Anteromedial Temporal Lobe Resection

Indications

• Medial temporal lobe epilepsy associated with mesial temporal sclerosis pathology consisting of neuronal cell loss, gliosis, and synaptic reorganization. Presumed mesial temporal sclerosis can be determined preoperatively as hippocampal atrophy or increased hippocampal fluid attenuated inversion recovery (FLAIR) signal on magnetic resonance imaging (MRI).

• Lesion-related temporal lobe epilepsy. Common lesions include vascular cavernous angiomas, focal developmental abnormalities, and low-grade neoplasms.

• Lesions may be associated with hippocampal atrophy, in which case dual pathology exists. In such cases, it is uncertain whether the atrophic hippocampus is nonfunctional and epileptogenic and should be removed or whether it is capable of normal function and resection would result in cognitive deficits. Neuropsychologic evaluation and the intracarotid amobarbital procedure are performed to address this uncertainty.

• Cryptogenic temporal lobe epilepsy, in which there is no imaged lesion or atrophy and the temporal lobe is identified as the putative epileptogenic region primarily based on intracranial electrophysiology