenty-nine (29) hadpathology-confrmed mesial temporal sclerosis (MTS). Group level analyses found declinesin verbal memory for patients with language-dominant resections (P <.05). No significant decline in neuropsychological measures occurred for patients with MTS. Participantswithout MTS who underwent a language-dominant lobe resection exhibited a signifcantdecline in verbal and visual memory (P <.05). Nondominant resection participants did notexhibit signifcant change in neuropsychology scores (P >.05).CONCLUSION: Neuropsychology outcomes of an ITG approach for selective mesialtemporal resection are comparable to other selective AH techniques showing minimaladverse cognitive effects. These data lend support to the ITG approach for selective AHas an option for MTLE.

Original language	English (US)
Pages (from-to)	833-841
Number of pages	9
Journal	Neurosurgery
Volume	82
Issue number	6
DOIs	https://doi.org/10.1093/neuros/nyx302
State	Published - Jun 1 2018
Externally published	Yes

Keywords

Amygdalohippocampectomy
Epilepsy
Inferior temporal gyrus
Neuropsychological outcomes

ASJC Scopus subject areas

Surgery
Clinical Neurology

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10.1093/neuros/nyx302

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Neuropsychology outcomes following trephine epilepsy surgery: The inferior temporal gyrus approach for amygdalohippocampectomy in medically refractory mesial temporal lobe epilepsy. / Schoenberg, Mike R.; Clifton, William E.; Sever, Ryan W. et al.
In: Neurosurgery, Vol. 82, No. 6, 01.06.2018, p. 833-841.

Research output: Contribution to journal › Article › peer-review

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title = "Neuropsychology outcomes following trephine epilepsy surgery: The inferior temporal gyrus approach for amygdalohippocampectomy in medically refractory mesial temporal lobe epilepsy",

abstract = "BACKGROUND: Surgery is indicated in cases of mesial temporal lobe epilepsy(MTLE)that are refractory to medical management. The inferior temporal gyrus (ITG) approachprovides access to the mesial temporal lobe (MTL) structures with minimal tissuedisruption. Reported neuropsychology outcomes following this approach are limited.OBJECTIVE: To report neuropsychological outcomes using an ITG approach to amygdalohippocampectomy (AH) in patients with medically refractory MTLE based on a prospectivedesign.METHODS: Fifty-four participants had Engel class I/II outcome following resection of MTLusing the ITG approach. All participants had localization-related epilepsy confrmed bylong-term surface video-electroencephalography and completed pre/postsurgical evaluations that included magnetic resonance imaging (MRI), Wada test or functional MRI, andneuropsychology assessment.RESULTS: Clinical semiology/video-electroencephalography indicated that of the 54patients, 28 (52%) had left MTLE and 26 (48%) had right MTLE. Dominant hemisphere resections were performed on 23 patients (43%), nondominant on 31(57%). Twenty-nine (29) hadpathology-confrmed mesial temporal sclerosis (MTS). Group level analyses found declinesin verbal memory for patients with language-dominant resections (P <.05). No significant decline in neuropsychological measures occurred for patients with MTS. Participantswithout MTS who underwent a language-dominant lobe resection exhibited a signifcantdecline in verbal and visual memory (P <.05). Nondominant resection participants did notexhibit signifcant change in neuropsychology scores (P >.05).CONCLUSION: Neuropsychology outcomes of an ITG approach for selective mesialtemporal resection are comparable to other selective AH techniques showing minimaladverse cognitive effects. These data lend support to the ITG approach for selective AHas an option for MTLE.",

keywords = "Amygdalohippocampectomy, Epilepsy, Inferior temporal gyrus, Neuropsychological outcomes",

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AU - Sever, Ryan W.

AU - Vale, Fernando L.

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N2 - BACKGROUND: Surgery is indicated in cases of mesial temporal lobe epilepsy(MTLE)that are refractory to medical management. The inferior temporal gyrus (ITG) approachprovides access to the mesial temporal lobe (MTL) structures with minimal tissuedisruption. Reported neuropsychology outcomes following this approach are limited.OBJECTIVE: To report neuropsychological outcomes using an ITG approach to amygdalohippocampectomy (AH) in patients with medically refractory MTLE based on a prospectivedesign.METHODS: Fifty-four participants had Engel class I/II outcome following resection of MTLusing the ITG approach. All participants had localization-related epilepsy confrmed bylong-term surface video-electroencephalography and completed pre/postsurgical evaluations that included magnetic resonance imaging (MRI), Wada test or functional MRI, andneuropsychology assessment.RESULTS: Clinical semiology/video-electroencephalography indicated that of the 54patients, 28 (52%) had left MTLE and 26 (48%) had right MTLE. Dominant hemisphere resections were performed on 23 patients (43%), nondominant on 31(57%). Twenty-nine (29) hadpathology-confrmed mesial temporal sclerosis (MTS). Group level analyses found declinesin verbal memory for patients with language-dominant resections (P <.05). No significant decline in neuropsychological measures occurred for patients with MTS. Participantswithout MTS who underwent a language-dominant lobe resection exhibited a signifcantdecline in verbal and visual memory (P <.05). Nondominant resection participants did notexhibit signifcant change in neuropsychology scores (P >.05).CONCLUSION: Neuropsychology outcomes of an ITG approach for selective mesialtemporal resection are comparable to other selective AH techniques showing minimaladverse cognitive effects. These data lend support to the ITG approach for selective AHas an option for MTLE.

AB - BACKGROUND: Surgery is indicated in cases of mesial temporal lobe epilepsy(MTLE)that are refractory to medical management. The inferior temporal gyrus (ITG) approachprovides access to the mesial temporal lobe (MTL) structures with minimal tissuedisruption. Reported neuropsychology outcomes following this approach are limited.OBJECTIVE: To report neuropsychological outcomes using an ITG approach to amygdalohippocampectomy (AH) in patients with medically refractory MTLE based on a prospectivedesign.METHODS: Fifty-four participants had Engel class I/II outcome following resection of MTLusing the ITG approach. All participants had localization-related epilepsy confrmed bylong-term surface video-electroencephalography and completed pre/postsurgical evaluations that included magnetic resonance imaging (MRI), Wada test or functional MRI, andneuropsychology assessment.RESULTS: Clinical semiology/video-electroencephalography indicated that of the 54patients, 28 (52%) had left MTLE and 26 (48%) had right MTLE. Dominant hemisphere resections were performed on 23 patients (43%), nondominant on 31(57%). Twenty-nine (29) hadpathology-confrmed mesial temporal sclerosis (MTS). Group level analyses found declinesin verbal memory for patients with language-dominant resections (P <.05). No significant decline in neuropsychological measures occurred for patients with MTS. Participantswithout MTS who underwent a language-dominant lobe resection exhibited a signifcantdecline in verbal and visual memory (P <.05). Nondominant resection participants did notexhibit signifcant change in neuropsychology scores (P >.05).CONCLUSION: Neuropsychology outcomes of an ITG approach for selective mesialtemporal resection are comparable to other selective AH techniques showing minimaladverse cognitive effects. These data lend support to the ITG approach for selective AHas an option for MTLE.

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Neuropsychology outcomes following trephine epilepsy surgery: The inferior temporal gyrus approach for amygdalohippocampectomy in medically refractory mesial temporal lobe epilepsy

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