title: Long-term seizure outcome after mesial temporal lobe epilepsy surgery: corticalamygdalohippocampectomy versus selective amygdalohippocampectomy.
abstract: OBJECTIVE
  Resection strategies for the treatment of temporal lobe epilepsy (TLE) are a matter of discussion, and little information is available. The aim of this study was to compare seizure outcomes at the 5-year follow-up in patients with medically refractory unilateral mesial TLE (MTLE) due to hippocampal sclerosis (HS) who were treated using a cortical amygdalohippocampectomy (CorAH) or a selective AH (SelAH).
  
  
  METHODS
  The authors obtained data from 100 adult patients who underwent surgery for MTLE. Fifty patients underwent a CorAH and 50 underwent an SelAH. Seizure control achieved with each technique was compared using the Engel classification scheme.
  
  
  RESULTS
  Overall, at the 5-year follow-up, favorable (Engel Classes I and II) seizure outcomes were noted in 82 and 90% of patients who had undergone CorAH and SelAH, respectively. Furthermore, 40% of the patients who had undergone a CorAH and 58% of those who had undergone an SelAH were seizure free (Engel Class Ia). There was no statistically significant difference between the 2 surgical approaches in terms of seizure outcome at the 5-year follow-up (p = 0.38).
  
  
  CONCLUSIONS
  Both CorAH and SelAH can lead to similar favorable seizure control in patients with MTLE/HS. However, the authors suggest that the transcortical selective approach has the great advantage of minimizing or completely abolishing the impact of dividing several venous and arterial adhesions which are tedious, time consuming, and, at times, associated with some degree of cerebral swelling.
authors.affiliation: Department of Neurosurgery, Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada. tanerato2000@yahoo.com
authors.forename: Taner
authors.initials: T
authors.lastname: Tanriverdi
authors.forename: Andre
authors.initials: A
authors.lastname: Olivier
authors.forename: Nicole
authors.initials: N
authors.lastname: Poulin
authors.forename: Frederick
authors.initials: F
authors.lastname: Andermann
authors.forename: François
authors.initials: F
authors.lastname: Dubeau
mesh_terms: D000328:Adult; D038481:Anterior Temporal Lobectomy / Q000009:adverse effects / Q000379:methods*; D015331:Cohort Studies; D018572:Disease-Free Survival; D004833:Epilepsy, Temporal Lobe / Q000209:etiology / Q000473:pathology / Q000601:surgery*; D005260:Female; D006624:Hippocampus / Q000473:pathology* / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012598:Sclerosis; D013997:Time Factors; D016896:Treatment Outcome