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Orrin Devinsky - One of the best experts on this subject based on the ideXlab platform.
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anterior temporal lobectomy with Amygdalohippocampectomy for mesial temporal sclerosis predictors of long term seizure control
Journal of Neurosurgery, 2013Co-Authors: Robert E Elliott, William B Barr, Robert J Bollo, Jonathan L Berliner, Alyson Silverberg, Chad Carlson, Eric B Geller, Orrin DevinskyAbstract:Object In this paper the authors' goal was to identify preoperative variables that predict long-term seizure freedom among patients with mesial temporal sclerosis (MTS) after single-stage anterior temporal lobectomy and Amygdalohippocampectomy (ATL-AH). Methods The authors retrospectively reviewed 116 consecutive patients (66 females, mean age at surgery 40.7 years) with refractory seizures and pathologically confirmed MTS who underwent ATL-AH with at least 2 years of follow-up. All patients underwent preoperative MRI and video-electroencephalography (EEG); 106 patients (91.4%) underwent Wada testing and 107 patients (92.2%) had neuropsychological evaluations. The authors assessed the concordance of these 4 studies (defined as test consistent with the side of eventual surgery) and analyzed the impact of preoperative variables on seizure freedom. Results The median follow-up after surgery was 6.7 years (mean 6.9 years). Overall, 103 patients (89%) were seizure free, and 109 patients (94%) had Engel Class I...
Robert E Gross - One of the best experts on this subject based on the ideXlab platform.
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laser interstitial thermal therapy for mesial temporal lobe epilepsy
Neurosurgery, 2016Co-Authors: Robert T Wicks, Walter J Jermakowicz, Jonathan R Jagid, Daniel E Couture, Jon T Willie, Adrian W Laxton, Robert E GrossAbstract:Approximately one-third of patients with epilepsy do not achieve adequate seizure control through medical management alone. Mesial temporal lobe epilepsy (MTLE) is one of the most common forms of medically refractory epilepsy referred for surgical management. Stereotactic laser amygdalohippocampotomy using magnetic resonance-guided laser interstitial thermal therapy (MRg-LITT) is an important emerging therapy for MTLE. Initial published reports support MRg-LITT as a less invasive surgical option with a shorter hospital stay and fewer neurocognitive side effects compared with craniotomy for anterior temporal lobectomy with Amygdalohippocampectomy and selective Amygdalohippocampectomy. We provide a historical overview of laser interstitial thermal therapy development and the technological advancements that led to the currently available commercial systems. Current applications of MRg-LITT for MTLE, reported outcomes, and technical issues of the surgical procedure are reviewed. Although initial reports indicate that stereotactic laser amygdalohippocampotomy may be a safe and effective therapy for medically refractory MTLE, further research is required to establish its long-term effectiveness and its cost/benefit profile. Abbreviations ATLAH, anterior temporal lobectomy with AmygdalohippocampectomyLITT, laser interstitial thermal therapyMRg-LITT, magnetic resonance-guided laser interstitial thermal therapyMTLE, mesial temporal lobe epilepsySAH, selective AmygdalohippocampectomySLAH, stereotactic laser amygdalohippocampotomy.
Aaron A Cohengadol - One of the best experts on this subject based on the ideXlab platform.
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superficial cortical landmarks for localization of the hippocampus application for temporal lobectomy and Amygdalohippocampectomy
Surgical Neurology International, 2015Co-Authors: Shane R Tubbs, Nicholas M. Barbaro, Marios Loukas, Aaron A CohengadolAbstract:Background: Accessing the hippocampus for Amygdalohippocampectomy and minimally invasive procedures, such as depth electrode placement, require an accurate knowledge regarding the location of the hippocampus. Methods: The authors removed 10 human cadaveric brains from the cranium and observed the relationships between the lateral temporal neocortex and the underlying hippocampus. They then measured the distance between the hippocampus and superficial landmarks. The authors also validated their study using magnetic resonance imaging (MRI) scans of 10 patients suffering from medial temporal lobe sclerosis where the distance from the hippocampal head to the anterior temporal tip was measured. Results: In general, the length of the hippocampus was along the inferior temporal sulcus and inferior aspect of the middle temporal gyrus. Although the hippocampus tended to be more superiorly located in female specimens and on the left side, this did not reach statistical significance. The length of the hippocampus tended to be shorter in females, but this too failed to reach statistical significance. The mean distance from the anterior temporal tip to the hippocampal head was identical in the cadavers and MRIs of patients with medial temporal lobe sclerosis. Conclusions: Additional landmarks for localizing the underlying hippocampus may be helpful in temporal lobe surgery. Based on this study, there are relatively constant anatomical landmarks between the hippocampus and overlying temporal cortex. Such landmarks may be used in localizing the hippocampus during Amygdalohippocampectomy and depth electrode implantation in verifying the accuracy of image-guided methods and as adjuvant methodologies when these latter technologies are not used or are unavailable.
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prospective analysis of diplopia after anterior temporal lobectomy for mesial temporal lobe sclerosis
Journal of Neurosurgery, 2003Co-Authors: Aaron A Cohengadol, Richard W Marsh, Jacqueline A Leavitt, James J Lynch, Gregory D. CascinoAbstract:Object. In this prospective study the authors investigated the incidence and natural history of postoperative diplopia in patients undergoing anterior temporal lobectomy (ATL) and Amygdalohippocampectomy for medically intractable mesial temporal lobe epilepsy. Methods. Forty-seven patients scheduled for ATL for medically refractory seizures were examined preoperatively, 2 to 7 days postoperatively, and 3 to 6 months postoperatively. Ophthalmological examination including pupillary measurements, stereoacuity measurements, palpebral fissure measurements, vertical fusional amplitudes, Lancaster red green testing, visual field testing, and alternate cover testing was performed. Antiepileptic drug levels were monitored. Nine (19%) of 47 patients developed diplopia postoperatively. The diplopia was caused by trochlear nerve palsy in every case. No oculomotor nerve dysfunction was documented. Trochlear nerve function recovered completely in all patients within 3 to 6 months postoperatively. Conclusions. Postoper...
James Thomas Butler - One of the best experts on this subject based on the ideXlab platform.
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randomised controlled trial of naming outcomes in anterior temporal lobectomy versus selective Amygdalohippocampectomy
Journal of Neurology Neurosurgery and Psychiatry, 2021Co-Authors: Victoria L Ivesdeliperi, James Thomas ButlerAbstract:Surgery for medically refractory temporal lobe epilepsy (TLE) is well established, with favourable outcomes in seizure control, patient quality of life (QOL) and treatment costs.1 2 However, postoperative cognitive decline is a concern. Dysnomia is reported in 25%–60% of patients following anterior temporal lobectomy (ATL) in the dominant hemisphere.3 Selective Amygdalohippocampectomy (SAH) is an alternative procedure in which temporal neocortex is spared to reduce functional impairment. No controlled studies have been conducted to demonstrate superior outcomes of either procedure. There is an imperative to establish whether SAH better preserves neuropsychological functioning without foregoing the seizure benefits of a more extensive resection. This study aimed to identify differential naming outcomes of SAH and ATL using a randomised controlled trial (RCT) design. A parallel-group, single-centre RCT was conducted at a tertiary healthcare facility between 2012 and 2018. The trial was discontinued due to a diminishing recruitment rate. No interim analyses were conducted. All right-handed patients aged between 18 and 60 years diagnosed with medically refractory left mesial TLE and deemed suitable candidates for surgery were given an opportunity to take part in the trial. Visual naming was the prespecified primary outcome and measured using the Boston Naming Test (BNT).4 The instrument is the most frequently used assessment of naming in patients with epilepsy and has been shown to reliably detect postoperative dysnomia.5 An intention-to-treat analysis was planned and a sample size of 48 was calculated based on 80% power of detecting a five-point difference between the …
Barry D Sinclair - One of the best experts on this subject based on the ideXlab platform.
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seizure outcome in pediatric medically refractory temporal lobe epilepsy surgery selective Amygdalohippocampectomy versus anterior temporal lobectomy
Journal of Neurosurgery, 2018Co-Authors: Cameron A Elliott, Andrew Broad, Karl Narvacan, Trevor A Steve, Thomas Snyder, Jordan Urlacher, Matt B Wheatley, Barry D SinclairAbstract:OBJECTIVE The aim of this study was to investigate long-term seizure outcome, rate of reoperation, and postoperative neuropsychological performance following selective Amygdalohippocampectomy (SelAH) or anterior temporal lobectomy (ATL) in pediatric patients with medically refractory temporal lobe epilepsy (TLE). METHODS The authors performed a retrospective review of cases of medically refractory pediatric TLE treated initially with either SelAH or ATL. Standardized pre- and postoperative evaluation included seizure charting, surface and long-term video-electroencephalography, 1.5-T MRI, and neuropsychological testing. RESULTS A total of 79 patients treated initially with SelAH (n = 18) or ATL (n = 61) were included in this study, with a mean follow-up of 5.3 ± 4 years (range 1-16 years). The patients' average age at initial surgery was 10.6 ± 5 years, with an average surgical delay of 5.7 ± 4 years between seizure onset and surgery. Seizure freedom (Engel I) following the initial operation was significantly more likely following ATL (47/61, 77%) than SelAH (8/18, 44%; p = 0.017, Fisher's exact test). There was no statistically significant difference in the proportion of patients with postoperative neuropsychological deficits following SelAH (8/18, 44%) or ATL (21/61, 34%). However, reoperation was significantly more likely following SelAH (8/18, 44%) than after ATL (7/61, 11%; p = 0.004) and was more likely to result in Engel I outcome for ATL after failed SelAH (7/8, 88%) than for posterior extension after failed ATL (1/7, 14%; p = 0.01). Reoperation was well tolerated without significant neuropsychological deterioration. Ultimately, including 15 reoperations, 58 of 79 (73%) patients were free from disabling seizures at the most recent follow-up. CONCLUSIONS SelAH among pediatric patients with medically refractory unilateral TLE yields significantly worse rates of seizure control compared with ATL. Reoperation is significantly more likely following SelAH, is not associated with incremental neuropsychological deterioration, and frequently results in freedom from disabling seizures. These results are significant in that they argue against using SelAH for pediatric TLE surgery.