Stereotactic radiofrequency amygdalohippocampectomy in the treatment of mesial temporal lobe epilepsy.
OBJECTIVE
Minimally invasive percutaneous single trajectory stereotactic radiofrequency amygdalohippocampectomy was used to treat mesial temporal lobe epilepsy (MTLE). The aim of the study was to evaluate complications and effectiveness of this procedure.


METHODS
A group of 51 patients with MTLE was treated using stereotactic thermo-lesion of amygdalohippocampal complex under local anaesthesia. The target was reached through the occipital approach with a single trajectory using MRI stereotactic localisation. Thermocoagulation of the amygdalohippocampal complex was planned according to the individual anatomy of each patient. Amygdalohippocampectomy was performed using a string electrode with a 10-mm active tip, and 16-38 lesions (median = 25) were performed in all patients along the 30- to 45-mm trajectory (median = 35) in the amygdalohippocampal complex.


RESULTS
The procedure was well tolerated by all patients with no severe permanent morbidity; meningitis was recorded in two patients (4%), hematoma was detected in four patients, clinically insignificant in three of them, and one patient required temporary ventricular drainage (2%). Thirty-two patients were followed up over at least 2 years, and the clinical outcomes were evaluated by Engel's classification; 25 of them (78%) were Engel I, five (16%) were Engel II, and two (6%) were Engel IV.


CONCLUSIONS
Stereotactic amygdalohippocampectomy is a minimally invasive procedure with low morbidity and good results that can be the method of choice in selected patients with MTLE.
Liscak
Roman
R
Department of Stereotactic and Radiation Neurosurgery, Hospital Na Homolce, Roentgenova 2, Prague, Czech Republic. roman.liscak@homolka.cz
Malikova
Hana
H
Kalina
Miroslav
M
Vojtech
Zdenek
Z
Prochazka
Tomas
T
Marusic
Petr
P
Vladyka
Vilibald
V
D000293:Adolescent; D000328:Adult; D000368:Aged; D000679:Amygdala / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D004833:Epilepsy, Temporal Lobe / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D006624:Hippocampus / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011183:Postoperative Complications / Q000209:etiology / Q000503:physiopathology; D016634:Radiosurgery / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult