Comparison of minimally invasive to standard temporal lobectomy approaches to epilepsy surgery: Seizure relief and visual confrontation naming outcomes

Karine Hageboutros; Kelsey C Hewitt; Gregory P Lee; Aastha Bansal; Cady Block; Nigel P Pedersen; Jon T Willie; David W Loring; Mike R Schoenberg; Kris A Smith; Cole A Giller; Robert E Gross; Daniel L Drane

doi:10.1016/j.yebeh.2024.109669

Comparison of minimally invasive to standard temporal lobectomy approaches to epilepsy surgery: Seizure relief and visual confrontation naming outcomes

Epilepsy Behav. 2024 Apr 24:155:109669. doi: 10.1016/j.yebeh.2024.109669. Online ahead of print.

Authors

Affiliations

¹ Neuropsychology Department, Barrow Neurological Institute, Phoenix, AZ 85013, USA.
² Department of Neurology, Emory University School of Medicine, Atlanta, GA 30322, USA.
³ Neuropsychology Department, Barrow Neurological Institute, Phoenix, AZ 85013, USA; Department of Neurosurgery, Medical College of Georgia, Augusta University, Augusta, GA 30912, USA.
⁴ Emory College of Arts and Sciences, Atlanta, GA 30322, USA.
⁵ Department of Neurology, University of California Davis, Sacramento, CA 95816, USA.
⁶ Department of Neurosurgery, Washington University School of Medicine, St. Louis, MO 63110, USA.
⁷ Department of Neurology, Emory University School of Medicine, Atlanta, GA 30322, USA; Department of Pediatrics, Emory University School of Medicine, Atlanta, GA 30322, USA.
⁸ Department of Neurosurgery, University of South Florida, Tampa, FL 33606, USA.
⁹ Department of Neurosurgery, Barrow Neurological Institute, Phoenix, AZ 85013, USA.
¹⁰ Department of Neurosurgery, Medical College of Georgia, Augusta University, Augusta, GA 30912, USA.
¹¹ Department of Neurological Surgery, Emory University School of Medicine, Atlanta, GA 30322, USA.
¹² Department of Neurology, Emory University School of Medicine, Atlanta, GA 30322, USA; Department of Pediatrics, Emory University School of Medicine, Atlanta, GA 30322, USA; Department of Neurology, University of Washington School of Medicine, Seattle, WA 98195, USA. Electronic address: ddrane@emory.edu.

PMID: 38663142
DOI: 10.1016/j.yebeh.2024.109669

Abstract

The purpose of this study was to systematically examine three different surgical approaches in treating left medial temporal lobe epilepsy (mTLE) (viz., subtemporal selective amygdalohippocampectomy [subSAH], stereotactic laser amygdalohippocampotomy [SLAH], and anterior temporal lobectomy [ATL]), to determine which procedures are most favorable in terms of visual confrontation naming and seizure relief outcome. This was a retrospective study of 33 adults with intractable mTLE who underwent left temporal lobe surgery at three different epilepsy surgery centers who also underwent pre-, and at least 6-month post-surgical neuropsychological testing. Measures included the Boston Naming Test (BNT) and the Engel Epilepsy Surgery Outcome Scale. Fisher's exact tests revealed a statistically significant decline in naming in ATLs compared to SLAHs, but no other significant group differences. 82% of ATL and 36% of subSAH patients showed a significant naming decline whereas no SLAH patient (0%) had a significant naming decline. Significant postoperative naming improvement was seen in 36% of SLAH patients in contrast to 9% improvement in subSAH patients and 0% improvement in ATLs. Finally, there were no statistically significant differences between surgical approaches with regard to seizure freedom outcome, although there was a trend towards better seizure relief outcome among the ATL patients. Results support a possible benefit of SLAH in preserving visual confrontation naming after left TLE surgery. While result interpretation is limited by the small sample size, findings suggest outcome is likely to differ by surgical approach, and that further research on cognitive and seizure freedom outcomes is needed to inform patients and providers of potential risks and benefits with each.

Keywords: Amygdalohippocampectomy; Anterior temporal lobectomy; Cognitive outcome; Epilepsy surgery; Language; Laser interstitial thermal therapy; Mesial temporal lobe epilepsy; Visual confrontation naming.