Epilepsy: Mesial Temporal

  • Patrick J. Karas
  • Sameer A. Sheth
  • Daniel YoshorEmail author


Mesial temporal lobe epilepsy (MTLE) is one of the most common focal epilepsy syndromes. Roughly one third of patients with MTLE continue to have disabling seizures despite multiple trials of antiepileptic medications. Surgical resection of the mesial temporal lobe in patients with drug-resistant mesial temporal epilepsy can lead to freedom from disabling seizures in 60–90% of patients. However proper patient selection is essential in order to achieve high rates of seizure freedom. In this chapter, we first discuss the pathophysiology and semiology of mesial temporal lobe epilepsy. After reviewing the diagnosis, we detail the preoperative workup necessary to determining if a patient is appropriate for surgery. Surgical intervention for mesial temporal epilepsy has evolved significantly over the past two decades. We discuss in detail the classical surgical approaches including anterior temporal lobectomy and selective amygdalohippocampectomy in addition to outcomes and complications of surgery. We then discuss newer surgical approaches to MTLE, including stereotactic laser amygdalohippocampotomy, stereotactic radiosurgery, and neuromodulation, emphasizing how these new techniques supplement traditional approaches in order to provide surgical options to a greater population of patients with MTLE.


Seizure Mesial temporal epilepsy Mesial temporal lobe epilepsy Mesial temporal sclerosis Anterior temporal lobectomy Selective amygdalohippocampectomy Stereotactic laser amygdalohippocampotomy Hippocampal transections Responsive neurostimulation Deep brain stimulation of the anterior nucleus of the thalamus Gamma Knife Epilepsy surgery Surgical techniques 



Anterior choroidal artery


Antiepileptic drug


Anterior nucleus of the thalamus


Anterior temporal lobectomy




Cerebrospinal fluid


Deep brain stimulation




Epilepsy monitoring unit




Hexamethylpropyleneamine oxime


Internal capsule


Inferior temporal gyrus


Laser interstitial thermal therapy




Mesial temporal lobe epilepsy


Middle temporal gyrus


Optic tract




Posterior cerebral artery


Positron emission tomography


Parahippocampal gyrus


Responsive neurostimulation


Selective amygdalohippocampectomy




Stereotactic laser amygdalohippocampotomy


Seizure onset zone


Single-photon emission computerized tomography


Stereotactic radiosurgery


Superior temporal gyrus






Temporal horn of the lateral ventricle


Vagus nerve stimulation



The authors are grateful to Dr. Winifred Hamilton for her artistic skill in drafting the original versions of Figs. 24.4, 24.5, 24.6, and 24.7 and Dr. Audrey Nath for providing images in Fig. 24.3.


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Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  • Patrick J. Karas
    • 1
  • Sameer A. Sheth
    • 1
  • Daniel Yoshor
    • 1
    Email author
  1. 1.Department of NeurosurgeryBaylor College of MedicineHoustonUSA

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