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Meta-Analysis
. 2024 Nov 28;166(1):487.
doi: 10.1007/s00701-024-06383-6.

An examination of seizure-free outcome and visual field deficits: Anterior temporal lobectomy versus selective amygdalohippocampectomy for temporal lobe epilepsy-a systematic review and meta-analysis for comprehensive understanding

Burhanuddin Sohail Rangwala  1 , Hussain Sohail Rangwala  1 , Muhammad Ashir Shafique  1 , Muhammad Saqlain Mustafa  1 , Fnu Danish  1 , Sahil Kumar  2 , Tooba Noor  1 , Areej Shakil  1 , Syeda Dua E Zehra Zaidi  1 , Amna Qamber  1 , Syeda Mahrukh Fatima Zaidi  3 , Inshal Jawed  3 , Abdul Haseeb  1 , Javed Iqbal  4
Affiliations
Meta-Analysis

An examination of seizure-free outcome and visual field deficits: Anterior temporal lobectomy versus selective amygdalohippocampectomy for temporal lobe epilepsy-a systematic review and meta-analysis for comprehensive understanding

Burhanuddin Sohail Rangwala et al. Acta Neurochir (Wien). .

Abstract

Background: This study compares Selective Amygdalohippocampectomy (SAHE) and Anterior Temporal Lobectomy (ATL) for temporal lobe epilepsy (TLE), focusing on seizure control and visual field deficits (VFD). While previous research suggests potential benefits of SAHE, this meta-analysis aims to clarify the comparative effectiveness of bothprocedures.

Methods: This study adhered to PRISMA guidelines, comparing seizure outcomes and VFDs between SAHE and ATL for temporal lobe epilepsy. Comprehensive data extraction and meta-analysis revealed comparable efficacy, with SAHE potentially offering advantages in VFD risk reduction. Quality assessment ensured methodological rigor.

Results: 29 studies comparing SAHE and ATL for TLE. Seizure freedom analysis encompassed 23 studies (n = 3238), showing no significant difference between SAHE and ATL (RR = 0.96, 95% CI = 0.89-1.03, P = 0.26). SAHE exhibited significantly lower visual field deficits (RR = 0.87, 95% CI = 0.78-0.97, P = 0.01). Subgroup analyses highlighted differences between transsylvian SAHE and ATL but not transcortical SAHE. No significant difference was found in seizure freedom between SAHE and ATL in patients with hippocampal sclerosis.

Conclusions: ATL is more effective than transsylvian SAHE in achieving seizure freedom. However, no significant difference in seizure freedom was observed between transcortical SAHE and ATL. There were no notable differences in seizure outcomes between the two techniques in patients with hippocampal sclerosis. In contrast, SAHE carries a lower risk of postoperative visual field deficits compared to ATL.

Keywords: Anterior temporal lobectomy; Meta-analysis; Seizure freedom; Selective amygdalohippocampectomy; Temporal lobe epilepsy; Visual field deficits.

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Conflict of interest statement

Declarations. Ethical approval: Not Applicable. Competing interests: The authors declare no competing interests.

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