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Comment & Response
September 2016

Surgical Treatment of Temporal Lobe Epilepsy—Reply: Type and Extent of Surgery Matters

Author Affiliations
  • 1Division of Epilepsy, Department of Neurology, Mayo Clinic, Rochester, Minnesota
JAMA Neurol. 2016;73(9):1157-1158. doi:10.1001/jamaneurol.2016.1850

In Reply We thank Nabavizadeh for his interest in our article.1 We appreciate the importance of surgical technique in the care and management of patients with medial temporal lobe epilepsy (MTLE) associated with mesial temporal sclerosis (MTS). The operative strategy in 25 of the 27 studies appeared to involve a medial temporal lobe resection, ie, an amygdalohippocampectomy, and a standard or tailored neocortical excision. The extent of the neocortical resection was variable and dependent on multiple factors including the localization and lateralization of eloquent cortex (eg, speech and language function), vascular anatomy, the results of intraoperative electrocorticography, and the neurosurgical teams’ surgical approach. The operative technique was not provided in 1 study. A selective amygdalohippocampectomy (SAH) was reported in a final study evaluating the diagnostic yield of positron emission tomography in MTLE. In all studies, the investigators emphasized the importance of hippocampal resection in individuals with MTS. Inadequate information was provided in these studies regarding the extent of entorhinal cortex resection.