Visual field preservation in anterior temporal lobectomy for epilepsy
EANS Academy. Pichierri A. 09/25/19; 275701; EP07036
Mr. Angelo Pichierri
Mr. Angelo Pichierri

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Besides the advantages of being seizure-free, working and driving are the two top expectations in patients with mesial temporal lobe epilepsy undergoing an anterior temporal lobectomy. While surgery succeeds in reaching a good control of patient's seizure in about 70% of patients, the risk of giving symptomatic upper quadrantanopia is as high as 33%, according to a metanalysis of large series using different approaches ; about 50% of these patients (16% overall) will not be able to drive or do specific works despite being seizure-free.
The inability to fully preserve the optic radiation, particularly the Meyer loop, is mainly due to its significant anatomical variability. Experimental and clinical papers on DTI demonstrated is now possible to visualise with accuracy the individual optic pathways. Integration of this modality in the intraoperative navigation systems has been proved to be helpful in reducing the risks of visual fields damage.
We report our experience in 20 patients who underwent ATL for epilespy with DTI-guided preservation of Meyer loop and optic radiation.
Our results show a reduction of the risk of visual field damage to 5%, while maintaining the same efficacy in terms of seizure control.
We will describe the technical aspects of our pre-planning and intraoperative navigation.
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