Tailored anteromedial lobectomy in the treatment of refractory epilepsy of the temporal lobe: long term surgical outcome and predictive factors.
OBJECTIVE
To analyze long-term results and to determine prognostic factors on seizure outcome in a series of patients with temporal lobe epilepsy (TLE) who underwent anteromedial temporal lobectomy (AMTL).


METHODS
From 1995 to 1998 forty-two patients suffering from non-lesional TLE underwent tailored AMTL at our Institution. We retrospectively reviewed surgical results and calculated predictive factors of good outcome in the long term.


RESULTS
Sixty-four percent of patients were rendered seizure free (median follow up 60 months). Eleven cases (26.2%) had a significant reduction of disabling epileptic episodes. Poor seizure control was observed in four patients (9.5%). Overall surgical morbidity was 4.7%. Medial temporal sclerosis (MTS) was the most common histopathological finding (69% of cases). The presence of unilateral hippocampal abnormalities on qualitative MRI was significantly associated with excellent postoperative outcome (p<0.011). Qualitative preoperative MRI had a positive predictive value of 83% in detecting both MTS at pathological examination and excellent outcome.


CONCLUSIONS
Tailored AMTL is a safe and effective procedure in the treatment of selected patients with medically refractory TLE. Data from preoperative qualitative MRI well correlated with histopathological findings. The presence of unilateral hippocampal atrophy on qualitative MRI was predictive of excellent outcome in the long-term follow up.
Roberti
Fabio
F
Department of Neurological Surgery, George Washington University Medical Center, Washington, DC, USA. roberti.fabio@gmail.com
Potolicchio
Samuel J
SJ
Caputy
Anthony J
AJ
D000328:Adult; D038481:Anterior Temporal Lobectomy / Q000379:methods*; D001284:Atrophy; D004292:Dominance, Cerebral / Q000502:physiology; D004569:Electroencephalography; D004833:Epilepsy, Temporal Lobe / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006624:Hippocampus / Q000473:pathology; D006801:Humans; D008297:Male; D011183:Postoperative Complications / Q000209:etiology*; D012189:Retrospective Studies; D013702:Temporal Lobe / Q000473:pathology; D016896:Treatment Outcome