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Anteromesial Temporal Lobectomy for Medically Intractable Temporal Lobe Epilepsy: An Operative Study
Published on: August 15, 2025
Resective epilepsy surgery in childhood: the Dutch experience 1992-2002
Marieke Van Oijen1, Hanneke De Waal, Peter C Van Rijen
1Department of Child Neurology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands.
Insights
Pediatric epilepsy surgery offers safe and effective long-term seizure control, particularly temporal resections. This study in 69 children shows sustained seizure freedom and no cognitive decline post-surgery.
Area of Science:
- Pediatric Neurosurgery
- Epileptology
- Clinical Outcomes Research
Background:
- Intractable epilepsy in children poses significant challenges to quality of life.
- Resective epilepsy surgery is a potential treatment option for pediatric patients with drug-resistant epilepsy.
- Long-term outcomes of epilepsy surgery in pediatric populations require continued investigation.
Purpose of the Study:
- To evaluate the long-term seizure and psychosocial outcomes of resective epilepsy surgery in pediatric patients.
- To analyze the effectiveness of different surgical approaches, including temporal resections, extra-temporal resections, and hemispherectomies.
- To assess the impact of surgery on antiepileptic drug (AED) usage and cognitive function.
Main Methods:
- Retrospective analysis of 69 pediatric patients undergoing resective epilepsy surgery between 1992 and 2002.
- Annual assessment of seizure outcome using the Engel classification.
- Two telephone surveys conducted at 2.5-year intervals to gather data on seizure frequency, AED use, and psychosocial development.
- Kaplan-Meier survival curves used to analyze seizure recurrence rates.
Main Results:
- 70-77% of patients achieved Engel class 1 seizure outcome at follow-up.
- Temporal resections demonstrated the highest success rates for seizure control (74-82% Engel 1).
- Antiepileptic drugs were successfully withdrawn in 53% of patients; no negative cognitive impact was observed.
- Seizure recurrence after initial freedom was 17% at a mean of 4.5 years and 21% at a mean of 7.5 years post-surgery.
Conclusions:
- Resective epilepsy surgery is a safe and effective treatment for pediatric intractable epilepsy, yielding satisfactory long-term results.
- Temporal resections are associated with the best seizure outcomes in pediatric epilepsy surgery.
- Continued monitoring is essential due to the potential for late seizure recurrence.
Purpose:
We present the outcome of resective epilepsy surgery in 69 pediatric patients who participated in the Dutch Collaborative Epilepsy Surgery Program (DCESP) between 1992 and 2002 with special emphasis on long-term follow-up.
Methods:
Sixty-nine children (aged 3 months to 17 years) operated on before 2003 were included in this study (34 temporal resections (49%), 17 extra-temporal resections (24%) and 19 hemispherectomies (27%)). Engel classification was used to assess seizure outcome annually. Cognitive outcome was assessed if possible. Two telephone surveys were carried out with an interval of 2(1/2) years to obtain data on seizure frequency, use of AEDs and on aspects op psychosocial development. Kaplan-Meier survival curves were constructed to assess recurrence of seizures after initial postsurgical seizure freedom, based on both telephone surveys.
Results:
Seventy percent scored Engel 1, 18% Engel 2, 6% Engel 3 and 6% Engel 4 at the time of the first telephone survey (2(1/2) years later: 77% Engel 1, 8% Engel 2, 12% Engel 3 and 3% Engel 4). Temporal resections were associated with the best seizure outcome (Engel 1 74% and 82%). AEDs could be withdrawn successfully in 53% of patients at time of the last follow-up. No negative impact on cognition was found. The first long-term follow-up (mean 4.5 years after surgery) measurement showed recurrence of seizures after initial seizure freedom in 17%. At time of the second long-term follow-up measurement (mean 7.5 years after surgery) this percentage had increased to 21%.
Conclusions:
Our results support previous reports that surgery for intractable epilepsy in pediatric patients can be safely performed with satisfactory long-term results. Best results are attained in temporal resections.
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