Minimally-invasive Treatment of Mesial Temporal Lobe Epilepsy - The Endoscopic Trans-maxillary Temporal Pole Approach
Abstract number :
1.321
Submission category :
9. Surgery / 9A. Adult
Year :
2022
Submission ID :
2204271
Source :
www.aesnet.org
Presentation date :
12/3/2022 12:00:00 PM
Published date :
Nov 22, 2022, 05:24 AM
Authors :
Arka Mallela, MD MS – University of Pittsburgh Medical Center; Hussam Abou-Al-Shaar, MD – Department of Neurosurgery – aboualshaarh@upmc.edu; Michael McDowell, MD – Department of Neurosurgery – Children's Hospital of Pittsburgh of University of Pittsburgh Medical Center; David Fernandes Cabral, MD – Department of Neurosurgery – University of Pittsburgh Medical Center; Luke Henry, PhD – Department of Neurosurgery – University of Pittsburgh Medical Center; James Sweat, BA – Department of Neurosurgery – University of Pittsburgh Medical Center; Anto Bagic, MD PhD – Department of Neurology – University of Pittsburgh Medical Center; Alexandra Urban, MD – Department of Neurology – University of Pittsburgh Medical Center; Nirav Barot, MBBS MPH – Department of Neurology – University of Pittsburgh Medical Center; James Castellano, MD PhD – Department of Neurology – University of Pittsburgh Medical Center; Thandar Aung, MD, MS – Department of Neurology – University of Pittsburgh Medical Center; Joanna Fong-Isariyawongse, MD – Department of Neurology – University of Pittsburgh Medical Center; Vijayalakshmi Rajasekaran, MD – Department of Neurology – University of Pittsburgh Medical Center; Carl Snyderman, MD – Department of Otolaryngology – University of Pittsburgh Medical Center; Paul Gardner, MD – Department of Neurosurgery – University of Pittsburgh Medical Center; Jorge Gonzalez-Martinez, MD PhD – Department of Neurosurgery – University of Pittsburgh Medical Center
Rationale: While multiple selective or minimally-invasive approaches have been proposed for mesial temporal lobe epilepsy (MTLE), due to the anatomic approach, these may suffer from suboptimal seizure outcomes or incur unacceptable neuropsychological morbidity. Here, we address the temporal pole (TP) and mesial temporal lobe (MTL) directly via the endoscopic anterior transmaxillary approach (eATM) with minimal brain violation/retraction to provide seizure control and minimize neuropsychological injury.
Methods: We prospectively collected four consecutive patients who underwent eATM for MTLE. After workup at a tertiary referral comprehensive epilepsy center, patients with medically-refractor epilepsy whose intracranial/non-invasive recordings confirmed an anatomically-restricted epileptogenic zones in the MTL were identified. Patients underwent eATM for MTL/TP resection and were followed for at least 12 months. We collected surgical details, epilepsy outcomes, and neuropsychological evaluations both pre and post-operatively.
Results: Utilizing the eATM approach, mesial-basal resections of the TP areas and MTL structures were successfully achieved in all four patients. All four patients achieved Engel Ia outcomes at the latest follow-up (19, 15, 14, and 12 months) without any evidence of neurological complaint or neuropsychological outcome on formal testing. Diffusion imaging results suggest preservation of critical white matter structures in this approach that may underlie the preservation of neuropsychological outcome.
Conclusions: This initial study demonstrates the feasibility, preliminary safety, and efficacy of this approach. By directly addressing the TP and MTL, lateral temporal neocortex and the temporal stem are better preserved, potentially contributing to better neuropsychological outcomes. Further developments of endoscopic technique may allow for a variety of selective mesial temporal or possibly frontobasal resections for medically refractory epilepsy.
Funding: No specific funding was received in support of this abstract.
Surgery