Table of Contents
Epilepsy Research and Treatment
Volume 2014, Article ID 306382, 8 pages
Clinical Study

Neurocognitive and Seizure Outcomes of Selective Amygdalohippocampectomy versus Anterior Temporal Lobectomy for Mesial Temporal Lobe Epilepsy

1Division of Neurosurgery, University of Toronto, Toronto, ON, Canada M5G 1X8
2Toronto Western Hospital, University Health Network, 399 Bathurst Street, Toronto, ON, Canada M5T 2S8
3Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Canada L8S 4K1
4Psychology Department, University of Toronto, Toronto, ON, Canada M5T 2S8
5Institute of Medical Sciences, University of Toronto, Toronto, Canada M5T 2S8
6Krembil Neuroscience Center, University Health Network, Toronto, Canada M5T 2S8
7Division of Fundamental Neurobiology, Toronto Western Research Institute, Toronto Western Hospital, Toronto, ON, Canada M5T 2S8
8Department of Neurology, University of Toronto, Toronto, ON, Canada M5T 2S8

Received 14 July 2014; Revised 17 September 2014; Accepted 18 September 2014; Published 1 October 2014

Academic Editor: Louis Lemieux

Copyright © 2014 Alireza Mansouri et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Objective. To report our institutional seizure and neuropsychological outcomes for a series of patients with mesial temporal lobe epilepsy (mTLE) undergoing anterior temporal lobectomy (ATL) or selective amygdalohippocampectomy (SelAH) between 2004 and 2011. Methods. A retrospective study of patients with mTLE was conducted. Seizure outcome was reported using time-to-event analysis. Cognitive outcome was reported using the change principal in component factor scores, one each, for intellectual abilities, visuospatial memory, and verbal memory. The Boston Naming Test was used for naming assessment. Language dominant and nondominant resections were compared separately. Student’s -test was used to assess statistical significance. Results. Ninety-six patients (75 ATL, 21 SelAH) were included; fifty-four had complete neuropsychological follow-up. Median follow-up was 40.5 months. There was no statistically significant difference in seizure freedom or any of the neuropsychological outcomes, although there was a trend toward greater postoperative decline in naming in the dominant hemisphere group following ATL. Conclusion. Seizure and neuropsychological outcomes did not differ for the two surgical approaches which is similar to most prior studies. Given the theoretical possibility of SelAH sparing language function in patients with epilepsy secondary to mesial temporal sclerosis and the limited high-quality evidence creating equipoise, a multicenter randomized clinical trial is warranted.