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MRI-guided stereotactic amygdalohippocampectomy: a single center experience.

Vojtěch Z, Malíková H, Krámská L, Liščák R, Vladyka V - Neuropsychiatr Dis Treat (2015)

Bottom Line: Neuropsychological results were obtained for a subset of 31 patients.No significant changes were found in memory performance, with a mean increase of 1, 3, and 0 memory quotient points in global, verbal, and visual memory, respectively (P<0.05).Stereotactic radiofrequency amygdalohippocampectomy offers a safe, effective, and less aggressive treatment modality in cases of well-defined mesial temporal lobe epilepsy.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurology, Na Homolce Hospital, Prague, Czech Republic.

ABSTRACT

Background: This paper presents our experience of stereotactic radiofrequency amygdalohippocampectomy performed for intractable mesial temporal lobe epilepsy.

Methods: The article describes the cases of 61 patients who were treated during the period from 2004 to 2010. Mean postoperative follow-up was 5.3 years. Neuropsychological results were obtained for a subset of 31 patients.

Results: At their last postsurgical visit, 43 (70.5%) patients were Engel class I, six (9.8%) class II, nine (14.8%) class III, and three (4.9%) class IV. The surgery was complicated by four intracranial hematomas. One of them caused acute hydrocephalus and was treated by shunting and resolved without sequelae, while another caused transitory aphasia. The remaining hematomas were asymptomatic. There were two cases of meningitis which required antibiotic treatment. One patient committed suicide due to postoperative depression. After the procedure, we performed open epilepsy surgery and rethermolesions in three and two patients, respectively (8.2%). Patients showed increases in their mean full scale, verbal, and performance intelligence quotient (IQ) scores of 4, 3, and 4 IQ points, respectively (P<0.05). Five (17.2%), four (13.8%), and four (13.3%) patients improved their full scale, verbal, and performance IQ scores, respectively. No significant changes were found in memory performance, with a mean increase of 1, 3, and 0 memory quotient points in global, verbal, and visual memory, respectively (P<0.05). Global memory improved in three (10.3%) patients, verbal memory in one (3.4%), and one patient (3.3%) showed deterioration in visual memory.

Conclusion: Stereotactic radiofrequency amygdalohippocampectomy offers a safe, effective, and less aggressive treatment modality in cases of well-defined mesial temporal lobe epilepsy. Seizure outcome is comparable with the results of conventional epilepsy surgery and cognitive results could be even better.

No MeSH data available.


Related in: MedlinePlus

MRI before (A), 1 week (B), and 1 year (C) after SAH.Abbreviations: MRI, magnetic resonance imaging; SAH, stereotactic radiofrequency amygdalohippocampectomy.
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f3-ndt-11-359: MRI before (A), 1 week (B), and 1 year (C) after SAH.Abbreviations: MRI, magnetic resonance imaging; SAH, stereotactic radiofrequency amygdalohippocampectomy.

Mentions: The early postoperative MRI scans showed coagulation lesions with heterogeneous signal intensity on both T1- and T2-WI, encompassing a significant part of the amygdala, hippocampus, and PHG.29 They contained hemorrhagic foci and were surrounded by vasogenic edema. After gadolinium contrast administration, peripheral ring enhancement occurred. The size of the lesions was 48.3±5.6 mm in their long axis and 20.5±3.6 mm in their short axis. MRI 1 year after the procedure showed postnecrotic oblong pseudocysts surrounded by atrophic tissue with gliosis. We did not find any long-lasting edema or contrast enhancement on follow-up. The mean size of pseudocysts was 32.2 mm in their long axis and 9.5 mm in their short axis (Figure 3).


MRI-guided stereotactic amygdalohippocampectomy: a single center experience.

Vojtěch Z, Malíková H, Krámská L, Liščák R, Vladyka V - Neuropsychiatr Dis Treat (2015)

MRI before (A), 1 week (B), and 1 year (C) after SAH.Abbreviations: MRI, magnetic resonance imaging; SAH, stereotactic radiofrequency amygdalohippocampectomy.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4334329&req=5

f3-ndt-11-359: MRI before (A), 1 week (B), and 1 year (C) after SAH.Abbreviations: MRI, magnetic resonance imaging; SAH, stereotactic radiofrequency amygdalohippocampectomy.
Mentions: The early postoperative MRI scans showed coagulation lesions with heterogeneous signal intensity on both T1- and T2-WI, encompassing a significant part of the amygdala, hippocampus, and PHG.29 They contained hemorrhagic foci and were surrounded by vasogenic edema. After gadolinium contrast administration, peripheral ring enhancement occurred. The size of the lesions was 48.3±5.6 mm in their long axis and 20.5±3.6 mm in their short axis. MRI 1 year after the procedure showed postnecrotic oblong pseudocysts surrounded by atrophic tissue with gliosis. We did not find any long-lasting edema or contrast enhancement on follow-up. The mean size of pseudocysts was 32.2 mm in their long axis and 9.5 mm in their short axis (Figure 3).

Bottom Line: Neuropsychological results were obtained for a subset of 31 patients.No significant changes were found in memory performance, with a mean increase of 1, 3, and 0 memory quotient points in global, verbal, and visual memory, respectively (P<0.05).Stereotactic radiofrequency amygdalohippocampectomy offers a safe, effective, and less aggressive treatment modality in cases of well-defined mesial temporal lobe epilepsy.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurology, Na Homolce Hospital, Prague, Czech Republic.

ABSTRACT

Background: This paper presents our experience of stereotactic radiofrequency amygdalohippocampectomy performed for intractable mesial temporal lobe epilepsy.

Methods: The article describes the cases of 61 patients who were treated during the period from 2004 to 2010. Mean postoperative follow-up was 5.3 years. Neuropsychological results were obtained for a subset of 31 patients.

Results: At their last postsurgical visit, 43 (70.5%) patients were Engel class I, six (9.8%) class II, nine (14.8%) class III, and three (4.9%) class IV. The surgery was complicated by four intracranial hematomas. One of them caused acute hydrocephalus and was treated by shunting and resolved without sequelae, while another caused transitory aphasia. The remaining hematomas were asymptomatic. There were two cases of meningitis which required antibiotic treatment. One patient committed suicide due to postoperative depression. After the procedure, we performed open epilepsy surgery and rethermolesions in three and two patients, respectively (8.2%). Patients showed increases in their mean full scale, verbal, and performance intelligence quotient (IQ) scores of 4, 3, and 4 IQ points, respectively (P<0.05). Five (17.2%), four (13.8%), and four (13.3%) patients improved their full scale, verbal, and performance IQ scores, respectively. No significant changes were found in memory performance, with a mean increase of 1, 3, and 0 memory quotient points in global, verbal, and visual memory, respectively (P<0.05). Global memory improved in three (10.3%) patients, verbal memory in one (3.4%), and one patient (3.3%) showed deterioration in visual memory.

Conclusion: Stereotactic radiofrequency amygdalohippocampectomy offers a safe, effective, and less aggressive treatment modality in cases of well-defined mesial temporal lobe epilepsy. Seizure outcome is comparable with the results of conventional epilepsy surgery and cognitive results could be even better.

No MeSH data available.


Related in: MedlinePlus