COMPARATIVE STUDY BETWEEN SELECTIVE AMYGDALO-HIPPOCAMPECTOMY AND FULL TEMPORAL LOBECTOMY IN THE MANAGEMENT OF INTRACTABLE TEMPORAL LOBE EPILEPSY

Abstract

We report our experience with 51 patients who underwent surgical resection in Beaumont Hospital ( DUBLIN) between 1990 and 1998. Twenty six underwent anterior temporal lobectomy (ATL) with a mean age of24.5 years and a mean age of onset of 10.1 years. Twenty five underwent selective arnygdalo-hippocampectomy (AHE) with a mean age of29.3 years and mean age of onset of 7.7 years. All patients had neuropsychological and psychometric assessment, twenty four hour video-,telemetry studies with sphenoidal and zygomatic leads, CT scan and/or MRI scanning and WADA test as appropriate. Patients with poor pre operative localisation were further • investigated with subdural strip electrode recording and/or intra operative electrocorticography. AHE was performed through the middle temporal gyms in twenty four cases and through a transsylvian approach in one case. Mean follow up period for ATL was 2.4 years and 14.6 months for AH E. The outcome was determined using the Angel Grading in both groups. Outcome was correlated with seizure cause, pre operative telemetry, pre operative Mffi and pathology findings. Factors favouring good outcome •in each group were documented. Eighty eight percent of patients in the AHE group had an Angel Grade I or IL outcome, compared to sixty six percent in those following ATL.