Abstract :
Background: Temporal lobe epilepsy is the most frequent type of treatment-resistantepilepsy. Mesial temporal sclerosis (MTS) is the most common recognized cause oftemporal lobe epilepsy (TLE). Only half of patients responds to medical treatment.Surgery is the only effective treatment for mesial temporal sclerosis epilepsy in case offailure of medical treatment with a success rate of 60% - 90%. Objective: is to assess thefeasibility of performing selective amygdalohippocampectomy without image guidancefor refractory mesial temporal lobe epilepsy cases caused by hippocamppal sclerosis.Patients and Methods: Twenty six patients (fifteen females and eleven males) with agerange 11-64 years, with intractable temporal lobe epilepsy, after proper evaluation;clinical, magnetic resonance imaging (MRI) and video electroencephalography, allselected cases had minimally invasive non-image guided selectiveamygdalohippocampectomy. Results: Precipitating factors were evident in 46,15% ofcases; subdivided as follows: 26,92 % had febrile seizure (the most common), 11,53%had head trauma, 3,84% had encephalitis and 3,84% had perinatal asphyxia. Thepreoperative median weekly seizure frequency was two. 53,84% of cases had CPS withsecondary generalization and 46,15% of cases had complex partial seizures (CPS)without secondary generalization. Patients used a median of 2 antiepileptic medications(AEDs) preoperatively. Seizure control outcomes at the last follow up revealed bymodified Engel outcome (table III): 65,38% of cases were Engel Class I, 11,53% ofcases were Engel Class II, 15,38% of cases were Engel Class III and 7,69% of caseswere Engel Class IV. Single case developed wound infection. 38,46% of cases hadcomplete AED cessation, 53,84% had reduction in AED doses and 7,69% had no changein AED regimen. Conclusion: Selective amygdalohippocampectomy is a safe, precise,easy and effective surgical procedure, without the necessity of image guidance or largerresection, in properly selected cases with refractory mesial temporal lobe epilepsy duehippocampal sclerosis
