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Peer-reviewedCC BY 4.0Neurosurgical Review

Standard anterior temporal lobectomy using a retractorless technique in patients with drug-resistant mesial temporal lobe epilepsy: long-term seizure outcomes and predictors of postoperative seizure freedom

  • Chonnawee Chaisawasthomrong1,2,3
  • Bunpot Sitthinamsuwan2,4
  • Chottiwat Tansirisithikul2,4
  • Chumpon Jetjumnong5
  • Sattawut Wongwiangjunt6
  • Vasinee Viarasilpa6
  • Peerada Pongsakornkullachart7
  • Sorawit Viravan7
  • Kanokwan Boonyapisit6
  • Jedsada Thaweepoksomboon6,8
  • Chanon Ngamsombat9
  • Nasuda Danchaivijitr9
1 more authors
  • Sarun Nunta-aree2,4
9 affiliations
  1. 1Faculty of Graduate Studies, Mahidol University, Nakhon Pathom, Thailand
  2. 2Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
  3. 3Department of Surgery, Ratchaburi Hospital, Ratchaburi, Thailand
  4. 4Division of Neurosurgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
  5. 5Division of Neurosurgery, Department of Surgery, Chiang Mai University, Chiang Mai, Thailand
  6. 6Division of Neurology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
  7. 7Division of Neurology, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
  8. 8Department of Internal Medicine, Siriraj Piyamaharajkarun Hospital, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
  9. 9Department of Radiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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Abstract

Background: Fixed brain retractors risk focal ischemia and cortical injury. Although retractorless dynamic retraction is established in skull base surgery, its role in epilepsy surgery remains poorly characterized. Objective: To evaluate long-term seizure outcomes, safety, and reliability of retractorless standard anterior temporal lobectomy (ATL) in drug-resistant mesial temporal lobe epilepsy (MTLE), and identify predictors of seizure freedom. Methods: We retrospectively analyzed 42 patients who underwent retractorless standard ATL for drug-resistant MTLE. Dynamic retraction used bipolar forceps and pressure-controlled suction. The primary outcome was seizure freedom (Engel Class Ia) at minimum 24-month follow-up; secondary outcomes were complications and resection adequacy on postoperative magnetic resonance imaging (MRI). Predictors were identified using multivariable logistic regression and Cox proportional hazards models. Results: At a mean follow-up of 66.3 months, 69% of patients achieved complete seizure freedom (Engel Class Ia), and 83.3% achieved freedom from disabling seizures (Engel Class I). Postoperative MRI confirmed adequate resection in 95.2% of cases. Complications were uncommon and unrelated to retraction injury. Low preoperative seizure frequency (< 3 seizures/week) was the sole independent predictor of seizure freedom (odds ratio, 24.21; P = 0.026), while higher frequency (≥ 3 seizures/week) was associated with increased recurrence risk (hazard ratio, 7.34; P = 0.042). Conclusion: Retractorless standard ATL is safe and effective for drug-resistant MTLE, achieving long-term seizure control while minimizing retraction-associated risks. Preoperative seizure burden was the dominant prognostic marker, supporting early surgical intervention.

Supplementary Information: The online version contains supplementary material available at https://doi.org/10.1007/s10143-026-04555-9.

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Cite

BibTeXRIS
BibTeX
@article{chaisawasthomrong2026standard,
  title = {{Standard anterior temporal lobectomy using a retractorless technique in patients with drug-resistant mesial temporal lobe epilepsy: long-term seizure outcomes and predictors of postoperative seizure freedom}},
  author = {Chonnawee Chaisawasthomrong and Bunpot Sitthinamsuwan and Chottiwat Tansirisithikul and Chumpon Jetjumnong and Sattawut Wongwiangjunt and Vasinee Viarasilpa and Peerada Pongsakornkullachart and Sorawit Viravan and Kanokwan Boonyapisit and Jedsada Thaweepoksomboon and Chanon Ngamsombat and Nasuda Danchaivijitr and Sarun Nunta-aree},
  journal = {Neurosurgical Review},
  year = {2026},
  month = nov,
  doi = {10.1007/s10143-026-04555-9},
  url = {https://doi.org/10.1007/s10143-026-04555-9},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - Standard anterior temporal lobectomy using a retractorless technique in patients with drug-resistant mesial temporal lobe epilepsy: long-term seizure outcomes and predictors of postoperative seizure freedom
AU  - Chonnawee Chaisawasthomrong
AU  - Bunpot Sitthinamsuwan
AU  - Chottiwat Tansirisithikul
AU  - Chumpon Jetjumnong
AU  - Sattawut Wongwiangjunt
AU  - Vasinee Viarasilpa
AU  - Peerada Pongsakornkullachart
AU  - Sorawit Viravan
AU  - Kanokwan Boonyapisit
AU  - Jedsada Thaweepoksomboon
AU  - Chanon Ngamsombat
AU  - Nasuda Danchaivijitr
AU  - Sarun Nunta-aree
PY  - 2026
DA  - 2026/11/03
JO  - Neurosurgical Review
DO  - 10.1007/s10143-026-04555-9
UR  - https://doi.org/10.1007/s10143-026-04555-9
AB  - Background: Fixed brain retractors risk focal ischemia and cortical injury. Although retractorless dynamic retraction is established in skull base surgery, its role in epilepsy surgery remains poorly characterized. Objective: To evaluate long-term seizure outcomes, safety, and reliability of retractorless standard anterior temporal lobectomy (ATL) in drug-resistant mesial temporal lobe epilepsy (MTLE), and identify predictors of seizure freedom. Methods: We retrospectively analyzed 42 patients who underwent retractorless standard ATL for drug-resistant MTLE. Dynamic retraction used bipolar forceps and pressure-controlled suction. The primary outcome was seizure freedom (Engel Class Ia) at minimum 24-month follow-up; secondary outcomes were complications and resection adequacy on postoperative magnetic resonance imaging (MRI). Predictors were identified using multivariable logistic regression and Cox proportional hazards models. Results: At a mean follow-up of 66.3 months, 69% of patients achieved complete seizure freedom (Engel Class Ia), and 83.3% achieved freedom from disabling seizures (Engel Class I). Postoperative MRI confirmed adequate resection in 95.2% of cases. Complications were uncommon and unrelated to retraction injury. Low preoperative seizure frequency (< 3 seizures/week) was the sole independent predictor of seizure freedom (odds ratio, 24.21; P = 0.026), while higher frequency (≥ 3 seizures/week) was associated with increased recurrence risk (hazard ratio, 7.34; P = 0.042). Conclusion: Retractorless standard ATL is safe and effective for drug-resistant MTLE, achieving long-term seizure control while minimizing retraction-associated risks. Preoperative seizure burden was the dominant prognostic marker, supporting early surgical intervention.  Supplementary Information: The online version contains supplementary material available at https://doi.org/10.1007/s10143-026-04555-9.
SN  - 0344-5607
SN  - 1437-2320
ER  -