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CC BY 4.0 · Arq Neuropsiquiatr 2023; 81(07): 647-655
DOI: 10.1055/s-0043-1771172
Original Article

Surgical treatment of temporal lobe epilepsy: comparative results of selective amygdalohippocampectomy versus anterior temporal lobectomy from a referral center in Brazil

Tratamento cirúrgico da epilepsia do lobo temporal: resultados comparativos da amigdalohipocampectomia seletiva versus lobectomia temporal anterior em um centro de referência no Brasil
Laryssa Crystinne Azevedo Almeida 
1   Santa Casa de Misericórdia de Belo Horizonte, Departamento de Neurologia e Neurocirurgia, Belo Horizonte MG, Brazil.
,
Vanessa Alves Lobato 
1   Santa Casa de Misericórdia de Belo Horizonte, Departamento de Neurologia e Neurocirurgia, Belo Horizonte MG, Brazil.
,
Maria do Carmo Vasconcelos Santos 
1   Santa Casa de Misericórdia de Belo Horizonte, Departamento de Neurologia e Neurocirurgia, Belo Horizonte MG, Brazil.
,
Aline Curcio de Moraes 
1   Santa Casa de Misericórdia de Belo Horizonte, Departamento de Neurologia e Neurocirurgia, Belo Horizonte MG, Brazil.
,
Bruno Silva Costa 
1   Santa Casa de Misericórdia de Belo Horizonte, Departamento de Neurologia e Neurocirurgia, Belo Horizonte MG, Brazil.
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Abstract

Background Temporal lobe epilepsy (TLE) is a high prevalence neurological disorder. Surgery has emerged as a promising treatment.

Objective The objective of this work is to compare the surgical results of anterior temporal lobectomy (ATL) versus selective amygdalohippocampectomy (SAH) in a cohort of 132 patients.

Methods We performed a retrospective study of 146 patients operated for TLE from 2008 to 2019. Initially, 13 patients were excluded from the study due to insufficient medical record data or follow-up loss. One patient was excluded from the analysis of the results due to death in the first postoperative week. We used the ILAE scale to classify seizure control after surgery. In patients with left hippocampal sclerosis, SAH was performed and in right temporal lobe epilepsy, ATL was the approach of choice.

Results The mean follow-up time after surgery was 57.2 months (12–137). In our data analysis, we found that the group of patients undergoing ATL had a higher prevalence of being completely seizure-free (ILAE I) (57.1% versus 31%) and a higher rate of satisfactory seizure control (88.6% versus 69.3%) p = 0,006, when compared with patients undergoing SAH.

Conclusion The literature is still controversial about seizure control concerning the technique used due to the lack of a robust methodology. Our data analysis identified the superiority of ATL over SAH in seizure outcomes. ATL may be the best option for adequately controlling seizures with minimal additional morbidity in countries with a cost limitation for extended propaedeutics.

Resumo

Antecedentes A epilepsia do lobo temporal (TLE) é uma desordem neurológica de alta prevalência. A cirurgia surgiu como um tratamento promissor.

Objetivo O objetivo deste trabalho é comparar os resultados da lobectomia temporal anterior (ATL) versus amigdalohipocampectomia seletiva (SAH) em uma coorte de 132 pacientes.

Métodos Realizamos um estudo retrospectivo de 146 pacientes operados por TLE de 2008 a 2019. Inicialmente, 13 pacientes foram excluídos por insuficiência de dados em prontuário ou perda de seguimento. Um paciente foi excluído da análise por óbito na primeira semana de pós-operatório. Usamos a escala ILAE para classificar o controle das crises após a cirurgia. Em pacientes com esclerose hipocampal à esquerda, foi realizada a SAH, e na epilepsia do lobo temporal à direita, a ATL foi a abordagem de escolha.

Resultados O tempo médio de seguimento após a cirurgia foi de 57,2 meses (12–137). Em nossa avaliação, encontramos que o grupo de pacientes submetidos à ATL apresentou maior prevalência de ausência total de crises (ILAE I) (57,1% versus 31%) e maior taxa de controle satisfatório da epilepsia (88,6% versus 69,3%) p = 0,006, quando comparado ao grupo submetido à SAH.

Conclusão A literatura ainda é controversa em relação à redução das crises de acordo com a técnica utilizada devido a falta de uma metodologia robusta. Nosso estudo identificou superioridade da ATL sobre a SAH nos desfechos convulsivos. ATL pode ser a melhor opção para controlar adequadamente as convulsões com morbidade adicional mínima em países com limitação de custo para propedêutica estendida.

Keywords

Epilepsy, Temporal Lobe - Hippocampal Sclerosis - Anterior Temporal Lobectomy - Epilepsies, Partial

Palavras-chave

Epilepsia do Lobo Temporal - Esclerose Hipocampal - Lobectomia Temporal Anterior - Epilepsias Parciais

Authors' Contributions

LCAA: conceptualization, data curation, formal analysis, investigation, methodology, writing – original draft, writing – review & editing; VAL: conceptualization, data curation, formal analysis, investigation, writing – original draft; MCVS: conceptualization, data curation, investigation, supervision; ACM: conceptualization, data curation, investigation; BSC: conceptualization, data curation, formal analysis, funding acquisition, investigation, methodology, project administration, supervision, validation, writing – review & editing.




Publikationsverlauf

Eingereicht: 04. Februar 2023

Angenommen: 12. April 2023

Artikel online veröffentlicht:
26. Juli 2023

© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution 4.0 International License, permitting copying and reproduction so long as the original work is given appropriate credit (https://creativecommons.org/licenses/by/4.0/)

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