title: Superselective anterior temporal resection in mesial temporal lobe epilepsy.
abstract: We report the case of a patient with pharmacoresistant mesial temporal lobe epilepsy presenting psychomotor seizures with onset at early childhood. MRI showed a blurred internal structure of the right hippocampus and right mammillary body atrophy. Neuropsychological testing revealed deficits in selective attention and visual planning. Non-invasive recording was not sufficient to precisely detect the seizure onset zone. Invasive recording showed seizure onset in the temporo-polar neocortex, with spread to the amygdalum and hippocampus. A superselective resection of the temporal pole and amygdalum was performed with preservation of the hippocampus. Histology revealed the presence of focal cortical dysplasia (Palmini type Ib). Seizure frequency was reduced after surgery, and seizure freedom for two years was achieved with optimisation of the antiepileptic drug regime. Memory functions were preserved, and selective attention and visual planning improved following limited resection. This case suggests that, in selected cases, highly targeted resections with preservation of memory-relevant structures may be the best choice considering both seizure control and unimpaired cognitive functioning.
authors.affiliation: Department of Stereotactic Neurosurgery, University Hospital Freiburg, Freiburg, Germany. joacir.cordeiro@uniklinik-freiburg.de
authors.forename: Joacir Graciolli
authors.initials: JG
authors.lastname: Cordeiro
authors.forename: Kathrin
authors.initials: K
authors.lastname: Wagner
authors.forename: Michael
authors.initials: M
authors.lastname: Trippel
authors.forename: Josef
authors.initials: J
authors.lastname: Zentner
authors.forename: Andreas
authors.initials: A
authors.lastname: Schulze-Bonhage
mesh_terms: D000679:Amygdala / Q000473:pathology; D038481:Anterior Temporal Lobectomy / Q000379:methods*; D000927:Anticonvulsants / Q000627:therapeutic use; D001288:Attention / Q000502:physiology; D001921:Brain / Q000473:pathology; D003071:Cognition / Q000502:physiology; D004569:Electroencephalography; D004833:Epilepsy, Temporal Lobe / Q000473:pathology / Q000523:psychology / Q000601:surgery*; D006624:Hippocampus / Q000473:pathology; D006801:Humans; D007360:Intelligence; D008297:Male; D008568:Memory / Q000502:physiology; D008875:Middle Aged; D009483:Neuropsychological Tests; D019635:Neurosurgical Procedures / Q000379:methods*; D013702:Temporal Lobe / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome; D014796:Visual Perception / Q000502:physiology
chemical_list: D000927:Anticonvulsants