Trends in Anterior Temporal Lobectomy and Selective Amygdalo-Hippocampectomy Performed on the Brazilian Public Health System from 2008 to 2022

To quantify the surgeries for epilepsy performed within the Brazilian Unified Health System (Sistema Único de Saúde, SUS, in Portuguese) in Brazil, analyze their evolution from 2008 to 2022 and evaluate the historical trend within the national territory. The present is a quantitative and descriptive study, with a cross-sectional design, that deals with resective surgeries for epilepsy performed by the SUS, in its regions and federative units from 2008 to 2022. The information was summarized in graphs and tables, with the help of the GraphPad Prism (GraphPad Software, LLC) and R (R Core Team) software. From 2008 to 2022, 2,921 procedures of microsurgery for temporal lobectomy and selective amygdalohippocampectomy were recorded in the Department of Informatics of the Unified Health system (Departamento de Informática do Sistema Único de Saúde, DATASUS, in Portuguese). Out of the total 2,921 microsurgeries performed, 588 were carried out through the Treatment Outside the Home (Tratamento Fora do Domicílio, TFD, in Portuguese) program. Of the 27 federative units, 9 states did not perform this type of surgery. The procedure rate started at 0.145 per 100 thousand inhabitants and reached its peak in 2010 (0.170), representing an increase of 17.2%. From 2011 to 2020, the procedure rate plummeted to its lowest point of 0.027 in 2020, growing again in 2021 and 2022, but with a cumulative decline of 76.9%. Compared to developed countries, Brazil follows the trend of declining rates of temporal lobectomy and selective amygdalohippocampectomy. Although the reasons are not yet clear, while in developed countries this decline seems to be linked to the incorporation of new technologies, in Brazil, the low access of the population to reference centers appears to be the predominant factor.