Zdeněk Vojtěch

The use of radiosurgery for the treatment of mesial temporal lobe epilepsy and long‐term results

Purpose:  To determine the efficacy of gamma knife radiosurgery in the treatment of mesial temporal lobe epilepsy due to mesial temporal sclerosis.

Cognitive outcome after stereotactic amygdalohippocampectomy

PURPOSE We sought to determine the neuropsychological outcome after stereotactic radiofrequency amygdalohippocampectomy performed for intractable mesial temporal lobe epilepsy. METHODS The article describes the cases of 31 patients who were evaluated using the Wechsler Adult Intelligence Scale-Revised and the Wechsler Memory Scale-Revised prior to, and one year after, surgery. KEY FINDINGS Patients showed increases in their mean Full Scale, Verbal and Performance IQ scores of 4, 3 and 4 IQ points respectively (p<.05). 5 (17.2%), 4 (13.8%) and 4 (13.3%) patients improved in their Full-scale, Verbal and Performance IQ respectively. No significant changes were found in memory performance - with a mean increase of 1, 3 and 0 MQ points in Global, Verbal and Visual memory respectively (p<.05). Global memory improved in 3 (10.3%) patients, verbal memory in 1 (3.4%) and 1 patient (3.3%) showed deterioration in visual memory. SIGNIFICANCE Our results provide evidence for unchanged memory in patients with MTLE after the procedure. No verbal memory deterioration was detected in any of our patients, while improvements were found in intellectual performance. The results suggest that stereotactic radiofrequency amygdalahippocampectomy could be superior to open surgery in terms of its neurocognitive outcomes. A larger randomised trial of these approaches is justified.

MRI-guided stereotactic amygdalohippocampectomy: a single center experience

Background This paper presents our experience of stereotactic radiofrequency amygdalohippocampectomy performed for intractable mesial temporal lobe epilepsy. Methods The article describes the cases of 61 patients who were treated during the period from 2004 to 2010. Mean postoperative follow-up was 5.3 years. Neuropsychological results were obtained for a subset of 31 patients. Results At their last postsurgical visit, 43 (70.5%) patients were Engel class I, six (9.8%) class II, nine (14.8%) class III, and three (4.9%) class IV. The surgery was complicated by four intracranial hematomas. One of them caused acute hydrocephalus and was treated by shunting and resolved without sequelae, while another caused transitory aphasia. The remaining hematomas were asymptomatic. There were two cases of meningitis which required antibiotic treatment. One patient committed suicide due to postoperative depression. After the procedure, we performed open epilepsy surgery and rethermolesions in three and two patients, respectively (8.2%). Patients showed increases in their mean full scale, verbal, and performance intelligence quotient (IQ) scores of 4, 3, and 4 IQ points, respectively (P<0.05). Five (17.2%), four (13.8%), and four (13.3%) patients improved their full scale, verbal, and performance IQ scores, respectively. No significant changes were found in memory performance, with a mean increase of 1, 3, and 0 memory quotient points in global, verbal, and visual memory, respectively (P<0.05). Global memory improved in three (10.3%) patients, verbal memory in one (3.4%), and one patient (3.3%) showed deterioration in visual memory. Conclusion Stereotactic radiofrequency amygdalohippocampectomy offers a safe, effective, and less aggressive treatment modality in cases of well-defined mesial temporal lobe epilepsy. Seizure outcome is comparable with the results of conventional epilepsy surgery and cognitive results could be even better.

Stereotactic amygdalohippocampectomy for temporal lobe epilepsy: promising results in 16 patients

OBJECTIVES Minimally invasive procedures for treating temporal lobe epilepsy have been investigated recently, namely stereotactic and gamma knife amygdalohippocampectomy (AHE). However, the results are not fully satisfactory. Our aim was to evaluate efficacy and side-effects of stereotactic AHE mimicking the neurosurgical procedure in terms of extent of the lesion. METHODS 16 consecutive patients were assessed using VEEG, MRI, FDG-PET and WADA test. All had definite pharmacoresistant medial temporal lobe epilepsy. The stereotactic AHE was performed on the Leksell stereotactic system. All lesions exceeded 40 mm along the long axis of the hippocamus. RESULTS Seizure outcome was favourable on one year follow-up: 12 patients (75%) were seizure-free (Engel I), three (19%) were Engel II, and one (6%) was Engel III. Side-effects were mild, lasting up to 7 days: cephalea, meningeal syndrome with sterile CSF in three subjects, and CSF leak lasting up to 3 days in seven subjects. CONCLUSION Stereotactic AHE encompassing sufficient volume of the amygdalohippocampal complex appears to be safe, effective, and free from long-term side-effects.

Five-Year Neuropsychological Outcome after Stereotactic Radiofrequency Amygdalohippocampectomy for Mesial Temporal Lobe Epilepsy: Longitudinal Study

Purpose: To assess the neuropsychological performance recoded over a period of 5 years after stereotactic radiofrequency amygdalohippocampectomy (SAHE) in the treatment of mesial temporal lobe epilepsy. Material and Methods: Thirty patients (mean age 38 years, 14 females/16 males) were included in this study. Twenty-one patients were treated on the left side, 9 on the right. Patients underwent neuropsychological evaluation by the Wechsler Adult Intelligence Scale-Revised and the Wechsler Memory Scale-Revised preoperatively and 5 years after SAHE. Results: Twenty-three (77%) patients were classified as Engel class I. At the group level, we found significant increases in all intelligence domains (Global, Visual, and Performance) by 19.1 (7.4), 15.8 (6.1), and 19.1 (7.9) points, respectively. Significant improvements were also detected in all memory measures (Global, Verbal, Visual, Attention/Concentration, Delayed Recall) by 19.4 (14.2), 16.9 (13.3), 19.0 (14.7), 15.3 (15.0), and 24.6 (13.4), respectively. Patients with left-sided surgery improved significantly more in Attention/Concentration. Otherwise, there were no statistically significant differences in memory function improvements between subgroups according to the operated side. Conclusion: After SAHE, we found favorable long-term neuropsychological outcomes. These results could be caused by incomplete destruction of target structures and minimization of collateral damage that possibly enables adaptive postoperative neuronal reorganization.

A neuropsychologist’s view: Outcome after RF-ablation for mTLE

Concern about postoperative worsening of cognitive functions after temporal lobe epilepsy surgery is an important issue. In this article we review our data on neuropsychological outcome after radiofrequency (RF) ablation of amygdalohippocampal complex (AHC). On a group level we found initial improvement in intelligence domains and unchanged memory scores one year after the surgery. During longitudinal follow-up, we found improvement in both intellectual and memory domains. This improvement was most pronounced up to two years after surgery. On an individual level, no patient worsened in any intellectual domain and most patients improved in memory. We hypothesize that this favorable outcome may be a consequence of minimization of collateral damage and incomplete destruction of target structures. We also summarize our experience with psychiatric complications of the procedure.