Visual field defects following different resective procedures for mesiotemporal lobe epilepsy |
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| Institution: | 1. Department of Neurosurgery, Medical Center — University of Freiburg, Breisacherstrasse 64, 79106 Freiburg, Germany;2. NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Trust and UCL Institute of Ophthalmology, London, United Kingdom;3. Eye Center, Medical Center — University of Freiburg, Killianstrasse 5, 79106 Freiburg, Germany;4. Department of Neuroradiology, Medical Center — University of Freiburg, Breisacherstrasse 64, 79106 Freiburg, Germany;5. Department of Epileptology, Medical Center — University of Freiburg, Breisacherstrasse 64, 79106 Freiburg, Germany;6. Epilepsy Center Kork, Landstrasse 1, 77694 Kehl, Germany;1. University of Iowa, Department of Psychological and Brain Sciences, W311 Seashore Hall, Iowa City, IA 52242, USA;2. University of Iowa Carver College of Medicine, Department of Neurology, 2007 Roy Carver Pavilion, 200 Hawkins Drive, Iowa City, IA 52242, USA;1. INSERM U1129 “Infantile Epilepsies and Brain Plasticity”, Paris, France;2. Université Paris Descartes, Sorbonne Paris Cité, France;3. CEA, Gif sur Yvette, France;4. Rothschild Foundation Hospital, Pediatric Neurosurgery Department, Paris, France;1. The Department of Medicine, St. Vincent''s Hospital Melbourne, St Vincent''s PO Box 2900, Fitzroy, VIC 3065, Australia;2. The University of Melbourne, Parkville, VIC 3010, Australia |
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| Abstract: | IntroductionOne of the most common side effects of mesiotemporal lobe resection in patients with medically intractable epilepsy are visual field defects (VFD). While peripheral defects usually remain unnoticed by patients, extended VFD influence daily life activities and can, in particular, affect driving regulations. This study had been designed to evaluate frequency and extent of VFD following different surgical approaches to the mesiotemporal area with respect to the ability to drive.Materials and methodsThis study comprises a consecutive series of 366 patients operated at the Epilepsy Center in Freiburg for intractable mesiotemporal lobe epilepsy from 1998 to 2016. The following procedures were performed: standard anterior temporal lobectomy (ATL: n = 134; 37%), anterior temporal or keyhole resection (KH: n = 53; 15%), and selective amygdalohippocampectomy via the transsylvian (tsAHE: n = 145; 40%) and the subtemporal (ssAHE: n = 34; 9%) approach. Frequency and extent of postoperative VFD were evaluated in relation to different surgical procedures. According to the German driving guidelines, postoperative VFD were classified as driving-relevant VFD with the involvement of absolute, homonymous central scotoma within 20° and driving-irrelevant VFD with either none or exclusively minor VFD sparing the center.ResultsPostoperative visual field examinations were available in 276 of 366 cases. Postoperative VFD were observed in 202 of 276 patients (73%) and were found to be driving-relevant in 133 of 276 patients (48%), whereas 69 patients (25%) showed VFD irrelevant for driving. Visual field defects were significantly less likely following ssAHE compared with other temporal resections, and if present, they were less frequently driving-relevant (p < 0.05), irrespective of the side of surgery.ConclusionSubtemporal sAHE (ssAHE) caused significantly less frequently and less severely driving-relevant VFD compared with all other approaches to the temporal lobe, irrespective of the side of surgery. |
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