Temporal lobe structural evaluation after transsylvian selective amygdalohippocampectomy

Neurosurg Focus. 2020 Apr 1;48(4):E14. doi: 10.3171/2020.1.FOCUS19937.


Objective: Mesial temporal lobe epilepsy (MTLE) is the most common type of focal epilepsy in adolescents and adults, and in 65% of cases, it is related to hippocampal sclerosis (HS). Selective surgical approaches to the treatment of MTLE have as their main goal resection of the amygdala and hippocampus with minimal damage to the neocortex, temporal stem, and optic radiations (ORs). The object of this study was to evaluate late postoperative imaging findings on the temporal lobe from a structural point of view.

Methods: The authors conducted a retrospective evaluation of all patients with refractory MTLE who had undergone transsylvian selective amygdalohippocampectomy (SAH) in the period from 2002 to 2015. A surgical group was compared to a control group (i.e., adults with refractory MTLE with an indication for surgical treatment of epilepsy but who did not undergo the surgical procedure). The inferior frontooccipital fasciculus (IFOF), uncinate fasciculus (UF), and ORs were evaluated on diffusion tensor imaging analysis. The temporal pole neocortex was evaluated using T2 relaxometry.

Results: For the IFOF and UF, there was a decrease in anisotropy, voxels, and fibers in the surgical group compared with those in the control group (p < 0.001). An increase in relaxometry time in the surgical group compared to that in the control group (p < 0.001) was documented, suggesting gliosis and neuronal loss in the temporal pole.

Conclusions: SAH techniques do not seem to totally preserve the temporal stem or even spare the neocortex of the temporal pole. Therefore, although the transsylvian approaches have been considered to be anatomically selective, there is evidence that the temporal pole neocortex suffers structural damage and potentially functional damage with these approaches.

Keywords: ATL = anterior temporal lobectomy; DTI = diffusion tensor imaging; FA = fractional anisotropy; HS = hippocampal sclerosis; IFOF = inferior frontooccipital fasciculus; MTLE = mesial temporal lobe epilepsy; OR = optic radiation; SAH = selective amygdalohippocampectomy; TI = transinsular; TP = temporal pole; TS = temporal stem; TU = transuncus; UF = uncinate fasciculus; epilepsy surgery; relaxometry; temporal lobe epilepsy; tractography.

MeSH terms

  • Adolescent
  • Adult
  • Amygdala / surgery*
  • Diffusion Tensor Imaging / methods
  • Epilepsy, Temporal Lobe / surgery*
  • Female
  • Hippocampus / surgery*
  • Humans
  • Male
  • Middle Aged
  • Neuropsychological Tests
  • Neurosurgical Procedures* / methods
  • Postoperative Period
  • Retrospective Studies
  • Temporal Lobe / surgery*