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Hippocampal Transection Plus Tumor Resection as a Novel Surgical Treatment for Temporal Lobe Epilepsy Associated with Cerebral Cavernous Malformations.

Abstract：

OBJECTIVE:The optimal surgical treatment for cavernous malformation-related temporal lobe epilepsy (CRTLE) is still controversial because it frequently involves the hippocampus as an epileptogenic zone. Here we describe our unique surgical strategy of performing hippocampal transection (HT) plus tumor resection for CRTLE to solve the question of how to balance postoperative seizure outcomes and neuropsychologic outcomes. METHODS:From 2005 to 2016, 7 cases of HT (3 on dominant side) plus tumor resection were performed for patients with CRTLE. We routinely perform intraoperative electrocorticography just before and after the resection of the tumor with hemosiderin rim. In cases with residual spikes from the hippocampus after the resection, we add HT, considering laterality of the lesion, preoperative memory functions, and magnetic resonance imaging abnormalities in hippocampi. Patient information, including seizure outcomes and preoperative and postoperative (24 months) Wechsler Memory Scale-Revised (WMS-R), were collected. RESULTS:In the mean follow-up of 62.7 months (range 20-119), the postoperative seizure outcome was as follows: Engel class I in 6 cases (85.7%) and II in 1 case (14.3%). Perioperative changes in WMS-R score were as follows: 93.5 preoperatively versus 99.5 postoperatively (P = 0.408) in verbal memory and 90.7 versus 98.0 (P = 0.351) in delayed recall. Overall, no patient presented with more than 25% decline in any of the WMS-R indices postoperatively. CONCLUSIONS:Despite the small sample size and noncontrolled study design, postoperative seizure outcomes were deemed acceptable with favorable memory outcomes, which rather improved postoperatively with marginal statistical significance. In patients with CRTLE, additional HT is a reasonable treatment option.

journal_name

World Neurosurg

journal_title

World neurosurgery

authors

Ishida W,Morino M,Matsumoto T,Casaos J,Ramhmdani S,Lo SL

doi

10.1016/j.wneu.2018.07.108

subject

Has Abstract

pub_date

2018-11-01 00:00:00

pages

e209-e215

eissn

1878-8750

issn

1878-8769

pii

S1878-8750(18)31586-9

journal_volume

119

pub_type

杂志文章

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Hippocampal Transection Plus Tumor Resection as a Novel Surgical Treatment for Temporal Lobe Epilepsy Associated with Cerebral Cavernous Malformations.