2016 Volume 25 Issue 12 Pages 992-999
Appropriate surgical manipulation of the mesial temporal lobe structures, as well as minimizing residual tumor for tumor control, is necessary in terms of seizure control in the surgical approach for mesial temporal glioneural tumors, which often cause chronic medical intractable epilepsy.
It is important to plan the surgical strategy not only to remove the tumor but also to achieve seizure relief and preserve cognitive function. This study investigated neuropsychological outcomes in patients with intractable temporal lobe epilepsy due to mesial temporal lobe glioneural tumors undergoing tumor resection by the transsylvian-transcisternal & ventricular approach (TSCV).
TSCV is a modified method of transsylvian selective amygdalohippocampectomy (TSA), which allows access to the tumor invading the amygdala, uncus, and hippocampus, both through the lateral ventricle, and through the cistern, followed by tailored resection of adjacent epileptogenic regions, such as the hippocampus and parahippocampal gyrus. Hippocampal resection was performed in all cases in which tumor invasion was suspected.
Analysis of seizure-free rate was performed on 26 consecutive cases of mesial temporal glioneural tumors treated by TSCV with hippocampal resection. Analysis of preoperative/postoperative memory scores evaluated by WMS-R on 17 cases, and IQ scores evaluated by WAIS on 14 cases, were also performed, in which follow up data was obtained. Good seizure control (92% seizure-free rate) was achieved, and no significant postoperative memory/IQ decline was observed. Pure lesionectomy of the tumor and epileptogenic regions with preservation of lateral temporal lobe cortex is effective for memory preservation, compared to anterior temporal lobectomy, in which lateral temporal lobe cortex is resected.
TSCV is an effective surgical strategy for mesial temporal glioneural tumors, in terms of minimizing residual tumor, seizure control, and preservation of the lateral temporal lobe cortex. This report focus on the surgical anatomy, operative procedures, and clinical outcome of TSCV.
