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Hippocampal resection in temporal lobe epilepsy: Do we need to resect the tail?

Dasgupta, Debayan; Finn, Roisin; Chari, Aswin; Giampiccolo, Davide; de Tisi, Jane; O’Keeffe, Aidan G.; Miserocchi, Anna; McEvoy, Andrew W.; Vos, Sjoerd B.; Duncan, John S.

Hippocampal resection in temporal lobe epilepsy: Do we need to resect the tail? Thumbnail


Debayan Dasgupta

Roisin Finn

Aswin Chari

Davide Giampiccolo

Jane de Tisi

Anna Miserocchi

Andrew W. McEvoy

Sjoerd B. Vos

John S. Duncan


Introduction: Anteromesial temporal lobe resection is the most common surgical technique used to treat drug-resistant mesial temporal lobe epilepsy, particularly when secondary to hippocampal sclerosis. Structural and functional imaging data suggest the importance of sparing the posterior hippocampus for minimising language and memory deficits. Recent work has challenged the view that maximal posterior hippocampal resection improves seizure outcome. This study was designed to assess whether resection of posterior hippocampal atrophy was associated with improved seizure outcome. Methods: Retrospective analysis of a prospective database of all anteromesial temporal lobe resections performed in individuals with hippocampal sclerosis at our epilepsy surgery centre, 2013–2021. Pre- and post-operative MRI were reviewed by 2 neurosurgical fellows to assess whether the atrophic segment, displayed by automated hippocampal morphometry, was resected, and ILAE seizure outcomes were collected at 1 year and last clinical follow-up. Data analysis used univariate and binary logistic regression. Results: Sixty consecutive eligible patients were identified of whom 70% were seizure free (ILAE Class 1 & 2) at one year. There was no statistically significant difference in seizure freedom outcomes in patients who had complete resection of atrophic posterior hippocampus or not (Fisher's Exact test statistic 0.69, not significant at p <.05) both at one year, and at last clinical follow-up. In the multivariate analysis only a history of status epilepticus (OR=0.2, 95%CI:0.042–0.955, p =.04) at one year, and pre-operative psychiatric disorder (OR=0.145, 95%CI:0.036–0.588, p =.007) at last clinical follow-up, were associated with a reduced chance of seizure freedom. Significance: Our data suggest that seizure freedom is not associated with whether or not posterior hippocampal atrophy is resected. This challenges the traditional surgical dogma of maximal posterior hippocampal resection in anteromesial temporal lobe resections and is a step further optimising this surgical procedure to maximise seizure freedom and minimise associated language and memory deficits.


Dasgupta, D., Finn, R., Chari, A., Giampiccolo, D., de Tisi, J., O’Keeffe, A. G., …Duncan, J. S. (2023). Hippocampal resection in temporal lobe epilepsy: Do we need to resect the tail?. Epilepsy Research, 190, Article 107086.

Journal Article Type Article
Acceptance Date Jan 9, 2023
Online Publication Date Jan 27, 2023
Publication Date Feb 1, 2023
Deposit Date Jan 18, 2023
Publicly Available Date Jan 27, 2023
Journal Epilepsy Research
Print ISSN 0920-1211
Electronic ISSN 1872-6844
Publisher Elsevier BV
Peer Reviewed Peer Reviewed
Volume 190
Article Number 107086
Keywords Neurology (clinical); Neurology
Public URL
Publisher URL
Additional Information This article is maintained by: Elsevier; Article Title: Hippocampal resection in Temporal Lobe epilepsy: do we need to resect the tail?; Journal Title: Epilepsy Research; CrossRef DOI link to publisher maintained version:; Content Type: article; Copyright: © 2023 The Authors. Published by Elsevier B.V.


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