Daniela Alves Fernandes1, Clarissa Lin Yasuda2, Tátila Martins Lopes1, Ghizoni Enrico3, Andréa Alessio1, Helder Tedeschi4, Evandro de Oliveira4, Fernando Cendes5. 1. Neuroimaging Laboratory, Hospital de Clínicas, 2° Floor, MRI Unit, Rua Vital Brasil, 251, University of Campinas, UNICAMP, Cidade Universitária Zeferino Vaz, 13083-888 Campinas, SP, Brazil. 2. Neuroimaging Laboratory, Hospital de Clínicas, 2° Floor, MRI Unit, Rua Vital Brasil, 251, University of Campinas, UNICAMP, Cidade Universitária Zeferino Vaz, 13083-888 Campinas, SP, Brazil; Epilepsy Service, Rua Vital Brasil, 251, University of Campinas, UNICAMP, Cidade Universitária Zeferino Vaz, 13083-888 Campinas, SP, Brazil. 3. Neuroimaging Laboratory, Hospital de Clínicas, 2° Floor, MRI Unit, Rua Vital Brasil, 251, University of Campinas, UNICAMP, Cidade Universitária Zeferino Vaz, 13083-888 Campinas, SP, Brazil; Neurosurgery Division, Department of Neurology, Hospital de Clínicas, Rua Vital Brasil, 251, University of Campinas, UNICAMP, Cidade Universitária Zeferino Vaz, 13083-888 Campinas, SP, Brazil. 4. Neurosurgery Division, Department of Neurology, Hospital de Clínicas, Rua Vital Brasil, 251, University of Campinas, UNICAMP, Cidade Universitária Zeferino Vaz, 13083-888 Campinas, SP, Brazil. 5. Neuroimaging Laboratory, Hospital de Clínicas, 2° Floor, MRI Unit, Rua Vital Brasil, 251, University of Campinas, UNICAMP, Cidade Universitária Zeferino Vaz, 13083-888 Campinas, SP, Brazil; Epilepsy Service, Rua Vital Brasil, 251, University of Campinas, UNICAMP, Cidade Universitária Zeferino Vaz, 13083-888 Campinas, SP, Brazil. Electronic address: fcendes@unicamp.br.
Abstract
OBJECTIVE: This study aimed to evaluate long-term atrophy in contralateral hippocampal volume after surgery for unilateral MTLE, as well as the cognitive outcome for patients submitted to either selective transsylvian amygdalohippocampectomy (SelAH) or anterior temporal lobe resection (ATL). METHODS: We performed a longitudinal study of 47 patients with MRI signs of unilateral hippocampal sclerosis (23 patients with right-sided hippocampal sclerosis) who underwent surgical treatment for MTLE. They underwent preoperative/postoperative high-resolution MRI as well as neuropsychological assessment for memory and estimated IQ. To investigate possible changes in the contralateral hippocampus of patients, we included 28 controls who underwent two MRIs at long-term intervals. RESULTS: The volumetry using preoperative MRI showed significant hippocampal atrophy ipsilateral to the side of surgery when compared with controls (p<0.0001) but no differences in contralateral hippocampal volumes. The mean postoperative follow-up was 8.7 years (± 2.5 SD; median=8.0). Our patients were classified as Engel I (80%), Engel II (18.2%), and Engel III (1.8%). We observed a small but significant reduction in the contralateral hippocampus of patients but no volume changes in controls. Most of the patients presented small declines in both estimated IQ and memory, which were more pronounced in patients with left TLE and in those with persistent seizures. Different surgical approaches did not impose differences in seizure control or in cognitive outcome. CONCLUSIONS: We observed small declines in cognitive scores with most of these patients, which were worse in patients with left-sided resection and in those who continued to suffer from postoperative seizures. We also demonstrated that manual volumetry can reveal a reduction in volume in the contralateral hippocampus, although this change was mild and could not be detected by visual analysis. These new findings suggest that dynamic processes continue to act after the removal of the hippocampus, and further studies with larger groups may help in understanding the underlying mechanisms.
OBJECTIVE: This study aimed to evaluate long-term atrophy in contralateral hippocampal volume after surgery for unilateral MTLE, as well as the cognitive outcome for patients submitted to either selective transsylvian amygdalohippocampectomy (SelAH) or anterior temporal lobe resection (ATL). METHODS: We performed a longitudinal study of 47 patients with MRI signs of unilateral hippocampal sclerosis (23 patients with right-sided hippocampal sclerosis) who underwent surgical treatment for MTLE. They underwent preoperative/postoperative high-resolution MRI as well as neuropsychological assessment for memory and estimated IQ. To investigate possible changes in the contralateral hippocampus of patients, we included 28 controls who underwent two MRIs at long-term intervals. RESULTS: The volumetry using preoperative MRI showed significant hippocampal atrophy ipsilateral to the side of surgery when compared with controls (p<0.0001) but no differences in contralateral hippocampal volumes. The mean postoperative follow-up was 8.7 years (± 2.5 SD; median=8.0). Our patients were classified as Engel I (80%), Engel II (18.2%), and Engel III (1.8%). We observed a small but significant reduction in the contralateral hippocampus of patients but no volume changes in controls. Most of the patients presented small declines in both estimated IQ and memory, which were more pronounced in patients with left TLE and in those with persistent seizures. Different surgical approaches did not impose differences in seizure control or in cognitive outcome. CONCLUSIONS: We observed small declines in cognitive scores with most of these patients, which were worse in patients with left-sided resection and in those who continued to suffer from postoperative seizures. We also demonstrated that manual volumetry can reveal a reduction in volume in the contralateral hippocampus, although this change was mild and could not be detected by visual analysis. These new findings suggest that dynamic processes continue to act after the removal of the hippocampus, and further studies with larger groups may help in understanding the underlying mechanisms.
Authors: Victoria L Morgan; Baxter P Rogers; Hernán F J González; Sarah E Goodale; Dario J Englot Journal: J Neurosurg Date: 2019-06-14 Impact factor: 5.115
Authors: Yue Liu; Dario J Englot; Victoria L Morgan; Warren D Taylor; Ying Wei; Ipek Oguz; Bennett A Landman; Ilwoo Lyu Journal: Proc SPIE Int Soc Opt Eng Date: 2021-02-15
Authors: Karin Gau; Charlotte S M Schmidt; Horst Urbach; Josef Zentner; Andreas Schulze-Bonhage; Christoph P Kaller; Niels Alexander Foit Journal: Neuroradiology Date: 2020-07-20 Impact factor: 2.804