{"title":"Functional anterior temporal lobectomy for temporal lobe epilepsy: from anatomical resection to functional disconnection.","authors":"Yong Liu, Qiang Meng, Yutao Ren, Hao Wu, Huanfa Li, Hui Li, Anqing Li, Haohao Cui, Xiaobo Ye, Shan Dong, Xiaofang Liu, Changwang Du, Hua Zhang","doi":"10.3171/2024.10.JNS241152","DOIUrl":null,"url":null,"abstract":"<p><strong>Objective: </strong>Although anterior temporal lobectomy (ATL) has the highest efficacy for temporal lobe epilepsy (TLE), there is currently a trend toward performing minimally invasive surgery (MIS) for TLE. However, the MIS methods, such as laser thermocoagulation, have been used at the expense of efficacy. Functional ATL (FATL), which involves functional disconnection instead of anatomical resection and was designed by the authors, resolves this problem. This study aimed to evaluate seizure outcomes of FATL as an MIS for TLE.</p><p><strong>Methods: </strong>A consecutive case series of FATLs for ATL was conducted between 2020 and 2022. FATL was scheduled after standard presurgical evaluations of TLE and applied the same criteria as standard ATL. Seizure outcomes were categorized by Engel classifications, with at least 2 years of follow-up.</p><p><strong>Results: </strong>Forty-nine patients with TLE who underwent FATL were included in the case series. The mean follow-up duration was 31.9 (range 24-42) months. Freedom from disabling seizures (Engel class I) occurred in 36 patients (73.5%) and significant improvement (Engel class I-II) occurred in 44 (89.8%) after surgery. The rate of complete freedom from all seizures (Engel class Ia) was 77.6% at 1 year after surgery and 69.4% at 2 years. No deaths or permanent morbidities after FATL were recorded. The complication rate was 2.0%.</p><p><strong>Conclusions: </strong>FATL incorporates a change from anatomical resection to functional disconnection without brain shift. As a keyhole surgery, the FATL incision is barely visible, with a better cosmetic appearance than ATL. FATL has the MIS quality as well as excellent seizure outcomes similar to those of ATL.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-10"},"PeriodicalIF":3.5000,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of neurosurgery","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.3171/2024.10.JNS241152","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"CLINICAL NEUROLOGY","Score":null,"Total":0}
引用次数: 0
Abstract
Objective: Although anterior temporal lobectomy (ATL) has the highest efficacy for temporal lobe epilepsy (TLE), there is currently a trend toward performing minimally invasive surgery (MIS) for TLE. However, the MIS methods, such as laser thermocoagulation, have been used at the expense of efficacy. Functional ATL (FATL), which involves functional disconnection instead of anatomical resection and was designed by the authors, resolves this problem. This study aimed to evaluate seizure outcomes of FATL as an MIS for TLE.
Methods: A consecutive case series of FATLs for ATL was conducted between 2020 and 2022. FATL was scheduled after standard presurgical evaluations of TLE and applied the same criteria as standard ATL. Seizure outcomes were categorized by Engel classifications, with at least 2 years of follow-up.
Results: Forty-nine patients with TLE who underwent FATL were included in the case series. The mean follow-up duration was 31.9 (range 24-42) months. Freedom from disabling seizures (Engel class I) occurred in 36 patients (73.5%) and significant improvement (Engel class I-II) occurred in 44 (89.8%) after surgery. The rate of complete freedom from all seizures (Engel class Ia) was 77.6% at 1 year after surgery and 69.4% at 2 years. No deaths or permanent morbidities after FATL were recorded. The complication rate was 2.0%.
Conclusions: FATL incorporates a change from anatomical resection to functional disconnection without brain shift. As a keyhole surgery, the FATL incision is barely visible, with a better cosmetic appearance than ATL. FATL has the MIS quality as well as excellent seizure outcomes similar to those of ATL.
期刊介绍:
The Journal of Neurosurgery, Journal of Neurosurgery: Spine, Journal of Neurosurgery: Pediatrics, and Neurosurgical Focus are devoted to the publication of original works relating primarily to neurosurgery, including studies in clinical neurophysiology, organic neurology, ophthalmology, radiology, pathology, and molecular biology. The Editors and Editorial Boards encourage submission of clinical and laboratory studies. Other manuscripts accepted for review include technical notes on instruments or equipment that are innovative or useful to clinicians and researchers in the field of neuroscience; papers describing unusual cases; manuscripts on historical persons or events related to neurosurgery; and in Neurosurgical Focus, occasional reviews. Letters to the Editor commenting on articles recently published in the Journal of Neurosurgery, Journal of Neurosurgery: Spine, and Journal of Neurosurgery: Pediatrics are welcome.