Evidence map›Paper›PMID 36709527›Full record

ArticleEpilepsy research2023

Hippocampal resection in temporal lobe epilepsy: Do we need to resect the tail?

Debayan Dasgupta, Roisin Finn, Aswin Chari, Davide Giampiccolo, Jane de Tisi, Aidan G O'Keeffe, Anna Miserocchi, Andrew W McEvoy, Sjoerd B Vos, John S Duncan

Open access · hybridAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Epilepsy research, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 8 papers.

0numbers the graph read from it
0cells of the map it votes in
8citing papers in PubMed
2.0field-weighted citation impact, top 15% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

8 citing papers in PubMed, 9 citations in OpenAlex.

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  8. Hippocampal resection during hemispherotomy: is it needed?Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery · 2024
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

10 authors at 6 institutions in 2 countries.

Debayan DasguptaDepartment of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, University College London, London, UK; Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, Queen Square, London, UK. Electronic address: debayan.dasgupta@ucl.ac.uk.
Roisin FinnVictor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, Queen Square, London, UK. Electronic address: roisin.finn@nhs.net.
Aswin ChariDepartment of Neurosurgery, Great Ormond Street Hospital, London, UK; Developmental Neuroscience, Great Ormond Street Institute of Child Health, University College London, London, UK. Electronic address: aswin.chari.18@ucl.ac.uk.
Davide GiampiccoloDepartment of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, University College London, London, UK; Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, Queen Square, London, UK; Institute of Neurosciences, Cleveland Clinic London, London, UK. Electronic address: d.giampiccolo@ucl.ac.uk.
Jane de TisiDepartment of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, University College London, London, UK. Electronic address: j.detisi@ucl.ac.uk.
Aidan G O'KeeffeSchool of Mathematical Sciences, University of Nottingham, Nottingham, UK. Electronic address: aidan.o'keeffe@nottingham.ac.uk.
Anna MiserocchiVictor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, Queen Square, London, UK. Electronic address: anna.miserocchi@nhs.net.
Andrew W McEvoyVictor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, Queen Square, London, UK. Electronic address: a.mcevoy@ucl.ac.uk.
Sjoerd B VosCentre for Medical Image Computing, Department of Computer Science, University College London, London, UK; Neuroradiological Academic Unit, UCL Queen Square Institute of Neurology, University College London, London, UK; Centre for Microscopy, Characterisation, and Analysis, The University of Western Australia, Nedlands, Australia. Electronic address: sjoerd.vos@uwa.edu.au.
John S DuncanDepartment of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, University College London, London, UK. Electronic address: j.duncan@ucl.ac.uk.
National Hospital for Neurology and Neurosurgery · GBEpilepsy Research UK · GBCleveland Clinic London · GBGreat Ormond Street Hospital · GBThe University of Western Australia · AUUniversity of Nottingham · GB

Funding

Wellcome TrustWellcome Trust 218380/Z/19/Z
6 · The paper itself

Abstract

introductionAnteromesial temporal lobe resection is the most common surgical technique used to treat drug-resistant mesial temporal lobe epilepsy, particularly when secondary to hippocampal sclerosis. Structural and functional imaging data suggest the importance of sparing the posterior hippocampus for minimising language and memory deficits. Recent work has challenged the view that maximal posterior hippocampal resection improves seizure outcome. This study was designed to assess whether resection of posterior hippocampal atrophy was associated with improved seizure outcome.

methodsRetrospective analysis of a prospective database of all anteromesial temporal lobe resections performed in individuals with hippocampal sclerosis at our epilepsy surgery centre, 2013-2021. Pre- and post-operative MRI were reviewed by 2 neurosurgical fellows to assess whether the atrophic segment, displayed by automated hippocampal morphometry, was resected, and ILAE seizure outcomes were collected at 1 year and last clinical follow-up. Data analysis used univariate and binary logistic regression.

resultsSixty consecutive eligible patients were identified of whom 70% were seizure free (ILAE Class 1 & 2) at one year. There was no statistically significant difference in seizure freedom outcomes in patients who had complete resection of atrophic posterior hippocampus or not (Fisher's Exact test statistic 0.69, not significant at p < .05) both at one year, and at last clinical follow-up. In the multivariate analysis only a history of status epilepticus (OR=0.2, 95%CI:0.042-0.955, p = .04) at one year, and pre-operative psychiatric disorder (OR=0.145, 95%CI:0.036-0.588, p = .007) at last clinical follow-up, were associated with a reduced chance of seizure freedom. SIGNIFICANCE: Our data suggest that seizure freedom is not associated with whether or not posterior hippocampal atrophy is resected. This challenges the traditional surgical dogma of maximal posterior hippocampal resection in anteromesial temporal lobe resections and is a step further optimising this surgical procedure to maximise seizure freedom and minimise associated language and memory deficits.

Indexed as

Drug Resistant EpilepsyEpilepsy, Temporal LobeAtrophyFollow-Up StudiesHippocampusHumansMagnetic Resonance ImagingMemory DisordersRetrospective StudiesSeizuresTreatment OutcomeDrug resistant focal epilepsyEpilepsy surgeryHippocampal sclerosisTemporal lobe epilepsyTemporal Lobe resection

Identifiers

PMID36709527
PMCPMC10626579
OpenAlexW4315644265

What OpenQuestion holds

Textmetadata
LicenceCC BY
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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.