Tailored temporal lobectomy for medically intractable epilepsy: Evaluation of pathology and predictors of outcome

Steven M. Falowski, David Wallace, Andres Kanner, Michael Smith, Michael Rossi, Antoaneta Balabanov, Bichun Ouyang, Richard W. Byrne

Research output: Contribution to journalArticlepeer-review

11 Scopus citations

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.

Original languageEnglish (US)
Pages (from-to)703-709
Number of pages7
JournalNeurosurgery
Volume71
Issue number3
DOIs
StatePublished - Sep 1 2012
Externally publishedYes

Keywords

  • Engel class
  • Hippocampectomy
  • Mesial temporal sclerosis
  • Seizure outcome
  • Tailored temporal lobectomy
  • Temporal lobe epilepsy
  • Temporal lobectomy

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

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