Resective Surgery for Temporal Lobe Epilepsy : Review on Surgical Outcome and Some Procedural Tips

Abstract

Standard anterior temporal lobectomy is accepted as a recommended surgical treatment of intractable temporal lobe epilepsy, since its efficacy and safety have been well established. While the presence of a localized lesion in preoperative MRI is one of the most important factors for favorable seizure outcome, diagnosis and treatment of extrahippocampal foci would be essential for further improvement of seizure outcome. A variety of surgical approaches to the medial temporal structures with less resection of temporal neocortices have been proposed to presumably prevent cognitive decline. To date, however, there is no evidence to support the superiority of a single approach to others on cognitive outcome. Important surgical points common to all approaches are 1) reliable access to the inferior horn of the lateral ventricle, and 2) prevention of injury to the crus cerebri and intracisternal vasculature, which can be accomplished by making the resection procedure predominantly subpial and confining manipulation of the hippocampal vessels to within the hippocampal sulcus.