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Vision after trans-sylvian or temporobasal selective amygdalohippocampectomy: a prospective randomised trial

  • Clinical Article - Functional
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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.

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Acknowledgments

We thank R.D. Ormond MD for language editing of the manuscript. We thank R. Fimmers MD for providing the randomisation list. We wish to acknowledge the contribution of other colleagues who maintained the epilepsy surgery database in the past at the Department of Neurosurgery: T. Kral MD and E. Behrens MD.

Author information

Author notes

  1. Daniel Delev

    Present address: Department of Neurosurgery, University Medical Centre, Freiburg, Germany

  2. Marec von Lehe

    Present address: Department of Neurosurgery, University Hospital Bochum, Bochum, Germany

  3. Hans Clusmann

    Present address: Department of Neurosurgery, RWTH Aachen University, Aachen, Germany

  4. Alexander Grote

    Present address: Department of Neurosurgery, Evangelisches Krankenhaus Bielefeld, Bielefeld, Germany

Authors and Affiliations

  1. Department of Neurosurgery, University of Bonn, University Medical Centre, Bonn, Germany

    Daniel Delev, Marec von Lehe, Hans Clusmann & Alexander Grote

  2. Department of Ophthalmology, University of Bonn, University Medical Centre, Bonn, Germany

    Bettina Wabbels

  3. Medical Faculty, University of Bonn, University Medical Centre, Bonn, Germany

    Johannes Schramm

  4. Department of Neuroradiology, University of Bonn, University Medical Centre, Bonn, Germany

    Michael Nelles

  5. Department of Epileptology, University of Bonn, University Medical Centre, Bonn, Germany

    Christian E. Elger

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  1. Daniel Delev
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Corresponding author

Correspondence to Daniel Delev.

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Conflict of interest

J.S. received reimbursement for congress costs from several scientific societies. C.E.E. is consultant for Desitin and Novartis and received honoraria for talks from Pfizer and Eisai. The funding sources had no role in the design of the study, interpretation of the results, or in the writing of the manuscript. None of the other authors has any conflict of interest to disclose.

Funding

Patients’ follow-up was funded as part of the transregional collaborative research consortium SFB-TR3 “Mesial temporal lobe epilepsies” of the Deutsche Forschungsgemeinschaft (DFG).

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

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Delev, D., Wabbels, B., Schramm, J. et al. Vision after trans-sylvian or temporobasal selective amygdalohippocampectomy: a prospective randomised trial. Acta Neurochir 158, 1757–1765 (2016). https://doi.org/10.1007/s00701-016-2860-y

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  • DOI: https://doi.org/10.1007/s00701-016-2860-y

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