Anterior temporal lobectomy and selective AmygdaloHippocampectomy complications across Europe: review, meta-analysis, and Delphi consensus

Introduction Epilepsy is a neurological disorder affecting over 50 million people globally, with around 30 % of them classified as having drug-resistant epilepsy (DRE). Temporal lobe epilepsy (TLE) is the most frequently encountered type of surgically treated epilepsy. The primary surgical approaches for TLE include anterior temporal lobectomy (ATL) and selective amygdalohippocampectomy (selAH). Research question This study sought to gather expert European consensus on surgical strategies and complication rate for ATL and selAH, in both adult and pediatric patients. Materials and methods A modified Delphi technique was employed, with 39 experienced epilepsy surgeons from 35 different European centers. A 22-item questionnaire addressed key surgical considerations, including mortality, morbidity, neurological deficits, infection rates, and potential psychiatric and cognitive complications. Results The survey had a 43 % response rate. Mortality rates for both surgical approaches ranged between 0 and 1 %. Visual field deficits (VFDs) were more frequently observed after ATL (over 16 %) compared to selAH (2-10 %). Permanent motor deficits were rare (<2 %), while complications such as infections and hematomas were reported in 0-2 % and less than 5 % of cases, respectively for both procedures. While psychiatric and cognitive complications were acknowledged, no consensus was reached regarding their prevalence or screening methods. Discussion The results underscore the value of advanced imaging, thorough preoperative evaluation, and intraoperative monitoring. Future research is needed to refine outcome optimization and standardize training protocols. Conclusions Consensus was achieved on critical aspects of surgical planning and complication management, providing support for the development of standardized practices in temporal lobe epilepsy surgery.