DIFFERENT SURGICAL TECHNIQUES IN REFRACTORY TEMPORAL LOBE EPILEPSY DUE TO HIPPOCAMPAL SCLEROSIS (TLE/HS): A PROSPECTIVE COMPARISON OF THE RESULTS IN THE FIRST 3 YEARS AFTER SURGERY
Abstract number :
3.240
Submission category :
Year :
2002
Submission ID :
2553
Source :
www.aesnet.org
Presentation date :
12/7/2002 12:00:00 AM
Published date :
Dec 1, 2002, 06:00 AM
Authors :
Eduardo Paglioli, Eliseu Paglioli-Neto, Andre Palmini, Jaderson Costa da Costa, Mirna Portuguez, Victor Martinez, Gilberto Trentin, Ney Azambuja, Maria-Elisa Calcagnotto, Ligia Coutinho, Sergio Raupp, Jo[atilde]o-Rubi[atilde]o Hoefel Filho. Porto Alegre E
RATIONALE: There is a paucity of direct comparisons of the effectiveness and safety of the two most commonly performed surgical techniques for treatment of TLE / HS in patients homogeneously evaluated by the same neurophysiological team, and operated by the same neurosurgeon.
The objectives of this work are to compare the surgical results regarding seizure control and complication rate in patients undergoing an anterior temporal lobectomy (ATL) and in those who had a selective amygdalohippocampectomy (SAH), in an homogeneous and consecutive series of patients with refractory TLE/ HS.
METHODS: We prospectively collected surgical outcome data in an yearly basis for the first 3 post-operative years of 131 patients consecutively operated for TLE/HS by the same neurosurgeon. Seventy-seven underwent an ATL and 54 a SAH. All had unilateral HS unequivocally detected by preoperative MRI and/or postoperative histopathology. Engel[scquote]s outcome classification was used to analyze the surgical results, which were compared through survival analyses and contingency tables.
RESULTS: The application of survival analyses to the 77 patients operated through an ATL and to the 54 who had a SAH showed that postoperative survival in outcome class IA for the former was 83%, 78%, and 75%, respectively, for years 1 to 3, while the figures for the latter, at the same time points, were 83%, 76%, and 70%, Contingency tables did not disclose any significant differences between the proportion of patients operated through each technique, separately analyzed in years 1, 2, and 3, and considering outcome classes IA, I, and I+II. Mortality and major neurologic deficits (hemiparesis or language abnormalities) did not occur with any of the two techniques. Two patients who had ATL spontaneously complained of a restriction in the contralateral visual field.
CONCLUSIONS: These data suggest that SAH is as effective and safe as ATL for control of medically refractory seizures in patients with TLE /HS, at least during the first post-operative years.
[Supported by: FAPERGS]