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Earlier work used manual piriform cortex segmentations truncated at the limen insulae and overlapping the amygdala. We re-evaluated this association using an investigator-independent, connectivity-based segmentation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Patients with TLE who underwent mesiotemporal epilepsy surgery at a single center with\u2009&gt;\u20091-year postoperative follow-up were included retrospectively (discovery cohort). Postoperative images and connectivity-defined piriform cortex subregions were registered to preoperative T1-weighted scans. Additional manual piriform cortex segmentation was performed for comparison. The extent of resection within temporal lobe subregions was compared between seizure-free (ILAE I) and non-seizure-free patients. Results were validated using a large independent cohort. For additional validation, voxel-based lesion-outcome mapping was performed using logistic regression.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Twenty-eight patients (15 female) with TLE of heterogeneous etiologies were included in the discovery cohort. No significant association between ILAE outcome and the extent of resection within manually or automatically defined piriform cortex was observed. Extensive analyses in the validation cohort (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009305, 205 with hippocampal sclerosis) confirmed this result. Additional voxel-based lesion-outcome mapping (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009305) showed no significant associations with ILAE I outcome. Resected proportions within other mesiotemporal regions were not associated with ILAE I outcome.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>No association between ILAE outcome and the resected proportion of specific mesiotemporal structures was detected. This result was robust across cohorts, piriform cortex definitions and analytical approaches. These results differ from previous reports and suggest that piriform cortex resection should be considered on an individualized basis rather than routinely incorporated into temporal lobe resections.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00415-026-13850-w","type":"journal-article","created":{"date-parts":[[2026,5,22]],"date-time":"2026-05-22T18:12:48Z","timestamp":1779473568000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["No link between piriform cortex subregion resection and seizure freedom in two cohorts with temporal lobe epilepsy"],"prefix":"10.1007","volume":"273","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0366-6724","authenticated-orcid":false,"given":"Felix","family":"Zahnert","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Florian","family":"Pfanzelt","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katja","family":"Menzler","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lena","family":"Habermehl","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Boris","family":"Keil","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lars","family":"Timmermann","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andr\u00e9","family":"Kemmling","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander","family":"Grote","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher","family":"Nimsky","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susanne","family":"Knake","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marcus","family":"Belke","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,5,22]]},"reference":[{"issue":"3","key":"13850_CR1","doi-asserted-by":"publisher","first-page":"279","DOI":"10.1001\/jamaneurol.2017.3949","volume":"75","author":"Z Chen","year":"2018","unstructured":"Chen Z, Brodie MJ, Liew D, Kwan P (2018) Treatment outcomes in patients with newly diagnosed epilepsy treated with established and new antiepileptic drugs: a 30-year longitudinal cohort study. 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F. Zahnert was supported by a grant from the German chapter of the International League Against Epilepsy (DGfE) in the form of an \u2018Otfrid Forster Grant\u2019. Felix Zahnert was furthermore supported by the clinician scientist program of the Philipps-University of Marburg and the LOEWE Research Cluster ADMIT (Advanced Medical Physics in Imaging and Therapy). F. Zahnert received compensation for travel expenses from UCB. F. Pfanzelt reports no disclosures. K. Menzler received speaker honoraria\/consultancy fees from UCB Pharma, Jazz Pharmaceuticals, Eisai and Bial. L. Habermehl received funding from the clinical fellowship program of the German chafter of the ILAE (DGfE) and travel expenses from Jazz pharmaceuticals. B. Keil reports no disclosures. L. Timmermann: Between May 2021 and September 2025 L. Timmermann received occasional payments as a consultant for Boston Scientific (before 2022), L. Timmermann received honoraria as a speaker on symposia sponsored by Boston Scientific, AbbVIE, Novartis, Neuraxpharm, Teva, the Movement Disorders Society und DIAPLAN (before 2022). The institution of L. Timmermann, not L. Timmermann personally received funding by Boston Scientific (before 2022), the German Research Foundation, the German Ministry of Education and Research, the Otto-Loewi-Foundation and the Deutsche Parkinson Vereinigung. Neither L. Timmermann, nor any member of his family holds stocks, stock options, patents or financial interests in any of the above-mentioned companies or their competitors. A. Kemmling is consultant for Phenox, Penumbra, Stryker. A. Grote reports no disclosures. C. Nimsky received speaker honoraria and is consultant for Brainlab, GE BKmedical, and Zeiss. S. Knake received speaker\u00b4s honoraria from Angellini Pharma, Bial, Eisai, Epilog, Desitin, Jazz Pharma, Kanso, Merck Serono, UCB and Zogenix. M. Belke reports no disclosures.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflicts of interest"}},{"value":"The study was approved by the Institutional Review Board of the University of Marburg School of Medicine (IRB00011440) in accordance with the Declaration of Helsinki. The requirement for informed consent was waived for the use of anonymized retrospective data in this study (approval number RS22\/57).","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}}],"article-number":"335"}}