Subtemporal hippocampectomy preserving the basal temporal language area for intractable mesial temporal lobe epilepsy: preliminary results.
OBJECTIVE
Decline in verbal memory as a surgical complication remains an unresolved problem in mesial temporal lobe epilepsy. Some areas in the temporal lobe associated with the language function, often including the basal temporal language area, have been removed or transected by conventional surgical procedures. The authors defined the basal temporal language area and removed only the epileptogenic zone with a subtemporal approach.


METHODS
The basal temporal language area was evaluated by using long-term subdural electrodes in five patients with language-dominant-side mesial temporal lobe epilepsy. While preserving this area, the hippocampus and the parahippocampal gyrus were removed by using a combined subtemporal, transventricular, transchoroidal fissure approach. Verbal memory performance was assessed with the Wechsler Memory Scale-Revised (WMS-R) before and after the operation.


RESULTS
The basal temporal language area, defined as a part of the inferior temporal gyrus, the fusiform gyrus, and the parahippocampal gyrus, was spared by entering the temporal horn via collateral sulcus. Verbal memory was significantly improved by 3 months and 1 year after the operation.


CONCLUSIONS
In language-dominant-side mesial temporal lobe epilepsy, preserving the basal temporal language area would have potential to improve verbal memory outcomes after removal of the epileptogenic zone.
Mikuni
Nobuhiro
N
Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto, Japan. mikunin@kuhp.kyoto-u.ac.jp
Miyamoto
Susumu
S
Ikeda
Akio
A
Satow
Takeshi
T
Taki
Junya
J
Takahashi
Jun
J
Ohigashi
Yoshitaka
Y
Hashimoto
Nobuo
N
D000328:Adult; D001931:Brain Mapping; D004833:Epilepsy, Temporal Lobe / Q000601:surgery*; D005260:Female; D007839:Functional Laterality / Q000502:physiology*; D006624:Hippocampus / Q000601:surgery*; D006801:Humans; D007802:Language; D008279:Magnetic Resonance Imaging; D008297:Male; D008568:Memory / Q000502:physiology; D008569:Memory Disorders / Q000453:epidemiology; D011939:Mental Recall / Q000502:physiology; D019635:Neurosurgical Procedures / Q000379:methods*; D020534:Parahippocampal Gyrus / Q000601:surgery; D011183:Postoperative Complications / Q000453:epidemiology; D013702:Temporal Lobe / Q000502:physiology*; D016896:Treatment Outcome; D014705:Verbal Behavior / Q000502:physiology; D014888:Wechsler Scales