الفهرس 
IntroductionOnly 14 pages are availabe for public view
 |  | from | 23 |  |  |
| | | from | 23 | | |
Abstract
Many studies were found to assess the radiofrequency ablation for different cerebral targets in treatment of the refractory epilepsy and most of them focused in the amygdala and hippocampus in MTLE. The advancement of the neuroimaging modalities and other investigation tools encouraged more studies that investigate the SEEG thermoablation in epilepsy treatment with more accurate targeting and less surgical exposure .
The prior literature showed that it is is uncommonly with patient with classic features of the mesial temporal lobe epilepsy to be subjected to SEEG. In our series it is noticed that the presence of febrile seizure and positive family history for epilepsy are revealed only in small percentage of the patients not like that commonly found in the mesial temporal lobe epilepsy patients which may reflect the complexity of our patient group that like mentioned before it. Commonly a history of febrile seizure is associated in nearly 60% of patients with tempoal lobe epilepsy118
Initial results for amygdalohippocompectomy :
As mentioned before the amygdala and hippocampus were targeted during neurosurgical procedures for psychatric disorders and the improve of seizure outcome was noticed during follow up for these patients which encourage neurosurgeon to direct the procedure mainly for the epilepsy treatment .
Schwab et al. performed the thermolesion in amygdala aided by depth electrode recording to determine the medial temporal lobe as epileptic focus and he started with small lesion (6 x 7-mm) in the posterior amygdala and three patients became seizure free, and four experienced significant reduction in the frequency and severity of their seizure119.
Another study with larger number of study population with medial temporal lobe epilepsy followed for more than one year had been made by Vaernet and nearly 18% of his patient turned seizure free and 37% of the patients showed more than 50% reduction in seizure frequency120.
The common denominator for these initial studies is the small lesion performed -hence the relatively poor outcome and the lateral temporal or parasagittal approach and this prompts the neurosurgeon to perform the lesioning through occipital approach traversing the longitudinal axis of hippocampus and co-lesioning of both amygdala and hippocampal system like that performed by Nadvornik as the lesion was more extensive along both amygdala and hippocampus (6mm wide and 30-4-mm long) in 8 patients with will defined unilateral temporal lobe foci and five were rendered seizure free and one had auras only while two patients had infrequent seizure121.
This early experience demonstrated that minimally invasive unilateral amygdalotomy and hippocompectomy could be carried out safely27, however the morbidity rate and lack of long term follow up besides the low number of the patients are defined as drawbacks for these initial studies and this explain the disfavor of these approaches for long period especially with the significant evolution of microscopic epilepsy surgery at this time and more favorable outcome regarding both control.