Sa. Renowden et al., SELECTIVE AMYGDALOHIPPOCAMPECTOMY FOR HIPPOCAMPAL SCLEROSIS - POSTOPERATIVE MR APPEARANCE, American journal of neuroradiology, 16(9), 1995, pp. 1855-1861
Citations number
23
Categorie Soggetti
Neurosciences,"Radiology,Nuclear Medicine & Medical Imaging
PURPOSE: To analyze the anatomic consequences of selective amygdalohip
pocampectomy (AH) in patients with hippocampal sclerosis and to correl
ate the clinical outcome with the MR appearance. METHODS: Seventeen pa
tients were examined with clinical and neuropsychologic examination an
d cranial MR after AH (7 transcortical AH, 10 trans-Sylvian AH), The c
linical and neuropsychologic outcomes after AH were compared with thos
e of anterior lobectomy (ATL). RESULTS: There was no significant diffe
rence in seizure cure between transcortical or trans-Sylvian AH and AT
L, However, patients with left AH fared significantly better in terms
of verbal IQ and nonverbal memory when compared with those with left A
TL. Verbal memory and cognition were not significantly different in th
e two AH groups. Variable amounts of hippocampal and amygdala remnants
were found in both AH groups and did not correlate with seizure cure.
White matter change consistent with gliosis probably secondary to wal
lerian degeneration was demonstrated in the anterior temporal lobe to
a mean distance of 4.5 cm after transcortical AH and to a lesser degre
e as a consequence of trans-Sylvian AH. Nine patients (53%) (4 transco
rtical AH, 5 trans-Sylvian AH) demonstrated wallerian degeneration in
the optic radiations after surgery. All had incomplete contralateral q
uadrantanopia. CONCLUSIONS: There is more secondary damage to the temp
oral lobe after AH than was previously recognized. The extent of hippo
campal and amygdala resection in AH do not seem to be directly related
to seizure cure. Visual field defects are common in AH because of the
anterior but variable course of the optic radiations.