title: Systematic review and meta-analysis of standard vs selective temporal lobe epilepsy surgery.
abstract: OBJECTIVE
  To compare standard anterior temporal lobectomy (ATL) with selective amygdalohippocampectomy (SAH) for postoperative seizure control in temporal lobe epilepsy (TLE).
  
  
  METHODS
  We searched MEDLINE and Embase using Medical Subject Headings and keywords related to ATL and SAH. We included original research that directly compared seizure outcomes in patients undergoing SAH or ATL for TLE. A fixed-effect model was used to derive a pooled risk ratio (RR) for either an Engel Class I (free of disabling seizures) or a composite of an Engel Class I and II (rare disabling seizures) outcome.
  
  
  RESULTS
  Of 4,675 abstracts initially identified by the search, 65 were reviewed as full text. Thirteen studies containing data from 8 countries (5 continents) met our inclusion criteria. Eleven studies comprising 1,203 patients demonstrated that participants were statistically more likely to achieve an Engel Class I outcome after ATL compared with SAH (risk ratio 1.32, 95% confidence interval [CI] 1.12-1.57; p < 0.01). The summary risk difference of 8% (95% CI 3%-14%) translates to a number needed to treat of 13 (95% CI 7-33) for 1 additional patient to achieve an Engel Class I outcome after ATL. The result remained significant when 2 studies that contained fewer than 15 participants in at least 1 arm were excluded and in analyses restricted to hippocampal sclerosis.
  
  
  CONCLUSIONS
  Standard ATL confers an improved chance of achieving freedom from disabling seizures in patients with TLE. Improved seizure freedom must be balanced against the neuropsychological impact of each procedure. A randomized controlled trial is justified.
authors.affiliation: Department of Medicine, Division of Neurology, Dalhousie University, Halifax, Canada. cjosephs@dal.ca
authors.forename: Colin B
authors.initials: CB
authors.lastname: Josephson
authors.forename: Jonathan
authors.initials: J
authors.lastname: Dykeman
authors.forename: Kirsten M
authors.initials: KM
authors.lastname: Fiest
authors.forename: Xiaorong
authors.initials: X
authors.lastname: Liu
authors.forename: R Mark
authors.initials: RM
authors.lastname: Sadler
authors.forename: Nathalie
authors.initials: N
authors.lastname: Jette
authors.forename: Samuel
authors.initials: S
authors.lastname: Wiebe
mesh_terms: D000679:Amygdala / Q000601:surgery*; D038481:Anterior Temporal Lobectomy / Q000379:methods*; D004833:Epilepsy, Temporal Lobe / Q000601:surgery*; D006624:Hippocampus / Q000601:surgery*; D006801:Humans; D012074:Remission Induction; D013702:Temporal Lobe / Q000601:surgery*