Please use this identifier to cite or link to this item: http://repositorio.unicamp.br/jspui/handle/REPOSIP/201458
Type: Artigo de periódico
Title: Long-term Postoperative Atrophy Of Contralateral Hippocampus And Cognitive Function In Unilateral Refractory Mtle With Unilateral Hippocampal Sclerosis.
Author: Fernandes, Daniela Alves
Yasuda, Clarissa Lin
Lopes, Tátila Martins
Enrico, Ghizoni
Alessio, Andréa
Tedeschi, Helder
de Oliveira, Evandro
Cendes, Fernando
Abstract: This study aimed to evaluate long-term atrophy in contralateral hippocampal volume after surgery for unilateral MTLE, as well as the cognitive outcome for patients submitted to either selective transsylvian amygdalohippocampectomy (SelAH) or anterior temporal lobe resection (ATL). We performed a longitudinal study of 47 patients with MRI signs of unilateral hippocampal sclerosis (23 patients with right-sided hippocampal sclerosis) who underwent surgical treatment for MTLE. They underwent preoperative/postoperative high-resolution MRI as well as neuropsychological assessment for memory and estimated IQ. To investigate possible changes in the contralateral hippocampus of patients, we included 28 controls who underwent two MRIs at long-term intervals. The volumetry using preoperative MRI showed significant hippocampal atrophy ipsilateral to the side of surgery when compared with controls (p<0.0001) but no differences in contralateral hippocampal volumes. The mean postoperative follow-up was 8.7 years (± 2.5 SD; median=8.0). Our patients were classified as Engel I (80%), Engel II (18.2%), and Engel III (1.8%). We observed a small but significant reduction in the contralateral hippocampus of patients but no volume changes in controls. Most of the patients presented small declines in both estimated IQ and memory, which were more pronounced in patients with left TLE and in those with persistent seizures. Different surgical approaches did not impose differences in seizure control or in cognitive outcome. We observed small declines in cognitive scores with most of these patients, which were worse in patients with left-sided resection and in those who continued to suffer from postoperative seizures. We also demonstrated that manual volumetry can reveal a reduction in volume in the contralateral hippocampus, although this change was mild and could not be detected by visual analysis. These new findings suggest that dynamic processes continue to act after the removal of the hippocampus, and further studies with larger groups may help in understanding the underlying mechanisms.
Subject: Adult
Atrophy
Epilepsy, Temporal Lobe
Female
Functional Laterality
Hippocampus
Humans
Longitudinal Studies
Magnetic Resonance Imaging
Male
Middle Aged
Neuropsychological Tests
Postoperative Complications
Prospective Studies
Sclerosis
Treatment Outcome
Cognition
Contralateral Hippocampus Atrophy
Epilepsy Surgery
Hippocampal Sclerosis
Mri
Mtle
Memory Outcome
Volumetry
Rights: fechado
Identifier DOI: 10.1016/j.yebeh.2014.04.028
Address: http://www.ncbi.nlm.nih.gov/pubmed/24907496
Date Issue: 2014
Appears in Collections:Artigos e Materiais de Revistas Científicas - Unicamp

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