Anterior temporal lobectomy for complex partial seizures: Evaluation, results, and long-term follow-up in 100 cases

Abstract The extent of resection was assessed in 94 patients who underwent temporal lobectomy for medically intractable complex partial seizures originating from a unilateral seizure focus in the anteromesial temporal lobe. Postoperative magnetic resonance imaging in the coronal plane was used to quantify the extent of resection of lateral and mesiobasal structures according to a 20-compartment model of the temporal lobe. Successful seizure outcome (≥90% reduction in seizure frequency) was accomplished in 83% of the patients (all followed up for more than 1 year; mean duration of follow-up, 25.2 months) and correlated significantly (P<0.05) with the extent of mesiobasal resection, regardless of the extent of resection of lateral structures. Successful seizure outcome was accomplished in 81% of the patients with no structural lesions, and also correlated significantly (P<0.05) with the extent of mesiobasal resection regardless of the extent of lateral resection. A successful seizure outcome was accomplished in 90% of the 21 patients with structural lesions documented by neuroimaging studies. Two patients who underwent extensive lobectomy without resection of the structural lesion had no reduction in seizure frequency postoperatively. We conclude that the most important factor in determining the outcome of temporal lobectomy in patients with unilateral anteromesial temporal lobe epileptogenicity is the extent of resection of structures in the mesiobasal temporal lobe. In patients with structural lesions, lesion resection may be an added contributor to successful seizure outcome. (Neurosurgery 29:55-61, 1991)

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Long-term seizure outcome following surgery for dysembryoplastic neuroepithelial tumor

Journal of Neurosurgery ◽

10.3171/jns.2006.104.1.62 ◽

2006 ◽

Vol 104 (1) ◽

pp. 62-69 ◽

Cited By ~ 59

Author(s):

Chow Huat Chan ◽

Richard G. Bittar ◽

Gavin A. Davis ◽

Renate M. Kalnins ◽

Gavin C. A. Fabinyi

Keyword(s):

Outcome Data ◽

Temporal Lobectomy ◽

Class I ◽

Surgical Removal ◽

Dysembryoplastic Neuroepithelial Tumor ◽

Seizure Outcome ◽

Short Term ◽

Long Term Follow Up

Object Resection of dysembryoplastic neuroepithelial tumor (DNET) is thought to result in favorable seizure outcome, but long-term follow-up data are scarce. The authors present a review of 18 patients who underwent surgical removal of a DNET: 12 via temporal lobectomy and six via lesionectomy. Methods The mean long-term follow up was 10.8 years (median 10.4 years, range 7.8 to 14.8 years), and results obtained during this time period were compared with previously reported short-term (mean 2.7 years) seizure outcome data. In the current study, 66.7% patients had an Engel Class I outcome and 55.6% had an Engel Class IA outcome compared with 77.8% and 55.6%, respectively. Temporal lobectomy (Engel Class I, 83.3%; Engel Class IA, 66.7%) led to a better seizure outcome than lesionectomy (Engel Classes I and IA, 33.3%). Two patients (11.1%) required repeated operation and both had an incomplete lesionectomy initially. Conclusions Results indicated that complete resection of a DNET leads to a favorable seizure outcome, with epilepsy cure in those who had experienced early postoperative seizure relief. Long-term seizure outcome after surgery is predictable based on the result of short-term follow up.

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Ultrasound-tailored functional hemispherectomy for surgical control of seizures in children

Neurosurgical FOCUS ◽

10.3171/foc.1996.1.5.5 ◽

1996 ◽

Vol 1 (5) ◽

pp. E4

Author(s):

Paul M. Kanev ◽

Catherine M. Foley ◽

Dan Miles

Keyword(s):

The Body ◽

Temporal Lobectomy ◽

Surgical Time ◽

Postoperative Fever ◽

Intractable Seizures ◽

Functional Hemispherectomy ◽

Fever Syndromes ◽

Long Term Follow Up

Functional hemispherectomy techniques have been designed to minimize the long-term complications of anatomical resection without reducing the effectiveness of seizure control. The authors have used an ultrasound-guided approach tailored to combine temporal lobectomy with frontal and occipital disconnections with a central topectomy of the lateral, insular, and interhemispheric cortex. This technique achieves a comprehensive functional disconnection and minimizes entrance and manipulation within the body of the lateral ventricle. Eight patients ranging in age from 10 months to 23 years with congenital paresis and medically intractable seizures underwent functional hemispherectomy via this technique. The average surgical time was 4.5 hours, and blood loss ranged from 90 to 400 ml. All but one patient was discharged after 5 days. Postoperative fever syndromes, aseptic meningitis, and infection were avoided. On long-term follow-up evaluation (range l8-60 months, mean 38 months), seven of eight patients remain seizure free and were not on a course of anticonvulsant agents. Advantages of this technique include avoiding entrance within the ventricle, a more predictable postoperative period, and reduced postoperative complications.

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Long-term seizure, cognitive, and psychiatric outcome following trans–middle temporal gyrus amygdalohippocampectomy and standard temporal lobectomy

Journal of Neurosurgery ◽

10.3171/2013.3.jns12714 ◽

2013 ◽

Vol 119 (1) ◽

pp. 16-23 ◽

Cited By ~ 37

Author(s):

Krzysztof A. Bujarski ◽

Fuyuki Hirashima ◽

David W. Roberts ◽

Barbara C. Jobst ◽

Karen L. Gilbert ◽

...

Keyword(s):

Temporal Lobectomy ◽

Middle Temporal Gyrus ◽

Seizure Outcome ◽

Middle Temporal ◽

Significant Difference ◽

Long Term Follow Up ◽

Psychiatric Outcomes ◽

Psychiatric Outcome

Object Previous comparisons of standard temporal lobectomy (STL) and selective amygdalohippocampectomy (SelAH) have been limited by inadequate long-term follow-up, variable definitions of favorable outcome, and inadequate consideration of psychiatric comorbidities. Methods The authors performed a retrospective analysis of seizure, cognitive, and psychiatric outcomes in a noncontemporaneous cohort of 69 patients with unilateral refractory temporal lobe epilepsy and MRI evidence of mesial temporal sclerosis after either an STL or an SelAH and examined seizure, cognitive, and psychiatric outcomes. Results The mean duration of follow-up for STL was 9.7 years (range 1–18 years), and for trans–middle temporal gyrus SelAH (mtg-SelAH) it was 6.85 years (range 1–15 years). There was no significant difference in seizure outcome when “favorable” was defined as time to loss of Engel Class I or II status; better seizure outcome was seen in the STL group when “favorable” was defined as time to loss of Engel Class IA status (p = 0.034). Further analysis revealed a higher occurrence of seizures solely during attempted medication withdrawal in the mtg-SelAH group than in the STL group (p = 0.016). The authors found no significant difference in the effect of surgery type on any cognitive and most psychiatric variables. Standard temporal lobectomy was associated with significantly higher scores on assessment of postsurgical paranoia (p = 0.048). Conclusions Overall, few differences in seizure, cognitive, and psychiatric outcome were found between STL and mtg-SelAH on long-term follow-up. Longer exposure to medication side effects after mtg-SelAH may adversely affect quality of life but is unlikely to cause additional functional impairment. In patients with high levels of presurgical psychiatric disease, mtg-SelAH may be the preferred surgery type.

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