Extent of Mesiobasal Resection Determines Outcome after Temporal Lobectomy for Intractable Complex Partial Seizures

Neurosurgery ◽  
1991 ◽  
Vol 29 (1) ◽  
pp. 55-61 ◽  
Author(s):  
Mohamed H. Nayel ◽  
Issam A. Awad ◽  
Hans Luders
Keyword(s):  
Temporal Lobe ◽  
Seizure Frequency ◽  
Compartment Model ◽  
Extent Of Resection ◽  
Temporal Lobectomy ◽  
Seizure Outcome ◽  
Partial Seizures ◽  
Complex Partial Seizures ◽  
Lateral Structures

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)

Lesionectomy versus electrophysiologically guided resection for temporal lobe tumors manifesting with complex partial seizures

1995 ◽  
Vol 83 (2) ◽  
pp. 231-236 ◽  
Author(s):  
Rashid Jooma ◽  
Hwa-shain Yeh ◽  
Michael D. Privitera ◽  
Maureen Gartner
Keyword(s):  
Surgical Treatment ◽  
Temporal Lobe ◽  
Analysis Of Covariance ◽  
Temporal Lobectomy ◽  
Epileptogenic Zone ◽  
Partial Seizures ◽  
Complex Partial Seizures ◽  
Group A ◽  
Group B

✓ Complex partial seizures associated with tumors and other mass lesions are readily diagnosed by modern imaging techniques but their optimum surgical treatment remains unresolved. Lesionectomy has been reported to produce seizure outcomes equal to outcomes after resection that ablates the epileptogenic cortex with the lesion. However, some evidence suggests that when the lesion is in the temporal lobe, simple excision of the tumor or lesion more often fails to control seizures. After retrospectively reviewing the records of 30 patients with complex partial seizures and temporal lobe tumors who underwent surgical treatment at the University of Cincinnati hospitals (1985–1992), the authors divided them into two groups: Group A (16 patients) underwent lesionectomy only and Group B (14 patients) received surgical treatment for seizures with electroencephalographic delineation of the epileptogenic zone and resection of the lesion. Seizure control was best achieved in Group B patients with 13 (92.8%) seizure free at follow up (mean 52 months). Only three (18.8%) of the Group A patients became seizure free after lesionectomy at follow up (mean 33 months). In eight Group A patients, who underwent temporal lobectomy as a second procedure after lesionectomy failed to control seizures, five (62.5%) became seizure free. Group B patients had a longer duration of seizures and were more likely to have lesions smaller than 2.5 cm compared with Group A. Analysis of covariance demonstrated that the differences in outcome between the groups remained significant even with adjustment for the variation in duration of seizures (p = 0.0006) and size of tumor (p = 0.0001). Based on this study, the authors found that the probable relief from seizures caused by a temporal lobe lesion is greater if the region of epileptogenicity, usually the amygdalohippocampal complex, is resected along with the tumor in a temporal lobectomy.

Seizure Types and Frequency in Patients Who “Fail” Temporal Lobectomy for Intractable Epilepsy

Neurosurgery ◽  
2013 ◽  
Vol 73 (5) ◽  
pp. 838-844 ◽  
Author(s):  
Dario J. Englot ◽  
Anthony T. Lee ◽  
Catherine Tsai ◽  
Cathra Halabi ◽  
Nicholas M. Barbaro ◽  
...  
Keyword(s):  
Intractable Epilepsy ◽  
Temporal Lobectomy ◽  
Seizure Type ◽  
Seizure Outcome ◽  
Seizure Freedom ◽  
Partial Seizures ◽  
Complex Partial Seizures ◽  
Generalized Seizures ◽  
Number Of Patients ◽  
Before And After

Abstract BACKGROUND: Temporal lobectomy can lead to favorable seizure outcomes in medically-refractory temporal lobe epilepsy (TLE). Although most studies focus on seizure freedom after temporal lobectomy, less is known about seizure semiology in patients who “fail” surgery. Morbidity differs between seizure types that impair or spare consciousness. Among TLE patients with seizures after surgery, how does temporal lobectomy influence seizure type and frequency? OBJECTIVE: To characterize seizure types and frequencies before and after temporal lobectomy for TLE, including consciousness-sparing or consciousness-impairing seizures. METHODS: We performed a retrospective longitudinal cohort study examining patients undergoing temporal lobectomy for epilepsy at our institution from January 1995 to August 2010. RESULTS: Among 241 TLE patients who received temporal lobectomy, 174 (72.2%) patients achieved Engel class I outcome (free of disabling seizures), including 141 (58.5%) with complete seizure freedom. Overall seizure frequency in patients with persistent postoperative seizures decreased by 70% (P < .01), with larger reductions in consciousness-impairing seizures. While the number of patients experiencing consciousness-sparing simple partial seizures decreased by only 19% after surgery, the number of individuals having consciousness-impairing complex partial seizures and generalized tonic-clonic seizures diminished by 70% and 68%, respectively (P < .001). Simple partial seizure was the predominant seizure type in 19.1% vs 37.0% of patients preoperatively and postoperatively, respectively (P < .001). Favorable seizure outcome was predicted by a lack of generalized seizures preoperatively (odds ratio 1.74, 95% confidence interval 1.06-2.86, P < .5). CONCLUSION: Given important clinical and mechanistic differences between seizures with or without impairment of consciousness, seizure type and frequency remain important considerations in epilepsy surgery.

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

Neurology ◽  
1990 ◽  
Vol 40 (3, Part 1) ◽  
pp. 413-413 ◽  
Author(s):  
T. S. Walczak ◽  
R. A. Radtke ◽  
J. O. McNamara ◽  
D. V. Lewis ◽  
J. S. Luther ◽  
...  
Keyword(s):  
Temporal Lobectomy ◽  
Partial Seizures ◽  
Complex Partial Seizures ◽  
Anterior Temporal Lobectomy ◽  
Long Term Follow Up

scholarly journals Gamma Knife radiosurgery for recurrent or residual seizures after anterior temporal lobectomy in mesial temporal lobe epilepsy patients with hippocampal sclerosis: long-term follow-up results of more than 4 years

2015 ◽  
Vol 123 (6) ◽  
pp. 1375-1382 ◽  
Author(s):  
Eun Mi Lee ◽  
Joong Koo Kang ◽  
Sang Joon Kim ◽  
Seok Ho Hong ◽  
Tae Sung Ko ◽  
...  
Keyword(s):  
Temporal Lobe ◽  
Hippocampal Sclerosis ◽  
Gamma Knife Radiosurgery ◽  
Mesial Temporal Lobe Epilepsy ◽  
Temporal Lobectomy ◽  
Seizure Outcome ◽  
Anterior Temporal Lobectomy ◽  
Mesial Temporal Lobe ◽  
Signal Changes

OBJECTGamma Knife radiosurgery (GKRS) has proven efficacy in the treatment of drug-resistant mesial temporal lobe epilepsy with hippocampal sclerosis (MTLE-HS) and is comparable to conventional resective surgery. It may be effective as an alternative treatment to reoperation after failed temporal lobe surgery in patients with MTLE-HS. The purpose of this study was to investigate the efficacy of GKRS in patients with unilateral MTLE-HS who did not achieve seizure control or had recurrent seizures after anterior temporal lobectomy (ATL).METHODSTwelve patients (8 males; mean age 35.50 ± 9.90 years) with MTLE-HS who underwent GKRS after failed ATL (Engel Classes III–IV) were included. GKRS targets included the remnant tissue or adjacent regions of the previously performed ATL with a marginal dose of 24–25 Gy at the 50% isodose line in all patients. Final seizure outcome was assessed using Engel’s modified criteria during the final 2 years preceding data analysis. A comparison between signal changes on follow-up MRI and clinical outcome was performed.RESULTSAll patients were followed up for at least 4 years with a mean duration of 6.18 ± 1.77 years (range 4–8.8 years) after GKRS. At the final assessment, 6 of 12 patients were classified as seizure free (Engel Class Ia, n = 3; Ic, n = 2; and Id, n = 1) and 6 patients were classified as not seizure free (Engel Class II, n = 1; III, n = 2; and IV, n = 3). Neither initial nor late MRI signal changes after GKRS statistically correlated with surgical outcome. Clinical seizure outcome did not differ significantly with initial or late MRI changes after GKRS.CONCLUSIONSGKRS can be considered an alternative option when the patients with MTLE-HS who had recurrent or residual seizures after ATL refuse a second operation.

scholarly journals Surgical and seizure outcome in children with DNETs who underwent epilepsy surgery

2015 ◽  
Vol 42 (S1) ◽  
pp. S22-S22
Author(s):  
AM Bueckert ◽  
J Pugh ◽  
T Snyder ◽  
M Wheatley ◽  
F Jacob ◽  
...  
Keyword(s):  
Surgical Resection ◽  
Epilepsy Surgery ◽  
Tumor Resection ◽  
Retrospective Chart Review ◽  
Benign Tumors ◽  
Seizure Outcome ◽  
Low Grade ◽  
Partial Seizures ◽  
Complex Partial Seizures

Background: Dysembryoblastic neuroepithelial tumors (DNETs) are benign tumors of the cerebral cortex that most commonly occur in children or young adults. Seizures are a frequent presenting feature, with an incidence of 80-100%, and are often an indication for surgical resection. Methods: We performed a retrospective chart review of children with DNETs who underwent epilepsy surgery between 1998 and 2014. Results: A total of 12 subjects were identified (6 males, 6 females), all of whom had seizures prior to surgical resection. Of these patients, 1 had infantile spasms, 2 had simple partial seizures and 10 had complex partial seizures. Tumors were located in the temporal (n=7), frontal (n=3) or parietal (n=2) cortex. These patients went on to have surgery on average 15 months after seizure onset, 3 had incomplete resections. At an average follow up of 6 years 4 months, all patients were class 1 on Engel’s Classification. All but one subject with rare non-disabling seizures were seizure free, with only 6 on medication. Follow up MR imaging revealed tumor recurrence in 1 subject. Conclusions: Despite differing seizure seminology and tumor location, surgical resection of these low-grade tumors resulted in excellent seizure outcome even in the setting of incomplete tumor resection.

Tailored Temporal Lobectomy for Medically Intractable Epilepsy

Neurosurgery ◽  
2012 ◽  
Vol 71 (3) ◽  
pp. 703-709 ◽  
Author(s):  
Steven M. Falowski ◽  
David Wallace ◽  
Andres Kanner ◽  
Michael Smith ◽  
Michael Rossi ◽  
...  
Keyword(s):  
Temporal Lobe ◽  
Hippocampal Sclerosis ◽  
Intractable Epilepsy ◽  
Temporal Lobectomy ◽  
Class I ◽  
Visual Field Defects ◽  
Seizure Outcome ◽  
Temporal Lobe Resection ◽  
Generalized Epilepsy

Abstract BACKGROUND: There have been only a few large series that have used a tailored temporal lobectomy. OBJECTIVE: To clarify whether tailoring a temporal lobe resection will lead to equivalent epilepsy outcomes or have the same predictive factors for success when compared with standard resections. METHODS: Retrospective analysis of 222 patients undergoing a tailored temporal lobe resection. Demographic measures and typical factors influencing outcome were evaluated. RESULTS: Pathology included 222 cases. With a mean follow-up of 5.4 years, 70% of patients achieved Engel class I outcome. A significant factor predicting Engel class I outcome on multivariate analysis was lesional pathology (P = .04). Among patients with hippocampal sclerosis, extent of lateral neocortical resection and hippocampal resection were not statistically associated with Engel class I outcome (P = .93 and P = .24). However, an analysis of Engel class subgroups a to d showed that patients who had a complete hippocampectomy in the total series were more likely to achieve an Engel class Ia outcome (P = .04). This was also true among patients with hippocampal sclerosis (P = .03). Secondarily, generalized seizure (P = .01) predicted outcome less than Engel class I. Predictive of poor outcome was the need for preoperative electrodes (P = .02). Complications included superior quadrant visual field defects, 2 cases of permanent dysphasia, and 3 wound infections. CONCLUSION: Predictors of successful seizure outcome for a tailored temporal lobectomy are similar to standard lobectomy. Patients with secondarily generalized epilepsy and cases in which preoperative subdural electrodes were thought necessary were less likely to achieve class I outcome. Among Engel class I cases, those who had a complete hippocampectomy were more likely to achieve Engel class Ia outcome.

scholarly journals Transient Hemifacial Sensory Loss with Xerophthalmia following Temporal Lobectomy

2000 ◽  
Vol 27 (3) ◽  
pp. 251-253 ◽  
Author(s):  
Ajith J. Thomas ◽  
Kost Elisevich ◽  
Brien Smith
Keyword(s):  
Temporal Lobe ◽  
Clinical Presentation ◽  
Nasal Congestion ◽  
Temporal Lobectomy ◽  
Sensory Loss ◽  
Partial Seizures ◽  
Complex Partial Seizures ◽  
Cavernous Malformations ◽  
Greater Superficial Petrosal Nerve ◽  
The Right

Objective and importance:The occurrence of a unilateral sensory loss in the second trigeminal distribution and the inability to tear following an ipsilateral temporal lobectomy has not been noted despite a number of reports of cranial nerve compromise under similar situations.Clinical presentation:A 48-year-old woman experienced complex partial seizures over three years attributable to the presence of cavernous malformations of the right temporal lobe.Intervention:An anterior temporal extrahippocampal resection was performed. The surgery was marked by the need for electrocoagulation of the dural base of the temporal lobe where numerous bleeding points were encountered. Postoperatively, the patient experienced an ipsilateral maxillary division sensory loss, absence of tearing, and diminished nasal congestion for an eight-month period until resolution.Conclusion:Injury of the fibers of the maxillary division of the trigeminal nerve and the adjacent greater superficial petrosal nerve appears to be the cause. No prior account of such an occurrence has been published.

Responsive Neurostimulation of the Mesial Temporal White Matter in Bilateral Temporal Lobe Epilepsy

Neurosurgery ◽  
2020 ◽  
Author(s):  
Ravi S Nunna ◽  
Alireza Borghei ◽  
Bledi C Brahimaj ◽  
Fiona Lynn ◽  
Diego Garibay-Pulido ◽  
...  
Keyword(s):  
White Matter ◽  
Temporal Lobe Epilepsy ◽  
Temporal Lobe ◽  
Seizure Frequency ◽  
Mesial Temporal Lobe Epilepsy ◽  
Temporal Lobectomy ◽  
Surgical Interventions ◽  
Temporal Stem ◽  
Postoperative Seizure

Abstract BACKGROUND Responsive neuromodulation (RNS) is a treatment option for patients with medically refractory bilateral mesial temporal lobe epilepsy (MTLE). A paucity of data exists on the feasibility and clinical outcome of hippocampal-sparing bilateral RNS depth lead placements within the parahippocampal white matter or temporal stem. OBJECTIVE To evaluate seizure reduction outcomes with at least a 1-yr follow-up in individuals with bilateral MTLE undergoing hippocampus-sparing implantation of RNS depth leads. METHODS A retrospective analysis of prospectively collected data was performed on patients at our institution with bilateral MTLE who were implanted with RNS depth leads along the longitudinal extent of bitemporal parahippocampal white matter or temporal stem. Baseline and postoperative seizure frequency, previous surgical interventions, and postimplantation electrocorticography and stimulation data were analyzed. RESULTS Ten patients were included in the study (7 male, 3 female). Overall seizure frequency declined by a median 44.25% at 3.13 yr (standard deviation 3.31) postimplantation. Four patients (40%) achieved 50% responder rate at latest follow-up. Two of four patients with focal onset bilateral tonic-clonic seizures became completely seizure-free. Forty percent of patients were previously implanted with a vagus nerve stimulator, and 20% underwent a prior temporal lobectomy. All depth lead placements were confirmed as radiographically located in the parahippocampal white matter or temporal stem without hippocampus violation. There were no cases of lead malposition. CONCLUSION Extrahippocampal or temporal stem white matter targeting during RNS surgery for bitemporal MTLE is feasible and allows for electrographic seizure detection. Larger controlled studies with longer follow-up are needed to validate these preliminary findings.

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