In the conventional surgery for temporal lobe epilepsy is temporal lobectomy. In this operation front part of the temporal lobe and the structure within it-the hippocampus, are resected. This can result in memory impairment because hippocampus plays a major role in memory formation. In addition it can lead to depression and loss of social skills. In addition, hippocampus is the major source of stem cells which are important in the ongoing healing process of the brain. Therefore, removal of these cells through temporal lobectomy may lead to depression and Alzheimer’s disease.
In the new operation known as “multiple hippocampal transections” (MHT) seizure circuits within the hippocampus are disrupted by making multiple vertical cuts while the functional fibers and stem cells are preserved. In diagram above the lines on the hippocampus (Hipp) represent the cuts through which seizure circuits are disrupted. The seizure activity in the brains cortex (which is the outer layer of the brain) are abolished by breaking seizure circuits within it by a procedure known as the multiple subpial cortical transection (MSCT).
Report on the new procedure has been published by Dr. H Shimizu in Japan (Journal of Clinical Neurosciences 2006:13:322-328) and recently by Dr. A Patil, Professor and Chief of neurosurgery at Creighton University Medical Center, Omaha, NE (USA) (Seizure 2013:22:322-328). In the latest publication with a follow of more than 2 year, seizure control was obtained in over 90% of patients. In addition, it showed preservation of verbal memory.
In this operation the hippocampus is not removed. It can therefore be performed on patients who are not suitable for temporal lobectomy.
Contact: arunpatil@creighton.edu
