Failure of temporal lobe resection for epilepsy in patients with mesial temporal sclerosis: Results and treatment options: Clinical article

Edwin Ramos, Selim Benbadis, Fernando Vale Diaz

Research output: Contribution to journalArticle

33 Citations (Scopus)

Abstract

Object. The purpose of this study was to identify the causes of failed temporal lobe resection in patients with mesial temporal sclerosis (MTS) and the role of repeat surgery for seizure control. Methods. This is a retrospective study of 105 patients who underwent temporal lobe resection for MTS with unilateral electroencephalographic findings. The mean follow-up duration was 36 months (range 24-84 months). Surgeries were all performed by the senior author (F.L.V.). Results. Following initial surgical intervention, 97 patients (92%) improved to Engel Class I or II (Group A), and 8 (8%) did not have significant improvement (Engel Class III or IV; Group B). These 8 patients were restudied using video-electroencephalography (EEG) and MR imaging. All major surgical failures occurred within 1 year after initial intervention. Reevaluation demonstrated 3 patients (37.5%) with contralateral temporal EEG findings. Five patients (62.5%) had evidence of ipsilateral recurrent discharges. Four patients underwent extended neocortical resection along the previous resection cavity. Their outcomes ranged from Engel Class I to Class III. Only 1 patient (12.5%) who failed to improve after initial surgery was found to have incomplete resection of mesial structures. This last patient underwent reoperation to complete the resection and improved to Engel Class I. Conclusions. Failure of temporal lobe resection for MTS is multifactorial. The cause of failure lies in the pathological substrate of the epileptogenic area. Complete seizure control cannot be predicted solely by conventional preoperative workup. Initial surgical failures from temporal lobe resection often benefit from reevaluation, because reoperation may be beneficial in selected patients. Based on this work, the authors have proposed a management and treatment algorithm for these patients.

Original languageEnglish (US)
Pages (from-to)1127-1134
Number of pages8
JournalJournal of neurosurgery
Volume110
Issue number6
DOIs
StatePublished - Jun 1 2009
Externally publishedYes

Fingerprint

Temporal Lobe Epilepsy
Sclerosis
Temporal Lobe
Reoperation
Therapeutics
Electroencephalography
Seizures
Operative Time
Retrospective Studies

Keywords

  • Amygdalohippocampectomy
  • Epilepsy surgery
  • Mesial temporal sclerosis
  • Reoperation
  • Temporal lobectomy

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery

Cite this

Failure of temporal lobe resection for epilepsy in patients with mesial temporal sclerosis : Results and treatment options: Clinical article. / Ramos, Edwin; Benbadis, Selim; Vale Diaz, Fernando.

In: Journal of neurosurgery, Vol. 110, No. 6, 01.06.2009, p. 1127-1134.

Research output: Contribution to journalArticle

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abstract = "Object. The purpose of this study was to identify the causes of failed temporal lobe resection in patients with mesial temporal sclerosis (MTS) and the role of repeat surgery for seizure control. Methods. This is a retrospective study of 105 patients who underwent temporal lobe resection for MTS with unilateral electroencephalographic findings. The mean follow-up duration was 36 months (range 24-84 months). Surgeries were all performed by the senior author (F.L.V.). Results. Following initial surgical intervention, 97 patients (92{\%}) improved to Engel Class I or II (Group A), and 8 (8{\%}) did not have significant improvement (Engel Class III or IV; Group B). These 8 patients were restudied using video-electroencephalography (EEG) and MR imaging. All major surgical failures occurred within 1 year after initial intervention. Reevaluation demonstrated 3 patients (37.5{\%}) with contralateral temporal EEG findings. Five patients (62.5{\%}) had evidence of ipsilateral recurrent discharges. Four patients underwent extended neocortical resection along the previous resection cavity. Their outcomes ranged from Engel Class I to Class III. Only 1 patient (12.5{\%}) who failed to improve after initial surgery was found to have incomplete resection of mesial structures. This last patient underwent reoperation to complete the resection and improved to Engel Class I. Conclusions. Failure of temporal lobe resection for MTS is multifactorial. The cause of failure lies in the pathological substrate of the epileptogenic area. Complete seizure control cannot be predicted solely by conventional preoperative workup. Initial surgical failures from temporal lobe resection often benefit from reevaluation, because reoperation may be beneficial in selected patients. Based on this work, the authors have proposed a management and treatment algorithm for these patients.",
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