Minimally invasive surgical approaches for temporal lobe epilepsy

Edward F Chang; Dario J Englot; Sumeet Vadera

doi:10.1016/j.yebeh.2015.04.033

Minimally invasive surgical approaches for temporal lobe epilepsy

Epilepsy Behav. 2015 Jun:47:24-33. doi: 10.1016/j.yebeh.2015.04.033. Epub 2015 May 24.

Authors

Edward F Chang¹, Dario J Englot², Sumeet Vadera³

Affiliations

¹ UCSF Comprehensive Epilepsy Center, University of California, San Francisco, CA, USA; Department of Neurological Surgery, University of California, San Francisco, CA, USA. Electronic address: ChangEd@neurosurg.ucsf.edu.
² UCSF Comprehensive Epilepsy Center, University of California, San Francisco, CA, USA; Department of Neurological Surgery, University of California, San Francisco, CA, USA.
³ Department of Neurological Surgery, University of California, Irvine, CA, USA.

Abstract

Surgery can be a highly effective treatment for medically refractory temporal lobe epilepsy (TLE). The emergence of minimally invasive resective and nonresective treatment options has led to interest in epilepsy surgery among patients and providers. Nevertheless, not all procedures are appropriate for all patients, and it is critical to consider seizure outcomes with each of these approaches, as seizure freedom is the greatest predictor of patient quality of life. Standard anterior temporal lobectomy (ATL) remains the gold standard in the treatment of TLE, with seizure freedom resulting in 60-80% of patients. It is currently the only resective epilepsy surgery supported by randomized controlled trials and offers the best protection against lateral temporal seizure onset. Selective amygdalohippocampectomy techniques preserve the lateral cortex and temporal stem to varying degrees and can result in favorable rates of seizure freedom but the risk of recurrent seizures appears slightly greater than with ATL, and it is not clear whether neuropsychological outcomes are improved with selective approaches. Stereotactic radiosurgery presents an opportunity to avoid surgery altogether, with seizure outcomes now under investigation. Stereotactic laser thermo-ablation allows destruction of the mesial temporal structures with low complication rates and minimal recovery time, and outcomes are also under study. Finally, while neuromodulatory devices such as responsive neurostimulation, vagus nerve stimulation, and deep brain stimulation have a role in the treatment of certain patients, these remain palliative procedures for those who are not candidates for resection or ablation, as complete seizure freedom rates are low. Further development and investigation of both established and novel strategies for the surgical treatment of TLE will be critical moving forward, given the significant burden of this disease.

Keywords: Gamma knife; Laser ablation; Responsive neurostimulation; Selective amygdalohippocampectomy; Temporal lobectomy.

Publication types

Review

MeSH terms

Amygdala / surgery*
Anterior Temporal Lobectomy / adverse effects*
Cerebral Cortex / surgery
Deep Brain Stimulation
Epilepsy / surgery
Epilepsy, Temporal Lobe / surgery*
Humans
Imaging, Three-Dimensional
Male
Middle Aged
Neurosurgical Procedures / methods*
Quality of Life
Radiosurgery
Seizures / etiology*
Seizures / prevention & control
Treatment Outcome
Vagus Nerve Stimulation

Grants and funding

F32 NS086353/NS/NINDS NIH HHS/United States