Long-term seizure, cognitive, and psychiatric outcome following trans-middle temporal gyrus amygdalohippocampectomy and standard temporal lobectomy: Clinical article

Krzysztof A. Bujarski, Fuyuki Hirashima, David W. Roberts, Barbara C. Jobst, Karen L. Gilbert, Robert M. Roth, Laura A. Flashman, Brenna C. McDonald, Andrew J. Saykin, Rod C. Scott, Eric Dinnerstein, Julie Preston, Peter D. Williamson, Vijay M. Thadani

Research output: Contribution to journalArticle

33 Scopus citations

Abstract

Object. Previous comparisons of standard temporal lobectomy (STL) and selective amygdalohippocampectomy (SelAH) have been limited by inadequate long-term follow-up, variable definitions of favorable outcome, and inadequate consideration of psychiatric comorbidities. Methods. The authors performed a retrospective analysis of seizure, cognitive, and psychiatric outcomes in a noncontemporaneous cohort of 69 patients with unilateral refractory temporal lobe epilepsy and MRI evidence of mesial temporal sclerosis after either an STL or an SelAH and examined seizure, cognitive, and psychiatric outcomes. Results. The mean duration of follow-up for STL was 9.7 years (range 1-18 years), and for trans-middle temporal gyrus SelAH (mtg-SelAH) it was 6.85 years (range 1-15 years). There was no significant difference in seizure outcome when 'favorable' was defined as time to loss of Engel Class I or II status; better seizure outcome was seen in the STL group when 'favorable' was defined as time to loss of Engel Class IA status (p = 0.034). Further analysis revealed a higher occurrence of seizures solely during attempted medication withdrawal in the mtg-SelAH group than in the STL group (p = 0.016). The authors found no significant difference in the effect of surgery type on any cognitive and most psychiatric variables. Standard temporal lobectomy was associated with significantly higher scores on assessment of postsurgical paranoia (p = 0.048). Conclusions. Overall, few differences in seizure, cognitive, and psychiatric outcome were found between STL and mtg-SelAH on long-term follow-up. Longer exposure to medication side effects after mtg-SelAH may adversely affect quality of life but is unlikely to cause additional functional impairment. In patients with high levels of presurgical psychiatric disease, mtg-SelAH may be the preferred surgery type.

Original languageEnglish (US)
Pages (from-to)16-23
Number of pages8
JournalJournal of neurosurgery
Volume119
Issue number1
DOIs
StatePublished - Jul 2013

Keywords

  • Cognitive outcome
  • Epilepsy
  • Middle temporal gyrus amygdalohippocampectomy
  • Psychiatric outcome
  • Seizure outcome
  • Standard temporal lobectomy

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery

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    Bujarski, K. A., Hirashima, F., Roberts, D. W., Jobst, B. C., Gilbert, K. L., Roth, R. M., Flashman, L. A., McDonald, B. C., Saykin, A. J., Scott, R. C., Dinnerstein, E., Preston, J., Williamson, P. D., & Thadani, V. M. (2013). Long-term seizure, cognitive, and psychiatric outcome following trans-middle temporal gyrus amygdalohippocampectomy and standard temporal lobectomy: Clinical article. Journal of neurosurgery, 119(1), 16-23. https://doi.org/10.3171/2013.3.JNS12714