Abstracts

Selective resection of mesial temporal structures in patients with intractable temporal lobe epilepsy has been advocated in an attempt to minimize temporal neocortical removal associated with standard temporal resections. The benefits of such a strategy have not been not well documented. A retrospective review of all patients who underwent either selective amygdalo-hippocampectomy (SAH) or a standard cortico-amygdalo-hippocampectomy (CAH) for their intractable temporal lobe epilepsy at the University of Calgary was completed. Patients had either a transcortical SAH or CAH, extending to 4.5 cm on the dominant middle temporal gyrus and 6 cm on the non-dominant temporal lobe A total of 72 patients were identified. Forty-eight (67% )had SAH and 24(33%)CAH. No difference in age at onset of epilepsy, side of surgery, seizure types, duration of epilepsy or age at surgery was identified between the two groups Patients undergoing SAH had preoperative evidence of MTS on MRI (81 vs 33%) while 67 % of MRIs were normal in patients undergoing CAH. Forty-five (63%) of 72 patients were free of disabling seizures at last follow up. Clinical and formal visual field deficits were more common in CAH than SAH. The duration of stay in hospital was shorter in patients with SAH. Detailed pre and post operative neuropsychological testing was available in 36 patients and revealed no significant differences in those undergoing SAH or CAH Patients treated with SAH for intractable temporal lobe epilepsy demonstrate greater evidence of mesial temporal lobe pathology, suffer fewer visual complications and require shorter duration of stay in hospital than patients undergoing more standard CAH. Neuropsychological consequences of temporal lobe surgery in this study were similar in those patients treated with both SAH and CAH.