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Surgery of intractable temporal lobe epilepsy presented with structural lesions
Yang-Hsin Shih1, Jiang-Fong Lirng, Der-Jen Yen
1Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan, ROC. yhshih@vghtpe.gov.tw
Journal of the Chinese Medical Association : JCMA
|January 2, 2004
Summary
For intractable temporal lobe epilepsy (TLE) with structural lesions, comprehensive presurgical evaluations are essential. Anterior temporal lobectomy (ATL) combined with lesion removal offers good seizure control outcomes.
Area of Science:
- Neurosurgery
- Epileptology
- Neuroradiology
Background:
- Approximately 30% of surgical specimens from intractable temporal lobe epilepsy (TLE) cases reveal structural lesions.
- Identifying the epileptogenic foci and their correlation with structural lesions is crucial for surgical planning.
- Surgical approaches for TLE with structural lesions yield variable seizure control rates.
Purpose of the Study:
- To evaluate the efficacy of detailed presurgical evaluations in identifying epileptogenic foci and structural lesions in patients with intractable TLE.
- To assess the seizure control outcomes following anterior temporal lobectomy (ATL) in patients with neoplastic and vascular structural lesions.
Main Methods:
- Preoperative investigations included electroencephalogram (EEG), EEG/video monitoring, magnetic resonance imaging (MRI), magnetic resonance spectroscopy (MRS), fluorodeoxyglucose-positron emission tomography (FDG-PET), and neuropsychological assessment.
- A cohort of 217 patients with intractable TLE who underwent ATL between 1987 and 1998 were analyzed.
- Patients were categorized into neoplastic (n=35) and vascular (n=12) groups based on resected specimen pathology.
Main Results:
- In the neoplastic group, 85.7% showed lateralizing EEG abnormalities, and 74.3% had MRI-confirmed tumors. FDG-PET revealed unilateral mesial temporal lobe hypometabolism in 88.2% of cases.
- In the vascular group, 91.6% had unilateral mesial temporal lobe spikes on EEG, and all 12 patients had MRI-detected lesions. FDG-PET showed unilateral mesial temporal lobe hypometabolism in 86% of cases.
- Postoperatively, 73% of the neoplastic group and 100% of the vascular group achieved seizure freedom (mean follow-up 4.2 years).
Conclusions:
- Detailed presurgical evaluations are mandatory for intractable TLE with structural lesions to ensure concordance between lesions and epileptogenic foci.
- Standard anterior temporal lobectomy (ATL) with complete lesion removal can lead to favorable postoperative seizure control.
- Accurate localization and resection of structural lesions are key to successful surgical management of TLE.