[Visual field disorder after surgery of temporal lobe epilepsy associated to hippocampus sclerosis].

OBJECTIVE: Assessment of frequency and severity of visual field disorders after neurosurgical operations at patients with pharmacoresistant form of epilepsy in hippocampus sclerosis.

MATERIAL AND METHODS: The study included 48 patients having surgical operations for a pharmacoresistant form of temporal lobe epilepsy due to hippocampus sclerosis. Anterior lobectomy with amygdalohippocampectomy (LE + AHE) was performed in 25 patients; Selective amygdalohippocampectomy (SAHE) was performed in 23 patients. We evaluated both the frequency of cases of homonymous visual field disorders and their severity.

RESULTS: After surgery the normal visual field was preserved at 7 (14.6%) patients. The appearance of visual field disorder by the type of homonymous hemianopsia was observed at 41 (85.4%) patients. When assessing the severity of visual field disorder, the smallest disorder was at patients who underwent sub-temporal access of SAHE: a statistically significant difference in the frequency of severe visual field disorder was revealed when comparing this group with patients having LE + AHE (p<0.02), as well as with patients having SAHE with access through sylvian gap (p<0.02).

CONCLUSION: SAHE with sub-temporal access allows maintaining or minimally injuring the central optic neuron fibers, including the Meyer loop at patients operated for symptomatic temporal lobe epilepsy.