Minimally Invasive Technique (Nummular Craniotomy) for Mesial Temporal Lobe Epilepsy: A Comparison of 2 Approaches.
OBJECTIVE
To describe our series of a minimally invasive technique using a small scalp incision and keyhole craniotomy for the removal of mesial temporal lobe structures through a transcortical approach in patients with medically intractable mesial temporal lobe epilepsy (MTLE). Studies that directly compare the clinical outcomes between minimally invasive and conventional techniques are scarce, and this information is lacking in the literature.


METHODS
The study enrolled 73 consecutive patients with refractory MTLE and unilateral hippocampal sclerosis; 30 patients were operated on with standard frontotemporal craniotomy between 2010 and 2013 and 43 patients were operated with a minimally invasive craniotomy (nummular craniotomy) between 2014 and 2016. The preoperative evaluation included clinical history, physical examination, video-electroencephalography, neuropsychologic assessment, and magnetic resonance imaging including thin-section coronal sequences.


RESULTS
There were no deaths in either group. Postoperative complications in the standard frontotemporal craniotomy group included temporal muscle atrophy (n = 4; 13.3%), cerebrospinal fluid leakage (n = 1; 3.3%), and wound infection (n = 1; 3.3%). No complications were observed in the keyhole craniotomy group. There was no between-group difference in postoperative seizure control. The mean Engel class I seizure-free outcome was 90.4% in the standard frontotemporal craniotomy group and 90.7% in the nummular craniotomy group (P > 0.05). Lengths of hospitalization (2.81 vs. 4.37 days, P < 0.001) and operative time (85.79 vs. 142.73 minutes, P < 0.001) were lower in the keyhole than in the standard frontotemporal craniotomy group, respectively.


CONCLUSIONS
The nummular technique was associated with faster recovery, early hospital discharge, and fewer complications than the standard technique. No differences were observed in postoperative seizure control. Keyhole craniotomy is a safe, easy, and effective treatment option for medically intractable MTLE.
['Sarmento|Stenio Abrantes|SA|', 'Rabelo|Nícollas Nunes|NN|', 'Figueiredo|Eberval Gadelha|EG|']
D000293:Adolescent D000328:Adult D002648:Child D002675:Child, Preschool D003399:Craniotomy D000069279:Drug Resistant Epilepsy D004833:Epilepsy, Temporal Lobe D005260:Female D006801:Humans D007902:Length of Stay D008297:Male D008875:Middle Aged D019060:Minimally Invasive Surgical Procedures D061646:Operative Time D011183:Postoperative Complications D012598:Sclerosis D012640:Seizures D016896:Treatment Outcome D055815:Young Adult
Nummular craniotomy Mesial temporal lobe epilepsy Epilepsy surgery techniques Keyhole approach Seizure outcome