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- Title
Vision after trans-sylvian or temporobasal selective amygdalohippocampectomy: a prospective randomised trial.
- Authors
Delev, Daniel; Wabbels, Bettina; Schramm, Johannes; Nelles, Michael; Elger, Christian; Lehe, Marec; Clusmann, Hans; Grote, Alexander
- Abstract
Background: Selective amygdalohippocampectomy (SAH) is an accepted surgical procedure for treatment of pharmacoresistant mesial temporal lobe epilepsy, but it may lead to postoperative visual field deficits (VFDs). Here we present a prospective randomised trial comparing the postoperative VFDs after either a trans-sylvian or temporobasal approach for SAH. Method: Forty-eight patients were randomly assigned to trans-sylvian ( n = 24) or temporobasal ( n = 24) SAH. Postoperative VFD were quantitatively evaluated using automated static and kinetic perimetry. In 24 cases, diffusion tensor imaging-based deterministic fibre-tracking of the optic radiation was performed. The primary endpoint was absence of postoperative VFD. The secondary endpoint was seizure outcome and driving ability. Results: Three patients (13 %) from the trans-sylvian group showed no VFD, compared to 11 patients (46 %) from the temporobasal group without VFD ( p = 0.01, RR = 3.7; CI = 1.2-11.5). Fifteen patients from each group (63 %) became completely seizure-free (ILAE1). Among those seizure-free cases, five trans-sylvian (33 %) and ten temporobasal (66 %) patients could apply for a driving licence (NNT = 3) when VFDs were considered. Although the trans-sylvian group experienced more frequent VFDs, the mean functional visual impairment showed a tendency to be less pronounced compared with the temporobasal group. DTI-based tracking of the optic radiation revealed that a lower distance of optic radiation to the temporal base correlated with increased rate of VFD in the temporobasal group. Conclusions: Temporobasal SAH shows significantly fewer VFDs and equal seizure-free rate compared with the trans-sylvian SAH. However, in patients in whom the optic radiation is close to the temporal base, the trans-sylvian approach may be a preferred alternative.
- Subjects
TEMPORAL lobe epilepsy; HIPPOCAMPUS (Brain); OPERATIVE surgery; SCOTOMA; SEIZURES (Medicine); SURGERY; THERAPEUTICS
- Publication
Acta Neurochirurgica, 2016, Vol 158, Issue 9, p1757
- ISSN
0001-6268
- Publication type
Article
- DOI
10.1007/s00701-016-2860-y