BACKGROUND: This paper presents our experience of stereotactic radiofrequency amygdalohippocampectomy performed for intractable mesial temporal lobe epilepsy. METHODS: The article describes the cases of 61 patients who were treated during the period from 2004 to 2010. Mean postoperative follow-up was 5.3 years. Neuropsychological results were obtained for a subset of 31 patients. RESULTS: At their last postsurgical visit, 43 (70.5%) patients were Engel class I, six (9.8%) class II, nine (14.8%) class III, and three (4.9%) class IV. The surgery was complicated by four intracranial hematomas. One of them caused acute hydrocephalus and was treated by shunting and resolved without sequelae, while another caused transitory aphasia. The remaining hematomas were asymptomatic. There were two cases of meningitis which required antibiotic treatment. One patient committed suicide due to postoperative depression. After the procedure, we performed open epilepsy surgery and rethermolesions in three and two patients, respectively (8.2%). Patients showed increases in their mean full scale, verbal, and performance intelligence quotient (IQ) scores of 4, 3, and 4 IQ points, respectively (P<0.05). Five (17.2%), four (13.8%), and four (13.3%) patients improved their full scale, verbal, and performance IQ scores, respectively. No significant changes were found in memory performance, with a mean increase of 1, 3, and 0 memory quotient points in global, verbal, and visual memory, respectively (P<0.05). Global memory improved in three (10.3%) patients, verbal memory in one (3.4%), and one patient (3.3%) showed deterioration in visual memory. CONCLUSION: Stereotactic radiofrequency amygdalohippocampectomy offers a safe, effective, and less aggressive treatment modality in cases of well-defined mesial temporal lobe epilepsy. Seizure outcome is comparable with the results of conventional epilepsy surgery and cognitive results could be even better.

Department of Neurology Na Homolce Hospital Prague Czech Republic

Department of Psychology Na Homolce Hospital Prague Czech Republic

Department of Radiodiagnostics Na Homolce Hospital Prague Czech Republic

Department of Stereotactic and Radiation Neurosurgery Na Homolce Hospital Prague Czech Republic

Zobrazit více v PubMed

Malmgren K, Thom M. Hippocampal sclerosis – origins and imaging. Epilepsia. 2012;53(Suppl 4):19–33. PubMed

Engel J, Wiebe S, French J, et al. Practice parameter: temporal lobe and localized neocortical resections for epilepsy. Epilepsia. 2003;44(6):741–751. PubMed

Spencer DD, Spencer SS, Mattson RH, Williamson PD, Novelly RA. Access to the posterior medial temporal lobe structures in the surgical treatment of temporal lobe epilepsy. Neurosurgery. 1984;15(5):667–671. PubMed

Yaşargil MG, Krayenbühl N, Roth P, Hsu SP, Yaşargil DC. The selective amygdalohippocampectomy for intractable temporal limbic seizures. J Neurosurg. 2010;112(1):168–185. PubMed

Olivier A. Transcortical selective amygdalohippocampectomy in temporal lobe epilepsy. Can J Neurol Sci. 2000;27(Suppl 1):S68–S76. ; discussion S92–S96. PubMed

Ramey WL, Martirosyan NL, Lieu CM, Hasham HA, Lemole GM, Weinand ME. Current management and surgical outcomes of medically intractable epilepsy. Clin Neurol Neurosurg. 2013;115(12):2411–2418. PubMed

Schramm J. Temporal lobe epilepsy surgery and the quest for optimal extent of resection: a review. Epilepsia. 2008;49(8):1296–1307. PubMed

Hamberger MJ, Drake EB. Cognitive functioning following epilepsy surgery. Curr Neurol Neurosci Rep. 2006;6(4):319–326. PubMed

Dulay MF, Busch RM. Prediction of neuropsychological outcome after resection of temporal and extratemporal seizure foci. Neurosurg Focus. 2012;32(3):E4. PubMed

Baxendale S, Thompson PJ, Duncan JS. Improvements in memory function following anterior temporal lobe resection for epilepsy. Neurology. 2008;71(17):1319–1325. PubMed

Schaller C, Jung A, Clusmann H, Schramm J, Meyer B. Rate of vasospasm following the transsylvian versus transcortical approach for selective amygdalohippocampectomy. Neurol Res. 2004;26(6):666–670. PubMed

Koch-Stoecker S, Schmitz B, Kanner AM. Treatment of postsurgical psychiatric complications. Epilepsia. 2013;54(Suppl 1):46–52. PubMed

Mengesha T, Abu-Ata M, Haas KF, et al. Visual field defects after selective amygdalohippocampectomy and standard temporal lobectomy. J Neuroophthalmol. 2009;29(3):208–213. PubMed

Georgiadis I, Kapsalaki EZ, Fountas KN. Temporal lobe resective surgery for medically intractable epilepsy: a review of complications and side effects. Epilepsy Res Treat. 2013;2013:752195. PubMed PMC

Polkey C. Surgical alternatives for the treatment of temporal lobe epilepsy. Br J Neurosurg. 1988;2(2):143–152. PubMed

Bouchard G, Kim YK, Umbach W. Stereotaxic methods in different forms of epilepsy. Confin Neurol. 1975;37(1–3):232–238. PubMed

Mempel E, Witkiewicz B, Stadnicki R, et al. The effect of medial amygdalotomy and anterior hippocampotomy on behavior and seizures in epileptic patients. Acta Neurochir Suppl (Wien) 1980;30:161–167. PubMed

Talairach J, Szikla G. Amygdalo-hippocampal partial destruction by yttrium-90 in the treatment of certain epilepsies of rhinencephalic manifestation. Neurochirurgie. 1965;11(3):233–240. French. PubMed

Vladyka V. Tactics in surgical treatment of epilepsy and its realization in cases of temporal epilepsy. Ces Slov Neurol Neurochir. 1978;41(74):95–106. PubMed

Kratimenos GP, Pell MF, Thomas DG, Shorvon SD, Fish DR, Smith SJ. Open stereotactic selective amygdalo-hippocampectomy for drug resistant epilepsy. Acta Neurochir (Wien) 1992;116(2–4):150–154. PubMed

Patil AA, Andrews R, Torkelson R. Stereotactic volumetric radiofrequency lesioning of intracranial structures for control of intractable seizures. Stereotact Funct Neurosurg. 1995;64(3):123–133. PubMed

Blume WT, Parrent AG, Kaibara M. Stereotactic amygdalohippocampectomy and mesial temporal spikes. Epilepsia. 1997;38(8):930–936. PubMed

Parrent AG, Blume WT. Stereotactic amygdalohippocampotomy for the treatment of medial temporal lobe epilepsy. Epilepsia. 1999;40(10):1408–1416. PubMed

Vojtěch Z, Malíková H, Krámská L, et al. Long-term seizure outcome after stereotactic amygdalohippocampectomy. Acta Neurochir (Wien) 2014;156(8):1529–1537. PubMed

Malíková H, Vojtěch Z, Liščák R, et al. Stereotactic radiofrequency amygdalohippocampectomy for the treatment of mesial temporal lobe epilepsy: correlation of MRI with clinical seizure outcome. Epilepsy Res. 2009;83(2–3):235–242. PubMed

Watson C, Jack CR, Jr, Cendes F. Volumetric magnetic resonance imaging. Clinical applications and contributions to the understanding of temporal lobe epilepsy. Arch Neurol. 1997;54(12):1521–1531. PubMed

MacMaster FP, Kusumakar V. Hippocampal volume in early onset depression. BMC Med. 2004;2:2. PubMed PMC

Vojtěch Z, Krámská L, Malíková H, et al. Cognitive outcome after stereotactic amygdalohippocampectomy. Seizure. 2012;21(5):327–333. PubMed

Liščák R, Malíková H, Kalina M, et al. Stereotactic radiofrequency amygdalohippocampectomy in the treatment of mesial temporal lobe epilepsy. Acta Neurochir (Wien) 2010;152(8):1291–1298. PubMed

Malíková H, Vojtěch Z, Liščák R, et al. Microsurgical and stereotactic radiofrequency amygdalohippocampectomy for the treatment of mesial temporal lobe epilepsy: different volume reduction, similar clinical seizure control. Stereotact Funct Neurosurg. 2010;88(1):42–50. PubMed

Malíková H, Liščák R, Vojtěch Z, et al. Stereotactic radiofrequency amygdalohippocampectomy: does reduction of entorhinal and perirhinal cortices influence good clinical seizure outcome? Epilepsia. 2011;52(5):932–940. PubMed

Malíková H, Krámská L, Liščák R, et al. Stereotactic radiofrequency amygdalohippocampectomy for the treatment of temporal lobe epilepsy: do good neuropsychological and seizure outcomes correlate with hippocampal volume reduction? Epilepsy Res. 2012;102(1–2):34–44. PubMed

Maliková H, Krámská L, Vojtěch Z, et al. Different surgical approaches for mesial temporal epilepsy: resection extent, seizure, and neuropsychological outcomes. Stereotact Funct Neurosurg. 2014;92(6):372–380. PubMed

Guénot M, Isnard J, Catenoix H, Mauguière F, Sindou M. SEEG-guided RF-thermocoagulation of epileptic foci: a therapeutic alternative for drug-resistant non-operable partial epilepsies. Adv Tech Stand Neurosurg. 2011;36:61–78. PubMed

Téllez-Zenteno JF, Dhar R, Wiebe S. Long-term seizure outcomes following epilepsy surgery: a systematic review and meta-analysis. Brain. 2005;128(Pt 5):1188–1198. PubMed

Elliott RE, Bollo RJ, Berliner JL, et al. Anterior temporal lobectomy with amygdalohippocampectomy for mesial temporal sclerosis: predictors of long-term seizure control. J Neurosurg. 2013;119(2):261–272. PubMed

Hader WJ, Téllez-Zenteno J, Metcalfe A, et al. Complications of epilepsy surgery: a systematic review of focal surgical resections and invasive EEG monitoring. Epilepsia. 2013;54(5):840–847. PubMed

Engel J, McDermott MP, Wiebe S, et al. Early Randomized Surgical Trial (ERSET) Study Group Early surgical therapy for drug-resistant temporal lobe epilepsy: a randomized trial. JAMA. 2012;307(9):922–930. PubMed PMC

Sherman EM, Wiebe S, Fay-McClymont TB, et al. Neuropsychological outcomes after epilepsy surgery: systematic review and pooled estimates. Epilepsia. 2011;52(5):857–869. PubMed

Shimizu H, Kawai K, Sunaga S, Sugano H, Yamada T. Hippocampal transection for treatment of left temporal lobe epilepsy with preservation of verbal memory. J Clin Neurosci. 2006;13(3):322–328. PubMed

Tassi L, Meroni A, Deleo F, et al. Temporal lobe epilepsy: neuropathological and clinical correlations in 243 surgically treated patients. Epileptic Disord. 2009;11(4):281–292. PubMed

Relationship between remnant hippocampus and amygdala and memory outcomes after stereotactic surgery for mesial temporal lobe epilepsy