Parahippocampectomy as a new surgical approach to mesial temporal lobe epilepsy due to hippocampal sclerosis: a pilot randomized comparative clinical trial.

Related Articles

Parahippocampectomy as a new surgical approach to mesial temporal lobe epilepsy due to hippocampal sclerosis: a pilot randomized comparative clinical trial.

World Neurosurg. 2017 Dec 08;:

Authors: Alonso-Vanegas MA, Freire Carlier ID, San-Juan D, Martínez NPsych AR, Trenado C

Abstract
BACKGROUND AND OBJECTIVE: The parahippocampal gyrus (PHG) plays an important role in the epileptogenic pathways of mTLE-HS, it´s resection could be preventing epileptic seizures with less complications. Evaluate the initial efficacy and safety of anterior temporal lobectomy (ATL), selective amygdalo-hipppocampectomy (SAH) and parahippocampectomy (PHC) surgical approaches in mTLE-HS.
METHODS: This was a randomized comparative pilot clinical trial (2008-2011) that included patients with mTLE-HS who underwent: ATL, trans-T3 SAH, and trans-T3 PHC. We described their socio-demographic characteristics, visual field profiles, verbal and visual memory profiles, and Engel scale outcome at baseline and at 1 and 5 years, using descriptive statistics along with parametric and non-parametric tests.
RESULTS: Forty-three patients with a mean age of 35.2 (18-56) years, 65% female, were analyzed: 14 PHC, 14 ATL, and 15 SAH. The following percentages refer to those patients who were seizure-free (Engel IA) at 1-year and 5-year follow-up respectively: 42.9% PHC, 71.4% ATL, and 60% SAH (p= 0.304); 28.6% PHC, 50% ATL, and 53.3% SAH (p= 0.353). Postoperative visual field deficits: 0% PHC, 85.7% ATL, and 46.7% SAH (p= 0.001). Verbal and/or visual memory worsening were present in: 21.3% PHC, 42.8% ATL, and 33.4% SAH (p= 0.488) and pre- and postoperative visual memory scores were significantly different in the SAH group only (p= 0.046).
CONCLUSION: PHC, ALT, and SAH demonstrate a preliminary similar efficacy in short-term seizure-free rates in patients with mTLE-HS. However, PHC efficacy to long-term decay compared to the other surgical techniques. PHC does not produce postoperative visual field deficits.

PMID: 29229342 [PubMed - as supplied by publisher]

http://ift.tt/2C0MvaE