title: Significance of fornix atrophy in temporal lobe epilepsy surgery outcome.
abstract: BACKGROUND
  Previous magnetic resonance imaging (MRI) studies have shown concurrent fornix atrophy in a large proportion of patients with hippocampal atrophy. The contribution of the fornix as an independent preoperative determinant of surgical outcome is unknown.
  
  
  OBJECTIVE
  To evaluate the contribution of the fornix as a determinant of surgical outcome in patients with preoperatively determined temporal lobe epilepsy.
  
  
  METHODS
  We selected 78 patients who had undergone anterior temporal lobectomy for intractable temporal lobe epilepsy at the University of Alabama at Birmingham Epilepsy Center during a 24-month period. All patients underwent standard presurgical investigations and intracranial investigations when needed. Magnetic resonance imaging volumetric studies were performed prior to surgery using previously published techniques. Patients were assessed regularly for postoperative seizure control. Outcome after at least 3 years was evaluated using Engel's classification for epilepsy. The chi2 test was used to compare categorical data.
  
  
  RESULTS
  Seventy-eight patients were included in this study. Eight patients were excluded because of inadequate follow-up. Thirty-five patients (44.9%) had unilateral isolated hippocampal atrophy exclusively on MRI volumetry, 29 (37.2%) had unilateral hippocampal atrophy with ipsilateral fornix atrophy, and 6 (7.7%) had isolated fornix atrophy without hippocampal atrophy. Twenty-eight patients (80%) in the unilateral hippocampal atrophy group were seizure free (ie, Engel class 1: patients who are completely seizure free with no aura and who do not receive antiepileptic drugs) compared with 21 patients (73%) in the fornix and hippocampal atrophy group (P =.57). All 6 patients with isolated fornix atrophy achieved an Engel's class 1 outcome.
  
  
  CONCLUSIONS
  These findings suggest that identification of fornix atrophy with or without associated hippocampal atrophy is not an important preoperative determinant of surgical outcome. However, in the presence of a normal hippocampus, fornix atrophy may be valuable in predicting seizure-free outcome.
authors.affiliation: University of Alabama at Birmingham Epilepsy Center, and the Department of Neurology and Neurosurgery, University of Alabama at Birmingham, 35294, USA.
authors.forename: Jorge G
authors.initials: JG
authors.lastname: Burneo
authors.forename: Erhan
authors.initials: E
authors.lastname: Bilir
authors.forename: Edward
authors.initials: E
authors.lastname: Faught
authors.forename: Richard
authors.initials: R
authors.lastname: Morawetz
authors.forename: Robert C
authors.initials: RC
authors.lastname: Knowlton
authors.forename: Roy
authors.initials: R
authors.lastname: Martin
authors.forename: Ruben I
authors.initials: RI
authors.lastname: Kuzniecky
mesh_terms: D000293:Adolescent; D000328:Adult; D001284:Atrophy / Q000473:pathology; D004833:Epilepsy, Temporal Lobe / Q000473:pathology* / Q000601:surgery*; D005260:Female; D020712:Fornix, Brain / Q000473:pathology*; D007839:Functional Laterality; D006624:Hippocampus / Q000473:pathology; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures; D011300:Preoperative Care; D012720:Severity of Illness Index; D016896:Treatment Outcome