title: Multiple hippocampal transections for intractable hippocampal epilepsy: Seizure outcome.
abstract: The purpose of this study was to evaluate the seizure outcomes after transverse multiple hippocampal transections (MHTs) in 13 patients with intractable TLE.
  
  
  
  Thirteen patients with normal memory scores, including 8 with nonlesional hippocampi on MRI, had temporal lobe epilepsy (TLE) necessitating depth electrode implantation. After confirming hippocampal seizure onset, they underwent MHT. Intraoperative monitoring was done with 5-6 hippocampal electrodes spaced at approximately 1-cm intervals and spike counting for 5-8min before each cut. The number of transections ranged between 4 and 7. Neuropsychological assessment was completed preoperatively and postoperatively for all patients and will be reported separately.
  
  
  
  Duration of epilepsy ranged between 5 and 55years. There were no complications. Intraoperatively, MHT resulted in marked spike reduction (p=0.003, paired t-test). Ten patients (77%) are seizure-free (average follow-up was 33months, range 20-65months) without medication changes. One of the 3 patients with persistent seizures had an MRI revealing incomplete transections, another had an additional neocortical seizure focus (as suggested by pure aphasic seizures), and the third had only 2 seizures in 4years, one of which occurred during antiseizure medication withdrawal. Verbal and visual memory outcomes will be reported separately. Right and left hippocampal volumes were not different preoperatively (n=12, p=0.64, Wilcoxon signed-rank test), but the transected hippocampal volume decreased postoperatively (p=0.0173).
  
  
  
  Multiple hippocampal transections provide an effective intervention and a safe alternative to temporal lobectomy in patients with hippocampal epilepsy.
authors.affiliation: George Washington University, Washington, DC, United States.
authors.forename: Mohamad Z
authors.initials: MZ
authors.lastname: Koubeissi
authors.affiliation: University Hospitals Case Medical Center, Cleveland, OH, United States.
authors.forename: Emine
authors.initials: E
authors.lastname: Kahriman
authors.affiliation: University Hospitals Case Medical Center, Cleveland, OH, United States.
authors.forename: Philip
authors.initials: P
authors.lastname: Fastenau
authors.affiliation: University Hospitals Case Medical Center, Cleveland, OH, United States.
authors.forename: Christopher
authors.initials: C
authors.lastname: Bailey
authors.affiliation: University Hospitals Case Medical Center, Cleveland, OH, United States.
authors.forename: Tanvir
authors.initials: T
authors.lastname: Syed
authors.affiliation: University Hospitals Case Medical Center, Cleveland, OH, United States.
authors.forename: Shahram
authors.initials: S
authors.lastname: Amina
authors.affiliation: University Hospitals Case Medical Center, Cleveland, OH, United States.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Miller
authors.affiliation: University Hospitals Case Medical Center, Cleveland, OH, United States.
authors.forename: Charles
authors.initials: C
authors.lastname: Munyon
authors.affiliation: Trinity Health System, Grand Rapids, MI, United States.
authors.forename: Adriana
authors.initials: A
authors.lastname: Tanner
authors.affiliation: Trinity Health System, Grand Rapids, MI, United States.
authors.forename: Kristina
authors.initials: K
authors.lastname: Karanec
authors.affiliation: University Hospitals Case Medical Center, Cleveland, OH, United States.
authors.forename: Ingrid
authors.initials: I
authors.lastname: Tuxhorn
authors.affiliation: University Hospitals Case Medical Center, Cleveland, OH, United States.
authors.forename: Hans
authors.initials: H
authors.lastname: Lüders
mesh_terms: D000293:Adolescent; D000328:Adult; D000069279:Drug Resistant Epilepsy / Q000000981:diagnostic imaging* / Q000601:surgery*; D004833:Epilepsy, Temporal Lobe / Q000000981:diagnostic imaging* / Q000601:surgery*; D005260:Female; D006624:Hippocampus / Q000000981:diagnostic imaging* / Q000601:surgery*; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000639:trends; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D012640:Seizures / Q000000981:diagnostic imaging / Q000601:surgery; D016896:Treatment Outcome; D055815:Young Adult
keywords: Epilepsy surgery; Hippocampal transections; Hippocampus; Memory processing; Temporal lobe epilepsy