Stereotactic amygdalohippocampectomy for temporal lobe epilepsy: promising results in 16 patients.
OBJECTIVE
Minimally invasive procedures for treating temporal lobe epilepsy have been investigated recently, namely stereotactic and gamma knife amygdalohippocampectomy (AHE). However, the results are not fully satisfactory. Our aim was to evaluate efficacy and side-effects of stereotactic AHE mimicking the neurosurgical procedure in terms of extent of the lesion.


METHODS
16 consecutive patients were assessed using VEEG, MRI, FDG-PET and WADA test. All had definite pharmacoresistant medial temporal lobe epilepsy. The stereotactic AHE was performed on the Leksell stereotactic system. All lesions exceeded 40 mm along the long axis of the hippocamus.


RESULTS
Seizure outcome was favourable on one year follow-up: 12 patients (75%) were seizure-free (Engel I), three (19%) were Engel II, and one (6%) was Engel III. Side-effects were mild, lasting up to 7 days: cephalea, meningeal syndrome with sterile CSF in three subjects, and CSF leak lasting up to 3 days in seven subjects.


CONCLUSIONS
Stereotactic AHE encompassing sufficient volume of the amygdalohippocampal complex appears to be safe, effective, and free from long-term side-effects.
Kalina
Miroslav
M
Na Homolce Hospital Epilepsy Center, Prague, Czech Republic. miroslav.kilina@homolka.cz
Lisck
Roman
R
Vojtech
Zdenek
Z
Adámková
Eva
E
Procházka
Tomás
T
Marecková
Iva
I
Vladyka
Vilidald
V
D000328:Adult; D000679:Amygdala / Q000378:metabolism / Q000473:pathology / Q000601:surgery*; D004351:Drug Resistance; D004833:Epilepsy, Temporal Lobe / Q000378:metabolism / Q000473:pathology / Q000601:surgery*; D005260:Female; D019788:Fluorodeoxyglucose F18; D006624:Hippocampus / Q000378:metabolism / Q000473:pathology / Q000601:surgery*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures; D049268:Positron-Emission Tomography; D019275:Radiopharmaceuticals; D013238:Stereotaxic Techniques
D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18