The Supracerebellar Transtentorial Approach for Lesional Mediobasal Temporal Lobe Epilepsy: A Systematic Review

Introduction: The Supracerebellar Transtentorial (SCTT) approach emerges as a promising solution for lesional mediobasal temporal region (MTR) epilepsy, potentially improving seizure control and postoperative outcomes. This study aims to assess the adoption, feasibility, safety, and reproducibility of the SCTT approach in treating lesional MTR epilepsy.

Methods: A systematic review was conducted in accordance with the PRISMA guidelines. We queried the MEDLINE, EMBASE, CINAHL, and Cochrane databases from their inception to the present, utilizing the search algorithm outlined. Included were studies that reported surgical and clinical outcomes of patients with lesional MTR epilepsy who underwent surgical treatment via the SCTT approach. No restrictions were imposed on publication date, study type, or language. The frequency distributions of the analyzed parameters were presented using descriptive statistics.

Results: In our comprehensive search, we identified 42 papers, of which only six, initially published in 2001, met our inclusion criteria. These studies collectively involved 64 patients, primarily adults, with a single pediatric series included. All of these patients presented with drug-resistant epilepsy (DRE) linked to lesions in the posterior mediobasal temporal region. The lesion types varied and included cases of mesial temporal sclerosis, cavernous malformation, meningioma, and other intrinsic tumors. Remarkably, the majority of these lesions were situated on the left side. All studies except one utilized the semi-sitting position for surgery. Many of the excluded publications primarily consisted of illustrative videos without reporting patient outcomes, indicating the early adoption phase of this technique. Complete radiological resection was successfully achieved in all cases, and no patients experienced visual or language complications. The follow-up period ranged from 1 to 48 months, though two studies did not specify the exact duration. The studies uniformly concluded that the SCTT approach is both feasible and safe for patients with DRE related to lesions in the MTR, highlighting its effectiveness.

Conclusion : The SCTT approach holds promise for managing lesional MTR epilepsy, although its relative unfamiliarity to neurosurgeons is apparent.