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Review
. 2025 Jun 18:5:104304.
doi: 10.1016/j.bas.2025.104304. eCollection 2025.

Anterior temporal lobectomy and selective AmygdaloHippocampectomy complications across Europe: review, meta-analysis, and Delphi consensus

Maria D Karagianni  1 , Olaf E M G Schijns  2   3   4 , Alexandros Brotis  1 , Anastasia Tasiou  1 , Christian Auer  5 , Thomas Blauwblomme  6 , Marcelo Budke  7 , Alexandre Rainha Campos  8 , Santiago Candela-Cantó  9 , Hans Clusmann  10 , Alessandro Consales  11 , Massimo Cossu  12 , Daniel Delev  10 , Christian Dorfer  13 , Georg Dorfmüller  14 , Arild Egge  15 , Lorand Eröss  16 , Sarah Ferrand-Sorbets  14 , Flavio Giordano  17 , Cihan Isler  18 , Jugoslav Ivanovic  15 , Thilo Kalbhenn  19 , Atte Karppinen  20 , Paivi Koroknay-Pal  20 , Niklaus Krayenbühl  21 , Marec von Lehe  22 , Carlo E Marras  23 , Ioannis Mavridis  24 , Daniel Nilsson  25 , Julia Onken  26 , Christian Raftopoulos  27 , Michele Rizzi  28 , Dirk van Roost  29 , Karl Rössler  13 , Jonathan Roth  30 , Jordi Rumia  9 , Alexandra Seromenho-Santos  31 , Thomas Sauvigny  32 , Didier Scavarda  33 , Christian Scheiwe  34 , Karl Schaller  35 , Sophie Schuind  36 , Ido Strauss  37   38 , Tom Theys  39 , Mustafa Uzan  18 , Konstantinos N Fountas  1   40 ; EANS Functional Neurosurgery section
Collaborators, Affiliations
Review

Anterior temporal lobectomy and selective AmygdaloHippocampectomy complications across Europe: review, meta-analysis, and Delphi consensus

Maria D Karagianni et al. Brain Spine. .

Abstract

Introduction: Epilepsy is a neurological disorder affecting over 50 million people globally, with around 30 % of them classified as having drug-resistant epilepsy (DRE). Temporal lobe epilepsy (TLE) is the most frequently encountered type of surgically treated epilepsy. The primary surgical approaches for TLE include anterior temporal lobectomy (ATL) and selective amygdalohippocampectomy (selAH).

Research question: This study sought to gather expert European consensus on surgical strategies and complication rate for ATL and selAH, in both adult and pediatric patients.

Materials and methods: A modified Delphi technique was employed, with 39 experienced epilepsy surgeons from 35 different European centers. A 22-item questionnaire addressed key surgical considerations, including mortality, morbidity, neurological deficits, infection rates, and potential psychiatric and cognitive complications.

Results: The survey had a 43 % response rate. Mortality rates for both surgical approaches ranged between 0 and 1 %. Visual field deficits (VFDs) were more frequently observed after ATL (over 16 %) compared to selAH (2-10 %). Permanent motor deficits were rare (<2 %), while complications such as infections and hematomas were reported in 0-2 % and less than 5 % of cases, respectively for both procedures. While psychiatric and cognitive complications were acknowledged, no consensus was reached regarding their prevalence or screening methods.

Discussion: The results underscore the value of advanced imaging, thorough preoperative evaluation, and intraoperative monitoring. Future research is needed to refine outcome optimization and standardize training protocols.

Conclusions: Consensus was achieved on critical aspects of surgical planning and complication management, providing support for the development of standardized practices in temporal lobe epilepsy surgery.

Keywords: Anterior temporal lobectomy; Complications; Epilepsy surgery; Morbidity; Mortality; Selective amygdalohippocampectomy.

PubMed Disclaimer

Conflict of interest statement

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Fig. 1
Fig. 1
Overview of our findings.
See this image and copyright information in PMC

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