NDLI: Transsylvian hippocampal transection for mesial temporal lobe epilepsy: surgical indications, procedure, and postoperative seizure and memory outcomes.

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Transsylvian hippocampal transection for mesial temporal lobe epilepsy: surgical indications, procedure, and postoperative seizure and memory outcomes.

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Transsylvian hippocampal transection for mesial temporal lobe epilepsy: surgical indications, procedure, and postoperative seizure and memory outcomes.

Content Provider	World Health Organization (WHO)-Global Index Medicus
Author	Uda, Takehiro Morino, Michiharu Ito, Hirotaka Minami, Noriaki Hosono, Atsushi Nagai, Taiki Matsumoto, Takahiro
Description	Country affiliation: Japan Author Affiliation: Uda T ( Department of Neurosurgery, Tokyo Metropolitan Neurological Hospital, Tokyo, Japan.)
Abstract	OBJECT: Amygdalohippocampectomy is a well-established, standard surgery for medically intractable mesial temporal lobe epilepsy (MTLE). However, in the case of MTLE without hippocampal atrophy or sclerosis, amygdalohippocampectomy is associated with decreased postoperative memory function. Hippocampal transection (HT) has been developed to overcome this problem. In HT the hippocampus is not removed; rather, the longitudinal hippocampal circuits of epileptic activities are disrupted by transection of the pyramidal layer of the hippocampus. The present study describes a less invasive modification of HT (transsylvian HT) and presents the seizure and memory outcomes for this procedure. METHODS: Thirty-seven patients with MTLE (18 men and 19 women; age range 9-63 years; 19 with surgery on the right side and 18 with surgery on the left side; seizure onset from 3 to 34 years) who were treated with transsylvian HT were retrospectively analyzed. All patients had left-side language dominance, and follow-up periods ranged from 12 to 94 months (median 49 months). Seizure outcomes were evaluated for all patients by using the Engel classification. Memory function was evaluated for 22 patients based on 3 indices (verbal memory, nonverbal memory, and delayed recall), with those scores obtained using the Wechsler Memory Scale-Revised. Patients underwent evaluation of the memory function before and after surgery (6 months-1 year). RESULTS: Engel Class I (completely seizure free) was achieved in 25 patients (67.6%). Class II and Class III designation was achieved in 10 (27%) and 2 patients (5.4%), respectively. There were differences in memory outcome between the sides of operation. On the right side, verbal memory significantly increased postoperatively (p = 0.003) but nonverbal memory and delayed recall showed no significant change after the operation (p = 0.718 and p = 0.210, respectively). On the left side, all 3 indices (verbal memory, nonverbal memory, and delayed recall) showed no significant change (p = 0.331, p = 0.458, and p = 0.366, respectively). CONCLUSIONS: Favorable seizure outcome and preservation of verbal memory were achieved with transsylvian HT for the treatment of MTLE without hippocampal atrophy or sclerosis.
File Format	HTM / HTML
ISSN	00223085
e-ISSN	19330693
Journal	Journal of Neurosurgery
Issue Number	5
Volume Number	119
Language	English
Publisher	American Association of Neurological Surgeons
Publisher Date	2013-11-01
Publisher Place	United States
Access Restriction	Open
Subject Keyword	Discipline Neurosurgery Epilepsy, Temporal Lobe Surgery Hippocampus Memory Disorders Neurosurgical Procedures Seizures Adolescent Physiopathology Retrospective Studies
Content Type	Text
Resource Type	Article
Subject	Neurology (clinical) Surgery

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