Surgical treatment of mesial temporal lobe epilepsy using different approaches

Objective To compare the advantages and disadvantages of four surgical approaches employed at present in the treatment of mesial temporal lobe epilepsy associated with hippocampal sclerosis (MTLE/HS).Methods Based on seizure history,seizure semiology,findings with long - term video - EEG monitoring and high resonance MRI scanning,106 patients with refractory MTLE/HS were consecutively selected and operated on for seizures. 23,23,30 and 30 patients underwent selective transcortical transventricular amygdalohippocampectomy,selective transsylvian fissure amygdalohippocampectomy,anterior medial temporal resection and transsubtemporal selective amygdalohippocampectomy respectively.All patients were followed up from 6 months to 9 years. Engel' s scale was employed for the evaluation of postoperative outcomes.All postoperative complications were analyzed according to prospectively documented data.Results The routine pathological study showed typical changes of hippocampal sclerosis. Regarding outcomes with respect to seizure control,the four surgical methods were not statistically different with high frequency of seizure freedom in this special epileptic syndrome. There was no surgical mortality. The main surgical complications included diplopia and intracranial infection.All these complications were transient and cured,and had no significant difference in occurrence among 4 groups.Conclusions In strictly selected patients with MTLE/HS,all the four surgical methods are highly effective and safe.At least at the begaining of performence of epilepsy surgery,these four procedures could be chosen based on surgical experiences of operators. Key words: Hippocampal sclerosis;  Temporal lobe epilepsy;  Selective amygdalohippocampectomy; Anterior medial temporal resection