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. 1. Introduction Anterior temporal lobectomy (ATL) is a well-established and efficacious surgical procedure for the treatment of medically refractory mTLE [1–3]. However, in some patients with mTLE, the ATL procedure has been associated with worsening of cognitive functions, particularly language and memory, when surgery involves the dominant hemisphere [4–7]. Thus, for the appropriate patient population, a more specific resection of the mesial structures through a selective amygdalohippocampectomy (SelAH) has been recommended by some groups [1, 8–10]. The rationale is that SelAH allows for sparing of the nonepileptogenic structures of the neocortex that are potentially involved in language and cognition, potentially resulting in less neuropsychological morbidity [11, 12]. A fair number of studies have been conducted to compare the efficacy of the two surgical approaches with regard to seizure outcome [1, 12–22], neuropsychological outcomes [9, 23–29], or both [10, 30–34] in adults with mTLE. As most of these are retrospective analyses of case series, conclusions are difficult
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