The Retrospective Analysis Of Frameless Stereotactic Radiofrequency Amygdalohippocampectomy In The Treatment Of Medial Temporal Lobe Epilepsy

Objective: To evaluate the therapeutic efficacy and the risk of neuropsychologicaldamage for frameless stereotactic radiofrequency amygdalohippocampectomy to mesialtemporal lobe epilepsy, patients were divided into MRI-negative, MRI-positive andbilateral temporal lobe epilepsy groups.Methods: Medical history of patients with mesial temporal lobe epilepsy, whowere treated with frameless stereotactic radiofrequency amygdalohippocampectomyamong Feb2006to July2011, was summarized by our team. All of them werefollow-upping according to Engel’s classification and figure out the rate of seizure free.First, those who got contacted was divided into MRI-negative and MRI-positive groupsto figure out the statistics difference in therapeutic efficacy; Second, WAIS-RC andWMS-RC were performed before, one week after and6monthts and more after SAHEand patients who completed all these have a right to compare these indexes at differenttime. Furthermore, these patients were divided into left coagulation group and rightcoagulation group to compare neuropsychological indexes at different time. Third, thecurative effect and neuropsycalogical function of12patients with bilateral temporal lobeepilepsy were analyzed separately. In addition to Engel’s classification, LiverpoolSeizure Severity Scale is used to evaluate curative effect. WAIS-RC and WMS-RCresults in before, one week after and6monthts and more after bilateral SAHE werecompared.Results:267patients were collected and only131cases reached. The followed uptime was12～77months. There was EngelⅠ in38patients, EngelⅡin28, Engel Ⅲ in54, and Engel Ⅳ in11. The rate of seizures free was29%. First, MRI-negative groupcompletely control of seizures were achieved in46%; MRI-positive group completelycontrol of seizures were only14.3%. There was significant difference in therapeuticefficacy (P<0.05). Second, the mean scores of neuropsychological examinationsincluding IQ and MQ in23patients with medial temporal lobe epilepsy were lower thanthe normal range. Patients showed significantly (P<0.05) descend in verbal IQ,Performance IQ and the MQ between three to seven days after SAHE. No significantchanges in Full-scale IQ of all subjects, and more, none of four kinds scores changessignificantly in left and right operative subjects when we tested them respectively. Six months and more after SAHE, Full-scale IQ, Verbal IQ, Performance IQ and MQ oftreated patients increased significantly (P<0.05). Patients treated on the right sideimproved in verbal IQ (P<0.05). No significant changes in memory and intelligence werefound in patients treated on the left side (P>0.05). Third, the12patients with BLTE，5were assessed as Engel Ⅰ,2as Engel Ⅱ,3as Engel Ⅲ, and the other2as Engel Ⅳrespectively. Severity scores were declined sharply at the follow up time compared withbaseline. No deficits of memory and intelligence correlated with SAHE except for atrend of transiently decline (P<0.05) immediately after operation in FIQ, but all indexessignificantly improved (P<0.05) at6months after coagulation.Conclusions: In our research, the patients in MRI positive group have congenitalanomaly or diffusion pathological change. These changes cannot be clearly coaugulatedby SAHE. Choosing MRI-negative patients to operative are the key factors to improvethe therapeutic efficacy of SAHE for temporal lobe epilepsy. There is a risk of a declineof neuropsychological functions in SAHE to medial temporal lobe epilepsy immediatelyafter surgery. The neuropsychological deficits were slight and could recover andimproved in three to six months. Patients have a significant improvement in the verbal IQwho treated on the right side by long-term observation. There have a reversible andimproved neuropsychological function in frameless stereotactic radiofrequencyamygdalohippocampectomy to mesial temporal lobe epilepsy. Bilateral SAHE is capableto terminate seizures or at least reduce seizure frequency and severity in patients withBTLE. Under the circumstance of limited lesions, neuropsychological function was notaffected by coagulation and was improved along with seizure control. Therefore, bilateralSAHE is worthy to be attempted for the treatment of BTLE.