Multiple Hippocampal Transections: Initial Clinical Experience with Modified Technique
Language English Country United States Media print-electronic
Document type Journal Article, Research Support, Non-U.S. Gov't
PubMed
39983984
DOI
10.1016/j.wneu.2025.123804
PII: S1878-8750(25)00160-3
Knihovny.cz E-resources
- Keywords
- Epilepsy, Memory, Multiple hippocampal transection, Temporal lobe,
- MeSH
- Adult MeSH
- Epilepsy, Temporal Lobe * surgery diagnostic imaging MeSH
- Hippocampus * surgery diagnostic imaging MeSH
- Middle Aged MeSH
- Humans MeSH
- Magnetic Resonance Imaging MeSH
- Young Adult MeSH
- Follow-Up Studies MeSH
- Neurosurgical Procedures * methods MeSH
- Neuropsychological Tests MeSH
- Drug Resistant Epilepsy * surgery diagnostic imaging MeSH
- Treatment Outcome MeSH
- Check Tag
- Adult MeSH
- Middle Aged MeSH
- Humans MeSH
- Young Adult MeSH
- Male MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Research Support, Non-U.S. Gov't MeSH
OBJECTIVE: Standard resective treatment of mesial temporal lobe epilepsy (MTLE) includes anteromesial temporal resection or amygdalohippocampectomy. One potential risk of these surgeries, especially in patients with magnetic resonance imaging (MRI)-negative findings, is postoperative memory impairment. An alternative to resective procedures that aim to preserve the neuropsychological profile are multiple hippocampal transections (MHTs). The objective of transections is to interrupt the longitudinal pathways of the hippocampus to prevent the spread of epileptic seizures while preserving the memory circuits. Previously performed MHT procedures were guided by questionable intraoperative electrocorticography. At our institution, we have developed and tested a modified technique to achieve complete MHTs. METHODS: Patients with pharmacoresistant unilaterally lateralized MTLE and MRI-negative findings with high risk of neuropsychologic deterioration were indicated for complete MHT. Comprehensive neuropsychological and epileptological evaluations and MRI follow-ups were conducted 1 year and 2 years postoperatively. The primary evaluated parameters were seizure reduction and significant changes in neuropsychological performance (± 1 SD). RESULTS: Complete MHTs were performed on 3 patients who completed 2-year follow-up. Two MHTs were performed on the right and 1 on the left side. Two patients are classified as Engel 1 and one patient as Engel 3. Two years after surgery, neuropsychologic evaluation did not show significant decrease in memory performance and performance in majority of cognitive tests. One-year MRI follow-up showed decrease of volume of hippocampus in all 3 patients. CONCLUSIONS: This modified technique of MHT in patients with MTLE and MRI-negative findings led to seizure reduction while preserving their neuropsychologic performance.
Department of Clinical Psychology Na Homolce Hospital Prague Czech Republic
Department of Neurology Epilepsy Center Na Homolce Hospital Prague Czech Republic
Department of Neurosurgery Faculty of Medicine Charles University Hradec Kralove Czech Republic
Department of Neurosurgery Na Homolce Hospital Prague Czech Republic
Department of Radiology Na Homolce Hospital Prague Czech Republic
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