Shearwood
McClelland III MD, Tina T Shih MD, Lawrence J Hirsch MD, Carl W Bazil MD, PhD,
Marla J Hamberger PhD, Guy M McKhann II MD, Robert R Goodman MD, PhD
Departments
of Neurological Surgery and Neurology, Columbia College of Physicians and
Surgeons, New York, New York.
Objective: Anteromedial temporal lobectomy (AMTL) is
an established treatment for medically refractory temporal lobe epilepsy (TLE). Evaluations often use intracranial
electrodes to identify seizure onsets. Experience
with noninvasive evaluations in nonlesional patients (few centers reporting
greater than 50 patients) has provided limited information concerning efficacy
and morbidity. To expand this
knowledge, we review an experience with a large patient series.
Methods: From 1/1992-12/2003, AMTL (75 left, 63
right; 69 males, 69 females) was performed (by RRG) on 138 consecutive
nonlesional TLE patients based on noninvasive evaluation (technique described
by Spencer et al.; Neurosurgery 15:667-671, 1984). Mean age was 35.6 years
(S.D. +- 12.3 years; range: 8-64).
Results: 134 patients had a hippocampal MRI
abnormality on the side of presumed seizure onset. 121 patients had minimum follow-up of 12 months. Using a
modified Engel outcome scale, 95 (78.5%) were class I; 18 (14.9%) class II; 4
(3.3%) class III (greater than 75% seizure reduction), and 4 (3.3%) class IV
(less than 75% improvement) at last follow-up. Morbidity (138 patients) included: 16 partial
quadrantinopsias (11.6%), 6 transient depressions, 4 subtotal hemianopsias
(2.9%; 1 associated with dyslexia and 1 with subcortical infarct and
transient hemiparesis), 4 transient diplopias (2.9%), 1 chronic
subdural hematoma, 1 trapped temporal horn, 1 transient psychosis, and 1 deep
vein thrombosis (0.7%). No
patients had persisting significant motor deficit, disabling
dysnomia/dysphasia, amnestic syndrome or mortality.
Conclusion:
A noninvasive protocol for AMTL in a large
consecutive series of nonlesional TLE patients produced seizure control
comparable to reported experiences with invasive protocols.