The syndrome of mesial temporal lobe epilepsy (MTLE) constitutes a well-known entity. In some patient series, it has been shown to account for 60% to 70% of focal epilepsies and 90% to 95% of temporal lobe epilepsies.1,2 A randomized study comparing surgical and medical treatment showed that 58% of operated vs only 8% of medically treated patients were seizure free at 1-year follow-up.3
Therefore, surgery is a reasonable option for patients with medically intractable MTLE.
Several surgical approaches to the mesiotemporal area are available: standard anterior temporal lobectomy, key-hole approach (anterior temporal lobectomy), and selective procedures sparing the temporolateral neocortex. In the present study, we provide a comprehensive review of our experience with the surgical treatment of MTLE in 162 patients using selective amygdalohippocampectomy (sAHE) via the transsylvian route as proposed by Wieser and Yasargil.4 The aim of this study was to analyze surgical, epileptological and neuropsychological results. Moreover, we evaluated the influence of the extent of hippocampal resection and postoperative gliosis on seizure and cognitive outcome.
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