Long-term postoperative atrophy of contralateral hippocampus and cognitive function in unilateral refractory MTLE with unilateral hippocampal sclerosis |
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| Institution: | 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. Epilepsy Service, Rua Vital Brasil, 251, University of Campinas, UNICAMP, Cidade Universitária Zeferino Vaz, 13083-888 Campinas, SP, Brazil;3. 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;1. Department of Neurosurgery, Fuzhou General Hospital of Nanjing Command, PLA, Fuzhou 350025, China;2. Department of Epileptology, Fuzhou General Hospital of Nanjing Command, PLA, Fuzhou 350025, China;3. Department of Medical Imaging, Fuzhou General Hospital of Nanjing Command, PLA, Fuzhou 350025, China;1. Department of Pediatric Neurology, Ankara Pediatrics, Hematology-Oncology Training and Research Hospital, Ankara, Turkey;2. Department of Pediatrics, Ankara Pediatrics, Hematology-Oncology Training and Research Hospital, Ankara, Turkey;1. Center for Neuromodulation Studies, Department of Psychiatry of the Federal University of São Paulo, Brazil;2. Disciplina de Neurociência, Universidade Federal de São Paulo/Escola Paulista de Medicina (UNIFESP/EPM), São Paulo, Brazil;3. Psychiatry Department, Santa Casa School of Medical Sciences, São Paulo, Brazil |
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| Abstract: | ObjectiveThis 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).MethodsWe 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.ResultsThe 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.ConclusionsWe 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. |
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