Dados do Trabalho

Título

Contralateral temporal pole connectivity alterations after standard anterior temporal lobectomy VS selective amygdalohippocampectomy

Introdução

Temporal lobe epilepsy (TLE) consists of the most commonly refractory form of epilepsy in adults and is divided into two groups: mesial (mTLE) and lateral TLE. Surgical ttreatment of medically refractory mTLE is the gold standard and consists of resection of the mesial temporal lobe structures. This can be achieved with several technics, amongst them, the standard anterior temporal lobectomy (ATL) and selective amygdalohippocampectomy (SelAH). Specifically, SelAH should minimize disturbance of temporal networks related to cognition when compared to ALT, however, a consensus has not been reached on this topic. Similarly, it would be reasonable to propose that ALT could lead to better seizure control due to the bigger extent of resection, yet, this finding has not been homogenous in the literature. Furthermore, magnetic resonance imaging (MRI) findings after SelAH might suggest that SelAH would lead to structural and potentially functional damage to the temporal neocortex, even if the resection is anatomically selective.

Objetivo

To assess whether patients that underwent SelAH preserve temporal pole connectivity as expected

Método

The MRI protocol was based on structural and functional images. MRI preprocessing and analyses were performed using the UF²C toolbox executed on the MATLAB platform (2014b, The MathWorks) with the SPM12 (Statistical Parametric Mapping 12). Different areas were compared using the paired T-test. Findings presenting with p<0,001 on voxel level and p<0,005 for cluster correction were considered relevant.

Resultados

There were little to no significant alterations in the contralateral temporal pole (TP) connectivity of patients submitted to ALT vs SelAH. One could hypothesize that with the removal of ipsilateral TP, connectivity of the contralateral TP would increase or decrease as a consequence of functional loss. In that sense, no significant differences between contralateral TP connectivity in ALT vs SelAH patients might indicate that the alterations in the connectivity of the ipsilateral TP were similar in both groups. Furthermore, the increases in connectivity of contralateral TP from patients that underwent ALT and SelAH were similar when compared to healthy controls.

Conclusão

Connectivity alterations seem to be similar between SelAH and ALT considering contralateral TP, which, taken together with previous data, suggests the anatomically selective SelAH may not be functionally selective.

Palavras-chave

Selective amygdalohippocampectomy; standard anterior temporal lobectomy; connectivity

Área

CIRURGIA DE EPILEPSIA