Keywords
anterior temporal lobectomy
laser interstitial thermal therapy
stereotactic radiosurgery
seizure freedom
How to Cite
Abstract
Background: Mesial temporal lobe epilepsy (MTLE), often associated with hippocampal sclerosis (HS), is the most common form of drug-resistant focal epilepsy. While anterior temporal lobectomy (ATL) has long been considered the gold standard for achieving seizure freedom, the evolution of neuroimaging and minimally invasive technologies has introduced several alternative surgical and ablative interventions. This review synthesizes current evidence regarding the efficacy, safety, and neuropsychological outcomes of various surgical treatments for MTLE.
Methods: PubMed, Google Scholar and Scopus were searched for articles that focus on the surgical treatments that treats mesial temporal epilepsy, using keywords such as “MTLE”, “anterior temporal lobectomy”, “seizures”, “radiosurgery”. Analysis was done from 16 studies, focusing on different treatments and different outcomes.
Results: Out of 16 studies, resective surgery, specifically ATL, remains the most effective intervention for seizure control, with seizure-freedom rates ranging from 58% to 89.5%. However, ATL is associated with a higher risk of superior quadrantanopia and verbal memory decline in the dominant hemisphere. SAH approaches, particularly via the subtemporal route, offer comparable seizure control with improved preservation of verbal memory. Minimally invasive LITT demonstrates seizure-freedom rates of approximately 53% to 66.7% while significantly reducing hospital stay and preserving functions. SRS offers a non-invasive alternative but with lower seizure-freedom rates (52%) and a delayed therapeutic effect.
Conclusion: The surgical management of MTLE is shifting toward a personalized approach. While open resective surgery provides the highest probability of a seizure-free life, minimally invasive techniques like LITT offer an attractive balance for patients prioritizing cognitive preservation and rapid recovery. Stereotactic radiosurgery and RF-TC remain valuable for specific patient populations where open surgery or thermal ablation is contraindicated.
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