Nonresective hippocampal surgery for epilepsy

Arun Angelo Patil, Richard V. Andrews

Research output: Contribution to journalReview article

9 Scopus citations

Abstract

Introduction Clinical experience with a new surgical procedure called multiple hippocampal transections is described. In this procedure, seizure circuits within the hippocampus are disrupted by making multiple cuts parallel to the hippocampal digitations; while the vertical functional fibers are preserved. Methods Ten patients with temporal lobe epilepsy are described. The male/female ratio is 6:4, the ages of the patients were 2053 years, and follow-up periods were 1034 months, with a median of 21 months. Five patients had no hippocampal sclerosis, two had minimal sclerosis, and three had significant sclerosis. Six patients had surgery on the dominant side and five had failed the Wada test. Multiple hippocampal transections were made at 4-mm intervals. The neocortex was then treated with multiple subpial transections. In addition, six patients had resections of the temporal tip. Results There were no permanent neurologic complications: seven patients are seizure-free, two have rare seizures, and one has 60% decrease in seizure frequency. Eight patients had both pre- and postoperative memory testing. Among these eight patients, five had improved verbal memory, three had improved visual memory, and three had a slight drop in visual memory. Conclusion This is a small series with a short follow-up period. However, the results are encouraging enough to warrant further trials. In addition, this may be an effective alternative procedure for those who fail the Wada test and do not have significant temporal lobe sclerosis or who have seizures originating from the dominant side.

Original languageEnglish (US)
Pages (from-to)645-649
Number of pages5
JournalWorld Neurosurgery
Volume74
Issue number6
DOIs
StatePublished - Dec 2010

Keywords

  • Epilepsy surgery
  • Hippocampal transections
  • Temporal lobe epilepsy

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

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