Prognostic value of histopathologic pattern for long-term surgical outcomes of 198 patients with confirmed mesial temporal lobe epilepsy

Hippocampal sclerosis (HS) is the most common neuropathologic findings in patients with intractable temporal lobe epilepsy (TLE). The international league against epilepsy has proposed a new classification of HS based on pyramidal cell loss on different subfields to facilitate the study of HS pathology in patients after anterior temporal lobectomy (ATL), and the influence of these HS patterns on the prognosis of patients with TLE is contradictory. This study aims to investigate the relationship between different HS subtypes and postoperative seizure outcomes for intractable patients with TLE. From January 2008 to December 2018, we retrospectively reviewed 198 TLE patients with ATL surgery, and all patients had a complete preoperative evaluation, a specimen of hippocampal tissue after surgery, cognitive test after surgery, and more than 2 years of postoperative follow-up. The main findings were as follows: 1) temporal neocortical gray matter heterotopia were more common in the no-HS group; 2) HS type 1 was associated with a longer duration of epilepsy; 3) history of meningitis was the independent predictor of HS type 1; 4) no-HS patients experienced worse postoperative seizure outcomes than those with HS type1 and type 2, whereas no difference in seizure outcomes was obtained between HS type 1 and type 2; 5) no-HS patients were at increased risk for verbal memory decline after left hippocampal resection. The HS subtypes were associated with the prognosis of patients with TLE, and other variables were the predictors of different HS types. `Further study was to identify the HS subtypes by noninvasive evaluation to approve better postoperative outcomes.