title: Complications After Surgery for Mesial Temporal Lobe Epilepsy Associated with Hippocampal Sclerosis.
abstract: BACKGROUND
  Hippocampal sclerosis is the most common cause of drug-resistant epilepsy amenable for surgical treatment and seizure control. This study aimed to analyze morbidities related to surgery of mesial temporal lobe epilepsy associated with hippocampal sclerosis and to identify possible risk factors for complications.
  
  
  METHODS
  A retrospective analysis of postoperative complications was made for 389 operations performed between 1990 and 2015 on patients aged 15-67 years (mean 36.8). Three surgical approaches were used: anterior temporal lobectomy (ATL) (n = 209), transcortical selective amygdalohippocampectomy (SAH) (n = 144), and transsylvian SAH (n = 36). Complications were classified as minor or major if there was a neurologic impairment or if further surgical or medical treatment was necessary.
  
  
  RESULTS
  Complications followed 15.4% of operations. They were classed as major for 4.1% of patients, but there were no mortalities. Persistent neurologic deficits occurred in 0.5% of patients. In 3 cases (0.8%) additional surgery was necessary to treat an intracranial hematoma, a delayed hydrocephalus, and a subdural empyema. Symptomatic visual field defects (VFDs) were frequent and included contralateral superior quadrantanopia (8.2%) or hemianopia (1.3%). Overall complications (P = 0.04) and symptomatic VFDs (P = 0.04) were most frequent in operations on men. Major complications occurred most often with the ATL surgical approach than with transcortical SAH (P = 0.03).
  
  
  CONCLUSIONS
  Major complications occur rarely after mesial temporal surgery on epileptic patients. They occur more often following the ATL rather than transcortical SAH approach. Complications tend to be temporary with symptoms of limited duration for surgery performed by experienced teams on carefully selected and evaluated patients.
authors.affiliation: Department of Neurosurgery, La Pitié-Salpêtrière University Hospital, Paris, France; Sorbonne University, UPMC, Paris, France. Electronic address: bertrand.mathon@aphp.fr.
authors.forename: Bertrand
authors.initials: B
authors.lastname: Mathon
authors.affiliation: Epilepsy Unit, Assistance Publique-Hôpitaux de Paris, La Pitié-Salpêtrière University Hospital, Paris, France; Brain and Spine Institute, Paris, France; Sorbonne University, UPMC, Paris, France.
authors.forename: Vincent
authors.initials: V
authors.lastname: Navarro
authors.affiliation: Department of Neuropathology, La Pitié-Salpêtrière University Hospital, Paris, France; Sorbonne University, UPMC, Paris, France.
authors.forename: Franck
authors.initials: F
authors.lastname: Bielle
authors.affiliation: Epilepsy Unit, Assistance Publique-Hôpitaux de Paris, La Pitié-Salpêtrière University Hospital, Paris, France.
authors.forename: Vi-Huong
authors.initials: VH
authors.lastname: Nguyen-Michel
authors.affiliation: Department of Neurosurgery, La Pitié-Salpêtrière University Hospital, Paris, France; Brain and Spine Institute, Paris, France; Sorbonne University, UPMC, Paris, France.
authors.forename: Alexandre
authors.initials: A
authors.lastname: Carpentier
authors.affiliation: Epilepsy Unit, Assistance Publique-Hôpitaux de Paris, La Pitié-Salpêtrière University Hospital, Paris, France; Brain and Spine Institute, Paris, France; Sorbonne University, UPMC, Paris, France.
authors.forename: Michel
authors.initials: M
authors.lastname: Baulac
authors.affiliation: Department of Neurosurgery, La Pitié-Salpêtrière University Hospital, Paris, France; Sorbonne University, UPMC, Paris, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Cornu
authors.affiliation: Epilepsy Unit, Assistance Publique-Hôpitaux de Paris, La Pitié-Salpêtrière University Hospital, Paris, France; Brain and Spine Institute, Paris, France.
authors.forename: Claude
authors.initials: C
authors.lastname: Adam
authors.affiliation: Epilepsy Unit, Assistance Publique-Hôpitaux de Paris, La Pitié-Salpêtrière University Hospital, Paris, France; Department of Rehabilitation, La Pitié-Salpêtrière University Hospital, Paris, France; Brain and Spine Institute, Paris, France; Sorbonne University, UPMC, Paris, France.
authors.forename: Sophie
authors.initials: S
authors.lastname: Dupont
authors.affiliation: Department of Neurosurgery, La Pitié-Salpêtrière University Hospital, Paris, France.
authors.forename: Stéphane
authors.initials: S
authors.lastname: Clemenceau
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001927:Brain Diseases / Q000601:surgery*; D004833:Epilepsy, Temporal Lobe / Q000601:surgery*; D005260:Female; D006624:Hippocampus / Q000473:pathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011182:Postoperative Care / Q000379:methods; D011183:Postoperative Complications / Q000209:etiology; D012189:Retrospective Studies; D012598:Sclerosis / Q000601:surgery; D055815:Young Adult
keywords: Adverse events; Epilepsy surgery; Mesial temporal sclerosis; Morbidity; Predictors; Visual field defects