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Does Resection of the Medial Temporal Lobe Improve the Outcome of Temporal Lobe Epilepsy Surgery?
Author(s) -
Bonilha Leonardo,
Yasuda Clarissa Lin,
Rorden Chris,
Li Li M.,
Tedeschi Helder,
De Oliveira Evandro,
Cendes Fernando
Publication year - 2007
Publication title -
epilepsia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.687
H-Index - 191
eISSN - 1528-1167
pISSN - 0013-9580
DOI - 10.1111/j.1528-1167.2006.00958.x
Subject(s) - temporal lobe , hippocampus , entorhinal cortex , epilepsy surgery , epilepsy , hippocampal formation , medicine , voxel , surgery , resection , temporal cortex , lobe , psychology , radiology , neuroscience , anatomy , psychiatry
Summary: Purpose: Surgical removal of the hippocampus is the standard of care of patients with drug‐resistant medial temporal lobe epilepsy (MTLE). The procedure carries a success rate of ∼75%, but the reasons that some patients fail to achieve seizure control after surgery remain inexplicable. The question of whether the resection of medial temporal lobe structures in addition to the hippocampus would influence the surgical outcome in patients with MTLE was examined. Methods: We conducted voxel‐based statistical analyses of postoperative high‐resolution MRI of MTLE patients who underwent anteromedial temporal resection. We applied a cost function transformation of the resection maps for each patient to a common set of spatial coordinates, and we analyzed the contribution of histologically distinct segments of the medial temporal lobe cortex to the surgical outcome. We also performed a voxel‐wise mapping of surgical outcome to the temporal lobe. Results: We observed that the extent of hippocampal removal was associated with better outcomes. However, when the resection of the hippocampus was combined with the resection of the medial temporal lobe, specifically the entorhinal cortex, a greater likelihood of higher seizure control after surgery was found. Conclusions: Based on this finding, it is possible that the efficiency of the surgical treatment of MTLE can be improved by adjusting the procedure to include the resection of the entorhinal cortex, in addition to the resection of the hippocampus.