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Updated: Aug 18, 2026
Anteromesial Temporal Lobectomy for Medically Intractable Temporal Lobe Epilepsy: An Operative Study
Published on: August 15, 2025
Surgical management of temporal lobe tumor-related epilepsy in children
Oguz Cataltepe1, Güzide Turanli, Dilek Yalnizoglu
1Departments of Neurosurgery and Pediatric Neurology, Hacettepe University Medical School, Ankara, Turkey. catalteo@um.mhc.org
Insights
Surgical resection of low-grade temporal lobe tumors in children with epilepsy can lead to high rates of seizure freedom. Gross-total tumor removal improves outcomes, with tailored approaches based on tumor location and proximity to eloquent cortex.
Area of Science:
- Pediatric Neurosurgery
- Epilepsy Surgery
- Neuroncology
Background:
- Slow-growing, low-grade temporal lobe tumors are a common cause of pediatric epilepsy.
- Management and surgical strategies for these tumors lack consensus.
Purpose of the Study:
- To review clinical, pathological, and radiological features of pediatric temporal lobe tumors associated with epilepsy.
- To discuss surgical treatment strategies and outcomes in 29 pediatric patients.
Main Methods:
- Retrospective review of medical records for 29 pediatric patients (ages 2-18) with temporal lobe tumor-related epilepsy.
- Analysis of seizure data, electrophysiology, imaging, operative details, pathology, and follow-up.
- Surgical approaches included lesionectomy with/without cortical resection or amygdalohippocampectomy based on tumor location.
Main Results:
- Most tumors were mesially located, with dysembryoplastic neuroepithelial tumors being the most common pathology.
- 69% of patients achieved seizure freedom (Engel Class I), and 14% showed significant improvement (Engel Class II) post-surgery.
- Gross-total tumor resection correlated with better seizure control outcomes.
Conclusions:
- Mesial low-grade temporal lobe neoplasms are frequent in pediatric epilepsy.
- Tumor resection, with or without amygdalohippocampectomy, offers high seizure-free rates.
- Management should be guided by anatomical location, utilizing advanced imaging for tumors near eloquent cortex.
Object:
Slow-growing, low-grade temporal lobe tumors are one of the most common causes of epilepsy in children. Although there are numerous consistent features in this patient group, consensus about the management and surgical approach is lacking. In this study the authors review the clinical, pathological, and radiological features as well as outcome data obtained in 29 pediatric patients with temporal lobe tumor-related epilepsy and discuss the surgical treatment strategies.
Methods:
In patients who presented with intractable seizures secondary to mass lesions and underwent comprehensive epilepsy workup, the tumor was resected and the diagnosis confirmed by pathological examination. A minimum follow-up period of 16 months was required. Medical records were reviewed for details of seizure type and duration, electrophysiological data, imaging studies, operative notes, pathological examination reports, and follow-up data. The surgical approach was as follows. The lesionectomy with/without cortical resection was performed in all cases of lateral temporal tumors. Lesionectomy was performed with/without cortical resection in cases of basal temporal tumors if the mesial structures were radiologically normal. Mesial temporal tumors were excised, as were the remaining mesial temporal structures in the nondominant hemisphere; however, if the tumor was in the dominant hemisphere, lesionectomy was performed only if the remaining mesial structures were radiologically normal. Twenty-nine patients between 2 and 18 years of age were identified. Most tumors were located in the mesial temporal lobe. All patients underwent resection of the tumor with or without mesial and cortical structures. The most common pathological entity was dysembryoplastic neuroepithelial tumor. Sixty-nine percent of the patients remained seizure free (Engel Class I) and 14% experienced significant improvement (Engel Class II) after surgery. Outcome was better in the patients who underwent gross-total tumor resection.
Conclusions:
Mesially located low-grade neoplasms were the most frequently observed mass lesions in children with temporal tumor-related epilepsy in this series. Resection of the tumor with or without amygdalohippocampectomy provides a high rate of seizure-free outcome. It is the author's opinion that temporal lobe tumors should be managed based on the subgroups defined by their anatomical locations. If the tumor is located in or in proximity to eloquent cortex, we recommend functional magnetic resonance imaging and invasive monitoring techniques to map the eloquent cortex and epileptogenic zone, thereby tailoring the resection.
