Results of anterior temporal lobectomy that spares the amygdala in patients with complex partial seizures.

In December, 1980, the authors modified their anterior temporal lobectomies to exclude the amygdala from resection, a decision influenced by the dearth of pathology in the amygdala compared to the hippocampus. Furthermore, it had never been demonstrated that a good result was contingent upon including the amygdala per se in the lobectomy. Fifty-five (79%) of 70 patients in whom the amygdala was not resected were benefited by surgery. This result is similar to that achieved in series of anterior temporal lobectomies that include the amygdala in the resection. The results take on a special significance when considered together with those of amygdala-hippocampectomy which has been effective for controlling complex partial seizures of temporal mesiobasal origin (the region of the hippocampus, parahippocampal gyrus, and amygdala). A survey of the combined results strongly suggests that the anterior hippocampus and/or associated entorhinal cortex may be all that need be removed to control complex partial seizures caused by a temporal mesiobasal focus.