title: Temporal lobe epilepsy surgery: different surgical strategies after a non-invasive diagnostic protocol.
abstract: OBJECTIVE
  To test a non-invasive presurgical protocol for temporal lobe epilepsy (TLE) based on "anatomo-electro-clinical correlations".
  
  
  METHODS
  All consecutive patients with suspected TLE and seizure history <2 years were entered into the protocol, which included video-electroencephalographic (EEG) monitoring and magnetic resonance imaging (MRI). Three different TLE subsyndromes (mesial, lateral, mesiolateral) were identified by combined anatomical, electrical, and clinical criteria. "Tailored" surgery for each subsyndrome was offered. Patients with seizure history <2 years, MRI evidence of temporal mass lesion, and concordant interictal EEG and clinical data bypassed video-EEG monitoring and were directly scheduled for surgery.
  
  
  RESULTS
  Lesionectomy was performed without video-EEG recording in 11 patients with tumorous TLE. Of 146 patients studied with video-EEG, 133 received a TLE diagnosis. Four were excluded for neuropsychological risks, eight refused surgery, and 121 underwent surgery. Of 132 consecutive patients who underwent surgery, 101 had at least one year of follow up. They were divided into a "hippocampal sclerosis/cryptogenic" group (n = 57) and a "tumours/cortical organisation disorders" group (n = 44). In the first group, extensive temporal lobectomy (ETL) was performed in 40 patients, anteromesial temporal lobectomy (AMTL) in 17 patients. At follow up, 47 patients were seizure free. In the second group, lesionectomy plus ETL was performed in 23 patients, lesionectomy plus AMTL in six patients, and lesionectomy alone in 15 patients. Thirty nine patients were seizure free.
  
  
  CONCLUSIONS
  These findings suggest that different TLE subsyndromes can be identified accurately using non-invasive anatomo-electro-clinical data and can be treated effectively and safely with tailored surgery.
authors.affiliation: Epilepsy Surgery Unit, Department of Neuroscience, IRCC Neuromed, 86077 Pozzilli (IS), Italy. episurg@neuromed.it
authors.forename: P P
authors.initials: PP
authors.lastname: Quarato
authors.forename: G
authors.initials: G
authors.lastname: Di Gennaro
authors.forename: A
authors.initials: A
authors.lastname: Mascia
authors.forename: L G
authors.initials: LG
authors.lastname: Grammaldo
authors.forename: G N
authors.initials: GN
authors.lastname: Meldolesi
authors.forename: A
authors.initials: A
authors.lastname: Picardi
authors.forename: T
authors.initials: T
authors.lastname: Giampà
authors.forename: C
authors.initials: C
authors.lastname: Falco
authors.forename: F
authors.initials: F
authors.lastname: Sebastiano
authors.forename: P
authors.initials: P
authors.lastname: Onorati
authors.forename: M
authors.initials: M
authors.lastname: Manfredi
authors.forename: G
authors.initials: G
authors.lastname: Cantore
authors.forename: V
authors.initials: V
authors.lastname: Esposito
mesh_terms: D000293:Adolescent; D000328:Adult; D001921:Brain / Q000473:pathology / Q000503:physiopathology / Q000601:surgery; D002648:Child; D004569:Electroencephalography; D004833:Epilepsy, Temporal Lobe / Q000175:diagnosis* / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000379:methods*; D011300:Preoperative Care; D014743:Videotape Recording