Clinical Case & Question• 65 year old right handed man presented with: – 7 weeks of complex partial seizures, intermittent memory and speech disturbance. – No deficit.• Is complete resection of the lesion associated with poor neurocognitive outcome?
Search strategy• P = Patients with medial temporal lobe neoplasia• I = Complete resection of lesion• C = Partial resection• O = Neurocognitive outcome• Ovid Medline, Scopus
Search terms• P = “medial temporal lobe” – MeSH: hippocampus, temporal lobe• P & I = “neoplasia” – MeSH: Brain neoplasia – Keywords: “surgery”;• O = “Cognitive outcome” – MeSH: Neuropsychological tests, cognition disorders
• Neurosurgery 54:1162-1169, 2004• Case series for subtemporal/ transchoroidal approach – 21 patients• 8 – tumours, 4- AVMs, 9 – HS• 14 – left side• Hippocampus & PH gyrus removed en bloc in MTL Epil.• Tumours removed in similar fashion – H & PH left intact as much as possible• No permanent deficit• No language or cognitive dysfunction.
KG Davies, RD Weeks. British Journal of Neurosurgery, 9(1), p7, 1995• Case series• 1969 – 1988• 24 pts with intractable epilepsy• Temporal lesions in 12 pts• Temporal tumours 6 (Oligodendroglioma 5, Meningioma 1)• Left side 10 pts• Ten pts – standard temporal lobectomy at 6 – 7 cm behind temporal pole• 1 case of persistent mild dysphasia• No case of memory impairment
Acta Paediatrica 95:1306-1320, 2006• Case report• 7F/ RHD with complex partial seizures, behavioural and speech difficulties• Pre-op Neuropsych.: above average gen. intelligence, below average verbalmemory & average figural memory.• Complete tumour excision and mesiobasal temporal cortex – xanthoastrocytoma• Post op – No seizures, verbalisation or behavioural deficits• Neuropsych w3 & w11: normalised verbal learning & improved figural memory
A. Wyler, B. Hermann, G. Somes. Extent of medial temporal resection on outcomefrom anterior temporal lobectomy: A randomised prospective study.Neurosurgery 37(5):982-991, 1995• Prospective, randomised, blinded CT• Comparing seizure and neuropsychological outcomes•• Anterior temporal lobectomy plus…• Group A (n = 34): hippocampal resection to anterior edge of cerebralpeduncle• Group B (n = 36): hippocampal resection to the level of sup. Colliculus• Groups well matched (age, laterality of surgery and speech, age of onset ofepilepsy)• Same amount of cortical resection
• Results at one year:a) Group B had statistically significant superior seizure outcome (69.4% vs 38.2%)b) When seizures recurred – Group A @ 1.3 yr, Group B @ 1.9 yrc) No increased neuropsychological morbidity with complete hippocampectomyd) Right side ATL – no significant memory deficite) Left side ATL – degree of hippocampal sclerosis predictive of verbal memory outcome
Conclusion• No Level I / II evidence were obtained from search to demonstratethat complete resection of left sided medial temporal tumour isassociated with poor neuro-cognitive outcome.