title: Vascular events after transsylvian selective amygdalohippocampectomy and impact on epilepsy outcome.
abstract: OBJECTIVE
  Epilepsy surgery is a standard treatment option for medically intractable temporal lobe epilepsy. Selective amygdalohippocampectomy (SAH) and anterior temporal lobectomy (ATL) are two of the standard surgical procedures in these cases. We conducted a retrospective analysis of patients treated with SAH via a modified transsylvian approach in our epilepsy center between 2008 and 2011, and we analyzed the impact of adjacent procedure-related infarctions on seizure outcome in these patients.
  
  
  METHODS
  Infarctions were detected by magnetic resonance imaging (MRI) within the first week postoperatively and by a second MRI 9 months after surgical intervention. Neuropsychological testing was performed preoperatively. Evaluation of seizure outcome and postoperative neuropsychological testing were conducted approximately 1 year after epilepsy surgery. Correlative clinical data were analyzed by retrospective chart review.
  
  
  RESULTS
  The postoperative MRI revealed temporal infarctions in 47.9% (n = 23/48) and frontal infarctions in 10.4% (n = 5/48) of the patients. These vascular events were asymptomatic in terms of focal neurologic deficits. Of the patients, 68.5% (n = 37/54) were free of disabling seizures (Engel class I) 1 year after the procedure. Patients with temporal infarctions were significantly more often free of disabling seizures (Engel class I, p = 0.046) than patients without temporal infarctions. Neuropsychological testing indicated a deterioration in verbal memory after SAH in patients with infarctions on the language-lateralized hemisphere compared to patients without infarction (p = 0.011). All other tested neuropsychological categories showed no significant differences between patients with or without infarctions.
  
  
  CONCLUSIONS
  Our results indicate a surprisingly high number of procedure-related temporal infarctions after transsylvian SAH. Hence, the volume of nonfunctional "eliminated" tissue is enlarged unintentionally, which is a possible explanation for better seizure outcome in these patients. This result supports the notion that ATL is the favorable procedure for temporal lobe epilepsy compared to SAH in the nondominant hemisphere, as neuropsychological deficits are rarely to be expected.
authors.affiliation: Department of Neurological Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Tobias
authors.initials: T
authors.lastname: Martens
authors.affiliation: Department of Neurology and Epileptology, Epilepsy Center Hamburg-Alsterdorf, Hamburg, Germany.
authors.forename: Matthias
authors.initials: M
authors.lastname: Merkel
authors.affiliation: Department of Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Brigitte
authors.initials: B
authors.lastname: Holst
authors.affiliation: Department of Neurology and Epileptology, Epilepsy Center Hamburg-Alsterdorf, Hamburg, Germany.
authors.forename: Katja
authors.initials: K
authors.lastname: Brückner
authors.affiliation: Department of Neurology and Epileptology, Epilepsy Center Hamburg-Alsterdorf, Hamburg, Germany.
authors.forename: Matthias
authors.initials: M
authors.lastname: Lindenau
authors.affiliation: Department of Neurology and Epileptology, Epilepsy Center Hamburg-Alsterdorf, Hamburg, Germany.
authors.forename: Stefan
authors.initials: S
authors.lastname: Stodieck
authors.affiliation: Department of Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Jens
authors.initials: J
authors.lastname: Fiehler
authors.affiliation: Department of Neurological Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Manfred
authors.initials: M
authors.lastname: Westphal
authors.affiliation: Department of Neurological Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.|Department of Neurosurgery, HELIOS Medical Center Schwerin, Schwerin, Germany.
authors.forename: Oliver
authors.initials: O
authors.lastname: Heese
mesh_terms: D000328:Adult; D000679:Amygdala / Q000601:surgery*; D038481:Anterior Temporal Lobectomy; D002544:Cerebral Infarction / Q000175:diagnosis*; D004292:Dominance, Cerebral / Q000502:physiology; D004569:Electroencephalography; D004833:Epilepsy, Temporal Lobe / Q000601:surgery*; D005260:Female; D005625:Frontal Lobe / Q000098:blood supply; D006624:Hippocampus / Q000601:surgery*; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D008279:Magnetic Resonance Imaging; D008297:Male; D008570:Memory, Short-Term / Q000502:physiology; D008875:Middle Aged; D009483:Neuropsychological Tests; D011183:Postoperative Complications / Q000175:diagnosis*; D012189:Retrospective Studies; D012815:Signal Processing, Computer-Assisted; D013702:Temporal Lobe / Q000098:blood supply; D016896:Treatment Outcome; D014706:Verbal Learning / Q000502:physiology; D014741:Video Recording
keywords: Epilepsy surgery; Infarction; MRI; Neuropsychology