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

Karagianni MD, Schijns OE, Brotis A, Tasiou A, Auer C, Blauwblomme T, Budke M, Campos AR, Candela-Cantó S, Clusmann H, Consales A, Cossu M, Delev D, Dorfer C, Dorfmüller G, Egge A, Eröss L, Ferrand-Sorbets S, Giordano F, Isler C, Ivanovic J, Kalbhenn T, Karppinen A, Koroknay-Pal P, Krayenbühl N, von Lehe M, Marras CE, Mavridis I, Nilsson D, Onken J, Raftopoulos C, Rizzi M, van Roost D, Rössler K, Roth J, Rumia J, Seromenho-Santos A, Sauvigny T, Scavarda D, Scheiwe C, Schaller K, Schuind S, Strauss I, Theys T, Uzan M, Fountas KN (2025)

Publication Type: Journal article, Review article

Publication year: 2025

Journal

Book Volume: 5

DOI: 10.1016/j.bas.2025.104304

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.

Involved external institutions

Universitätsklinikum Aachen (UKA) Germany (DE) Medizinische Universität Wien Austria (AT) Università degli Studi di Firenze / University of Florence Italy (IT) Centro Hospitalar de Lisboa Ocidental E.P.E. (CHLO) Portugal (PT) General University Hospital of Larissa Greece (GR) University Hospital of Alexandroupolis Greece (GR) Maastricht University Netherlands (NL) Sahlgrenska University Hospital / Sahlgrenska Universitetssjukhuset Sweden (SE) Hospital Sant Joan de Déu Barcelona Spain (ES) Tel Aviv Sourasky Medical Center / Ichilov Hospital Israel (IL) Universitätsklinikum Hamburg-Eppendorf (UKE) Germany (DE) Universitätsklinikum Freiburg Germany (DE) Geneva University Hospitals / Hôpitaux universitaires de Genève (HUG) Switzerland (CH) University Hospital Leuven (UZ) / Universitaire ziekenhuizen Leuven Belgium (BE) Kepler Universitätsklinikum (KUK) Austria (AT) Université Sorbonne Paris Cité France (FR) Hospital Infantil Universitario Niño Jesús / Hospital del Niño Jesús Spain (ES) Hôpital de la Timone France (FR) Istanbul University Cerrahpaşa / İstanbul Üniversitesi Cerrahpaşa (IUC) Turkey (TR) Universitäts-Kinderspital Zürich Switzerland (CH) Ospedale Pediatrico Bambino Gesu Italy (IT) Charité - Universitätsmedizin Berlin Germany (DE) Istituto Giannina Gaslini Italy (IT) Cliniques universitaires Saint-Luc (CHU St-Luc) Belgium (BE) Ospedale Niguarda Ca' Granda / ASST Grande Ospedale Metropolitano Niguarda Italy (IT) National Institute of Mental Health Information Resource Center United States (USA) (US) Helsingin yliopisto / University of Helsinki Finland (FI) Foundation of the Carlo Besta Neurological Institute (IRCCS) Italy (IT) Ruppiner Kliniken Germany (DE) University Hospital Ghent Belgium (BE) Hôpital Erasme Belgium (BE) Fondation Adolphe de Rothschild Hospital France (FR) Oslo University Hospital / Oslo Universitetssykehus Rikshospitalet Norway (NO) Universität Bielefeld Germany (DE)

How to cite

APA:

Karagianni, M.D., Schijns, O.E., Brotis, A., Tasiou, A., Auer, C., Blauwblomme, T.,... Fountas, K.N. (2025). Anterior temporal lobectomy and selective AmygdaloHippocampectomy complications across Europe: review, meta-analysis, and Delphi consensus. Brain and Spine, 5. https://doi.org/10.1016/j.bas.2025.104304

MLA:

Karagianni, Maria D., et al. "Anterior temporal lobectomy and selective AmygdaloHippocampectomy complications across Europe: review, meta-analysis, and Delphi consensus." Brain and Spine 5 (2025).

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