Epileptic Disorders

, Volume 13, Issue 3, pp 284–290 | Cite as

Superselective anterior temporal resection in mesial temporal lobe epilepsy

  • Joacir Graciolli Cordeiro
  • Kathrin Wagner
  • Michael Trippel
  • Josef Zentner
  • Andreas Schulze-Bonhage
Clinical Commentary
  • 111 Downloads

Abstract

We report the case of a patient with pharmacoresistant mesial temporal lobe epilepsy presenting psychomotor seizures with onset at early childhood. MRI showed a blurred internal structure of the right hippocampus and right mammillary body atrophy. Neuropsychological testing revealed deficits in selective attention and visual planning. Non-invasive recordingwas not sufficient to precisely detect the seizure onset zone. Invasive recording showed seizure onset in the temporo-polar neocortex, with spread to the amygdalum and hippocampus. A superselective resection of the temporal pole and amygdalum was performed with preservation of the hippocampus. Histology revealed the presence of focal cortical dysplasia (Palmini type Ib). Seizure frequency was reduced after surgery, and seizure freedom for two years was achieved with optimisation of the antiepileptic drug regime. Memory functions were preserved, and selective attention and visual planning improved following limited resection. This case suggests that, in selected cases, highly targeted resections with preservation of memory-relevant structures may be the best choice considering both seizure control and unimpaired cognitive functioning.

Key words

epilepsy surgery resection mesial temporal lobe epilepsy focal cortical dysplasia 

References

  1. Alpherts WCJ, Vermeulen J, van Rijen PC, da Silva FHL, van Veelen CWM. Standard versus tailored left temporal lobe resections: differences in cognitive outcome? Neuropsychologia 2008; 46: 455–460.PubMedCrossRefGoogle Scholar
  2. Clusmann H, Schramm J, Kral T, et al. Prognostic factors and outcome after different types of resection for temporal lobe epilepsy. J Neurosurg 2002; 97: 1131–1141.PubMedCrossRefGoogle Scholar
  3. Commission on classification and terminology of international league against epilepsy: proposal of revised classification of epilepsies and epileptic syndromes. Epilepsia 1989; 30: 389–399.Google Scholar
  4. Elsharkawy AE, Pannek H, Woermann FG, et al. Apical temporal lobe resection; “tailored” hippocampus-sparing resection based on presurgical evaluation data. Acta Neurochir (Wien) 2011; 153: 231–238.CrossRefGoogle Scholar
  5. Fauser S, Schulze-Bonhage A. How large must an epileptic focus be to cause an electrographic status epilepticus — a case report. Clin Neurophysiol 2004; 115: 2274–2279.PubMedCrossRefGoogle Scholar
  6. Fauser S, Schulze-Bonhage A. Epileptogenicity of cortical dysplasia in temporal lobe dual pathology: an electrophysiological study with invasive recordings. Brain 2006; 129: 82–95.PubMedCrossRefGoogle Scholar
  7. Fauser S, Bast T, Altenmüller D, et al. Factors influencing surgical outcome in patients with focal cortical dysplasia. J Neurol Neurosurg Psychiatr 2008; 79: 103–105.PubMedCrossRefGoogle Scholar
  8. Frings L, Schulze-Bonhage A, Spreer J, Wagner K. Remote effects of hippocampal damage on default network connectivity in the human brain. J Neurol 2009; 256: 2021–2029.PubMedCrossRefGoogle Scholar
  9. Giovagnoli AR, Casazza M, Avanzini G. Visual learning on a selective reminding procedure and delayed recall in patients with temporal lobe epilepsy. Epilepsia 1995; 36: 704–711.PubMedCrossRefGoogle Scholar
  10. Glikmann-Johnston Y, Saling MM, Chen J, et al. Structural and functional correlates of unilateral mesial temporal lobe spatial memory impairment. Brain 2008; 131: 3006–3018.PubMedCrossRefGoogle Scholar
  11. Gloor P. Mesial temporal sclerosis: historical background and an overview from a modern perspective. In: Lüders H. Epilepsy surgery. New York: Raven, 1991: 689–703.Google Scholar
  12. Gotman J, Levtova V. Amygdala-hippocampus relationships in temporal lobe seizures: a phase-coherence study. Epilepsy Res 1996; 25: 51–57.PubMedCrossRefGoogle Scholar
  13. Helmstaedter C, Richter S, Röske S, et al. Differential effects of temporal pole resection with amygdalohippocampectomy versus selective amygdalohippocampectomy on materialspecific memory in patients with mesial temporal lobe epilepsy. Epilepsia 2008; 49: 88–97.PubMedCrossRefGoogle Scholar
  14. Helmstaedter C, Petzold I, Bien CG. The cognitive consequence of resecting nonlesional tissues in epilepsy surgery-Results from MRI- and histopathology-negative patients with temporal lobe epilepsy. Epilepsia 2011; 52: 1402–1408.PubMedCrossRefGoogle Scholar
  15. Hood TW, Siegfried J, Wieser HG. The role of stereotactic amygdalotomy in the treatment of temporal lobe epilepsy associated with behavioural disorders. Appl Neurophysiol 1983; 46: 19–25.PubMedGoogle Scholar
  16. Kanner AM, Kaydanova Y, de Toledo-Morrell L, et al. Tailored anterior temporal lobectomy. Relation between extent of resection of mesial structures and postsurgical seizure outcome. Arch Neurol 1995; 52: 173–178.PubMedCrossRefGoogle Scholar
  17. Ladavas E, Umilta C, Provinciali L. Hemisphere-dependent cognitive performances in epileptic patients. Epilepsia 1979; 20: 493–502.PubMedCrossRefGoogle Scholar
  18. Levesque MF, Nakasato N, Vinters HV, Babb TL. Surgical treatment of limbic epilepsy associated with extrahippocampal lesions: the problem of dual pathology. J Neurosurg 1991; 75: 364–370.PubMedCrossRefGoogle Scholar
  19. Maguire EA, Burgess N, Donnett JG, et al. Knowing where and getting there: a human navigation network. Science 1998; 280: 921–924.PubMedCrossRefGoogle Scholar
  20. Majdan A, Sziklas V, Jones-Gotman MJ. Performance of healthy subjects and patients with resection from the anterior temporal lobe on matched tests of verbal and visuoperceptual learning. J Clin Exp Neuropsychol 1996; 18: 416–430.PubMedCrossRefGoogle Scholar
  21. Narabayashi H. Lessons from amygdaloid surgery in longterm observation. In: Gillingham FJ, Hitchcock ER, Nádvornik P. Stereotactic treatment of epilepsy. Acta Neurochir 1976; 23: 241–245.Google Scholar
  22. Narabayashi H, Mizutani T. Epileptic seizures and the stereotactic amygdalotomy. Confinia Neurol 1970; 32: 289–297.CrossRefGoogle Scholar
  23. Ojemann GA, Ward Jr. AA. Stereotactic and other procedures for epilepsy. In: Purpura DP, Penry JK, Walter RD. Adv Neurol 1975; 8: 241–263.Google Scholar
  24. Ravagnati L. Stereotactic surgery for epilepsy. In: Wieser HG, Elger CE. Presurgical evaluation of epileptics. Heidelberg, New York: Springer, 1987: 361–371.CrossRefGoogle Scholar
  25. Saling MM. Verbal memory in mesial temporal lobe epilepsy: beyond material specificity. Brain 2009; 132: 570–582.PubMedCrossRefGoogle Scholar
  26. Schmidt D, Baumgartner C, Löscher W. The chance of cure following surgery for drug-resistant temporal lobe epilepsy. What doweknowand dowe need to revise our expectations? Epilepsy Res 2004; 60: 187–201.PubMedGoogle Scholar
  27. Schulze-Bonhage A, Dennig D, Wagner K, et al. Seizure control resulting from intrahippocampal depth electrode insertion. J Neurol Neurosurg Psychiatr 2010; 81: 352–353.PubMedCrossRefGoogle Scholar
  28. Semah F, Picot MC, Adam C, et al. Is the underlying cause of epilepsy a major prognostic factor for recurrence? Neurology 1998; 51: 1256–1262.PubMedGoogle Scholar
  29. Sherman EMS, Wiebe S, Fay-McClymont TB, et al. Neuropsychological outcomes after epilepsy surgery: systematic review and pooled estimates. Epilepsia 2011; 52: 857–869.PubMedCrossRefGoogle Scholar
  30. Siegfried J, Wieser HG. The actual role of stereotactic operations on deep brain structures in the treatment of medically refractory epilepsies. In: Broggi G. The rational basis of the surgical treatment of epilepsies (Current Problems in Epilepsy 5). London, Paris: John Libbey, 1988: 113–119.Google Scholar
  31. Takaya S, Mikuni N, Mitsueda T, et al. Improved cerebral function in mesial temporal lobe epilepsy after subtemporal amygdalohippocampectomy. Brain 2009; 132: 185–194.PubMedCrossRefGoogle Scholar
  32. Vermathen P, Ende G, Laxer KD, et al. Temporal lobectomy for epilepsy: recovery of the contralateral hippocampus measured by (1)H MRS. Neurology 2002; 59: 633–636.PubMedGoogle Scholar
  33. Volcy Gomez M. Mesial temporal lobe epilepsy: its physiopathology, clinical characteristics, treatment and prognosis. Rev Neurol 2004; 38: 663–667.PubMedGoogle Scholar
  34. Watson C, Andermann F, Gloor P, et al. Anatomic basis of amygdaloid and hippocampal volume measurement by magnetic resonance imaging. Neurology 1992; 42: 1743–1750.PubMedGoogle Scholar
  35. Wieser HG. Mesial temporal lobe epilepsy versus amygdalar epilepsy: late seizure recurrence after initially successful amygdalotomy and regained seizure control following hippocampectomy. Epileptic Disord 2000; 2: 141–152.PubMedGoogle Scholar
  36. Zentner J, Wolf HK, Helmstaedter C, et al. Clinical relevance of amygdala sclerosis in temporal lobe epilepsy. J Neurosurg 1999; 91: 59–67.PubMedCrossRefGoogle Scholar

Copyright information

© John Libbey Eurotext and Springer 2011

Authors and Affiliations

  • Joacir Graciolli Cordeiro
    • 1
    • 2
    • 5
  • Kathrin Wagner
    • 3
  • Michael Trippel
    • 1
  • Josef Zentner
    • 4
  • Andreas Schulze-Bonhage
    • 3
  1. 1.Department of Stereotactic NeurosurgeryUniversity Hospital FreiburgFreiburgGermany
  2. 2.Department of Neurosurgery, Hospital de ClínicasFederal University of ParanáParanáBrazil
  3. 3.Epilepsy CenterUniversity Hospital FreiburgFreiburgGermany
  4. 4.Department of General NeurosurgeryUniversity Hospital FreiburgFreiburgGermany
  5. 5.Department of Stereotactic NeurosurgeryUniklinikFreiburg im BreisgauGermany

Personalised recommendations