ABSTRACT
OBJECTIVES: Temporal lobe epilepsy is the most common form of intractable partial epilepsy in adults with hippocampal sclerosis accounting for the majority of cases. Selective amygdalo-hippocampectomy (SEAH) is suggested as a safe and effective surgical procedure with the advantage of a better cognitive outcome. METHODS: We prospectively documented 56 consecutive patients with medically refractory medial temporal lob epilepsy. Candidates for surgery were determined as those with characteristic clinical and imaging findings, ictal recordings, and neuropsychological evaluation. A standard SEAH was performed and hippocampal sclerosis was histologically confirmed. RESULTS: In our study 76.7% of patients were classified as Engel I and 62.2% as ILAE I at their last follow up. Overall, at the last follow-up, 51.8% of patients were seizure-free since surgery (Engel 1a and ILAE 1a), 25% had stopped antiepileptic treatment, and another 52% had decreased either the dosage or number of antiepileptic drugs. 86.3% of the patients with abnormality on neurocognitive tasks showed improvement at the end of the 6 months post surgery. CONCLUSION: SEAH is a safe and effective surgical procedure without the necessity of a larger resection and further invasive methods.
Subject(s)
Amygdala/surgery , Hippocampus/pathology , Hippocampus/surgery , Neurosurgical Procedures , Adolescent , Adult , Child , Cognition/physiology , Drug Resistance , Electrophysiology , Epilepsy, Temporal Lobe/etiology , Epilepsy, Temporal Lobe/surgery , Female , Humans , Intelligence Tests , Male , Middle Aged , Neuropsychological Tests , Postoperative Complications/epidemiology , Postoperative Complications/psychology , Prospective Studies , Recurrence , Sclerosis , Seizures/etiology , Treatment Outcome , Young AdultABSTRACT
A retrospective study was conducted to assess the surgical outcomes of degenerative lumbar spinal stenosis. Thirty-four patients treated with decompressive surgery in Departments of III. Neurosurgery, Bakirkoy Hospital for Psychiatric and Neurological Diseases between 2000-2004 were reviewed. There were 13 males and 21 females. The average age was 57.5 (range 51 to 73 years old) and the average follow-up time was 23 (12- 60) mounts. The types of surgery consisted of standard single laminectomy. The surgical outcomes were assessed with dynamic radiographic investigation and more than 15 degrees were assessed as segmental instability. Average preoperative sagittal rotation angles were measured 3.5 degrees and average postoperative angles were measured 6.5 degrees. Only one patient (%3) with two level laminectomy and 17 degrees postoperative sagittal rotation angle showed a significantly poorer clinical outcome and accepted instable. This study showed that, treatment of degenerative lumbar stenosis can be safely and effectively performed with standard laminectomy alone, resulting no significant sagittal plane instability. We concluded that single decompressive surgery offers satisfactory results in degenerative lumbar stenosis.
