Hana Malikova MD, Presenter: Nothing to Disclose

Lenka Kramska, Abstract Co-Author: Nothing to Disclose

Zdenek Vojtech MD, Abstract Co-Author: Nothing to Disclose

Roman Liscak PhD, Abstract Co-Author: Nothing to Disclose

Surgical therapy of intractable mesial temporal lobe epilepsy (MTLE) is an effective and well-established treatment that brings seizure relief in 60-70% of patients. Anterior temporal resection (ATL) is commonly used surgical procedure. Stereotactic radiofrequency amygdalohippocampectomy (SAHE) is a minimally invasive selective approach. It is known that the surgical treatment of MTLE bears the risk of memory impairment especially in left-sided surgery. The aim of the study was to compare 2 different surgical approaches, standard ATL and alternative SAHE for MTLE, with respect to the extent of resection or destruction, and clinical outcomes.

75 MTLE patients were included; 41 treated by SAHE (11 right-sided, 30 left-sided) and 34 treated by ATL (21 right-sided, 13 left-sided). All patients underwent MRI volumetry of hippocampus and amygdala and neuropsychological evaluation preoperatively and 1 year after operation. Clinical seizure outcome was assessed 2 years after therapy.

Hippocampal (60.6±18.7%) and amygdalar (50.3±21.9%) volume reduction by SAHE was significantly lower than by ATL (86.0±12.7%, 80.2±20.9%, respectively). Seizure control by SAHE was comparable with ATL (Engel I in 75.6% and 76.5%) 2 years after surgery. Neuropsychological results of SAHE patients were better than in ATL patients. In SAHE patients no memory impairment was found, they improved in Global MQ and Verbal MQ. In ATL group, memory performance was significantly deteriorated only in Delayed Recall.

In this study we have proven that destruction of hippocampal and amygdalar tissue by SAHE was significantly lower than hippocampal and amygdalar resection after ATL. Seizure control by SAHE was comparable to ATL. However, SAHE offers better neuropsychological results.

SAHE is minimally invasive selective treatment for MTLE that partialy spares mesial structures of temporal lobe and offers comparable seizure control as ATL, with better neuropsychological results.

Malikova, H, Kramska, L, Vojtech, Z, Liscak, R, Stereotactic Amygdalohippocampectomy and Anterior Temporal Resection for Mesial Temporal Lobe Epilepsy: Resection or Destruction Extent versus Seizure and Neuropsychological Outcomes.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14005072.html