title: Neurocognitive and Seizure Outcomes of Selective Amygdalohippocampectomy versus Anterior Temporal Lobectomy for Mesial Temporal Lobe Epilepsy.
abstract: Objective. To report our institutional seizure and neuropsychological outcomes for a series of patients with mesial temporal lobe epilepsy (mTLE) undergoing anterior temporal lobectomy (ATL) or selective amygdalohippocampectomy (SelAH) between 2004 and 2011. Methods. A retrospective study of patients with mTLE was conducted. Seizure outcome was reported using time-to-event analysis. Cognitive outcome was reported using the change principal in component factor scores, one each, for intellectual abilities, visuospatial memory, and verbal memory. The Boston Naming Test was used for naming assessment. Language dominant and nondominant resections were compared separately. Student's t-test was used to assess statistical significance. Results. Ninety-six patients (75 ATL, 21 SelAH) were included; fifty-four had complete neuropsychological follow-up. Median follow-up was 40.5 months. There was no statistically significant difference in seizure freedom or any of the neuropsychological outcomes, although there was a trend toward greater postoperative decline in naming in the dominant hemisphere group following ATL. Conclusion. Seizure and neuropsychological outcomes did not differ for the two surgical approaches which is similar to most prior studies. Given the theoretical possibility of SelAH sparing language function in patients with epilepsy secondary to mesial temporal sclerosis and the limited high-quality evidence creating equipoise, a multicenter randomized clinical trial is warranted.
authors.affiliation: Division of Neurosurgery, University of Toronto, Toronto, ON, Canada M5G 1X8 ; Toronto Western Hospital, University Health Network, 399 Bathurst Street, Toronto, ON, Canada M5T 2S8.
authors.forename: Alireza
authors.initials: A
authors.lastname: Mansouri
authors.affiliation: Division of Neurosurgery, University of Toronto, Toronto, ON, Canada M5G 1X8 ; Toronto Western Hospital, University Health Network, 399 Bathurst Street, Toronto, ON, Canada M5T 2S8 ; Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Canada L8S 4K1.
authors.forename: Aria
authors.identifier: 0000-0003-3431-1889
authors.initials: A
authors.lastname: Fallah
authors.affiliation: Toronto Western Hospital, University Health Network, 399 Bathurst Street, Toronto, ON, Canada M5T 2S8 ; Psychology Department, University of Toronto, Toronto, ON, Canada M5T 2S8 ; Institute of Medical Sciences, University of Toronto, Toronto, Canada M5T 2S8 ; Krembil Neuroscience Center, University Health Network, Toronto, Canada M5T 2S8.
authors.forename: Mary Pat
authors.initials: MP
authors.lastname: McAndrews
authors.affiliation: Toronto Western Hospital, University Health Network, 399 Bathurst Street, Toronto, ON, Canada M5T 2S8 ; Psychology Department, University of Toronto, Toronto, ON, Canada M5T 2S8 ; Krembil Neuroscience Center, University Health Network, Toronto, Canada M5T 2S8.
authors.forename: Melanie
authors.initials: M
authors.lastname: Cohn
authors.affiliation: Toronto Western Hospital, University Health Network, 399 Bathurst Street, Toronto, ON, Canada M5T 2S8 ; Krembil Neuroscience Center, University Health Network, Toronto, Canada M5T 2S8 ; Division of Fundamental Neurobiology, Toronto Western Research Institute, Toronto Western Hospital, Toronto, ON, Canada M5T 2S8.
authors.forename: Diana
authors.identifier: 0000-0001-7598-1358
authors.initials: D
authors.lastname: Mayor
authors.affiliation: Toronto Western Hospital, University Health Network, 399 Bathurst Street, Toronto, ON, Canada M5T 2S8 ; Department of Neurology, University of Toronto, Toronto, ON, Canada M5T 2S8.
authors.forename: Danielle
authors.initials: D
authors.lastname: Andrade
authors.affiliation: Toronto Western Hospital, University Health Network, 399 Bathurst Street, Toronto, ON, Canada M5T 2S8 ; Department of Neurology, University of Toronto, Toronto, ON, Canada M5T 2S8.
authors.forename: Peter
authors.initials: P
authors.lastname: Carlen
authors.affiliation: Toronto Western Hospital, University Health Network, 399 Bathurst Street, Toronto, ON, Canada M5T 2S8 ; Department of Neurology, University of Toronto, Toronto, ON, Canada M5T 2S8.
authors.forename: Jose M
authors.initials: JM
authors.lastname: Del Campo
authors.affiliation: Toronto Western Hospital, University Health Network, 399 Bathurst Street, Toronto, ON, Canada M5T 2S8 ; Department of Neurology, University of Toronto, Toronto, ON, Canada M5T 2S8.
authors.forename: Peter
authors.identifier: 0000-0001-9261-4832
authors.initials: P
authors.lastname: Tai
authors.affiliation: Toronto Western Hospital, University Health Network, 399 Bathurst Street, Toronto, ON, Canada M5T 2S8 ; Department of Neurology, University of Toronto, Toronto, ON, Canada M5T 2S8.
authors.forename: Richard A
authors.initials: RA
authors.lastname: Wennberg
authors.affiliation: Division of Neurosurgery, University of Toronto, Toronto, ON, Canada M5G 1X8 ; Toronto Western Hospital, University Health Network, 399 Bathurst Street, Toronto, ON, Canada M5T 2S8 ; Krembil Neuroscience Center, University Health Network, Toronto, Canada M5T 2S8 ; Division of Fundamental Neurobiology, Toronto Western Research Institute, Toronto Western Hospital, Toronto, ON, Canada M5T 2S8.
authors.forename: Taufik A
authors.initials: TA
authors.lastname: Valiante