Turkish Neurosurgery
Long-Term Outcomes of Anterior Temporal Lobectomy in Adults with Temporal Lobe Epilepsy: A Comprehensive Analysis of a 20-Year, 168-Patient Cohort
Ozan Hasimoglu 1, Tuba Ozge Karacoban1, Taha Hanoglu 1, Nur Bahar Geylan2, Demet Kınay3, Gul Gunay4, Ayten Ceyhan4, Murat Mert Atmaca5, Ozan Barut6, Omer Batu Hergunsel7, Bekir Tugcu1
1Basaksehir Cam and Sakura City Hospital, Neurosurgery, Istanbul,
2Basaksehir Cam and Sakura City Hospital, Neurosurgery Nursing, Neuropsychiatry, Istanbul,
3University of Health Sciences Prof. Dr. Cemil Taşcıoğlu City Hospital, Neurology, Istanbul,
4University of Health Sciences Turkey, Bakırköy Prof. Dr. Mazhar Osman Mental Health and Neurology Training and Research Hospital,, Neurology, Istanbul,
5Sultan 2. Abdul Hamıd Khan Educatıonal And Research Hospital, Neurology, Istanbul,
6Bingol State Hospital, Neurosurgery, Bingol,
7Sisli Hamidiye Etfal Training and Research Hospital, Neurosurgery, Istanbul,
DOI: 10.5137/1019-5149.JTN.48548-25.4

Aim:This study aims to evaluate the long-term clinical outcomes and histopathological classifications of anterior temporal lobectomy in adult patients with mesial temporal lobe epilepsy associated with hippocampal sclerosis. Additionally, it analyzes the impact of preoperative evaluation processes and histopathological classifications on surgical success.Material and Methods:A retrospective analysis was conducted on 168 adult patients diagnosed with drug-resistant mesial temporal lobe epilepsy who underwent resection surgery and were histopathologically confirmed to have hippocampal sclerosis between 2006 and 2025. Preoperative evaluations included video-EEG, high-resolution brain MRI, neuropsychological tests, and PET-CT. Postoperative outcomes were assessed using the Engel classification. Demographic characteristics, age at epilepsy onset, epilepsy duration, initial precipitating injury, family history, histopathological findings, and diagnostic evaluations were analyzed in relation to long-term seizure outcomes using Kaplan-Meier and multivariate analyses.Results:Among the 168 patients included in the study, 95.2% achieved Engel Class I seizure freedom in the first year, with a long-term seizure freedom rate of 85.1%. The mean follow-up duration was 117.74 months. Histopathological evaluations revealed that HS-ILAE Type 1 was the most common classification, identified in 73.8% of cases. Patients with a longer preoperative epilepsy duration had a significantly higher risk of seizure recurrence (p = 0.009). Family history was also significantly associated with seizure control (p = 0.021). However, no significant relationship was found between histopathological classifications and seizure control (p > 0.05).Conclusion:Anterior temporal lobectomy and amygdalohippocampectomy are effective surgical options for achieving high rates of seizure freedom in patients with mesial temporal lobe epilepsy associated with hippocampal sclerosis. Longer preoperative epilepsy duration and a positive family history were identified as negative prognostic factors for seizure recurrence. Our study provides significant contributions to the literature with its long-term follow-up and extensive cohort of adult patients with temporal lobe epilepsy.

Corresponding author : Ozan Hasimoglu