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Updated: Jul 11, 2026
Anteromesial Temporal Lobectomy for Medically Intractable Temporal Lobe Epilepsy: An Operative Study
Published on: August 15, 2025
Surgery for medically intractable temporal lobe epilepsy during early life
Bruno Maton1, Prasanna Jayakar, Trevor Resnick
1The Brain Institute, Miami Children's Hospital, Miami, Florida, USA.
Insights
Pediatric temporal lobe epilepsy (TLE) surgery in children under 5 can lead to significant seizure reduction. This study shows favorable outcomes, with 65% seizure-free after surgery.
Area of Science:
- Pediatric Neurology
- Neurosurgery
- Epileptology
Background:
- Early-life temporal lobe epilepsy (TLE) can be devastating, causing drug-resistant seizures and neurological decline.
- Limited data exists on epilepsy surgery outcomes in infants and young children, especially for TLE.
Purpose of the Study:
- To evaluate the efficacy and safety of temporal resection for TLE in children under five years old.
- To assess seizure control and neurological outcomes following surgery in this specific pediatric population.
Main Methods:
- Retrospective analysis of 20 children under age 5 who underwent temporal resection for TLE.
- Minimum 2-year follow-up period to assess seizure outcomes and complications.
- Utilized EEG, MRI, and SPECT for diagnosis and localization.
Main Results:
- 65% of children achieved seizure freedom, and 15% had over 90% seizure reduction at a mean follow-up of 5.5 years.
- Diverse clinical presentations included psychomotor seizures, motor changes, and epileptic spasms.
- Common pathologies included cortical dysplasia (8/20) and tumors (8/20), with hippocampal sclerosis in 4 cases (often dual pathology).
Conclusions:
- Temporal lobe epilepsy in early life presents with varied and severe symptoms.
- Excisional surgery for TLE in young children yields favorable seizure reduction rates comparable to older patients.
Purpose:
Temporal lobe epilepsy (TLE) in early life is often a catastrophic disorder with pharmacoresistant seizures and secondary neurological deterioration. there is little data available regarding epilepsy surgery performed in infants and young children and no prior study has focused on tle.
Methods:
We analyzed the results of temporal resection for epilepsy as the primary indication in children less than age 5 years who had at least 2 years of follow-up.
Results:
20 children (14 males) were identified with a mean age at surgery of 26 months and a mean age at seizure onset of 12 months. Clinical presentation was diverse. Typical psychomotor seizures (n = 4; mean age at surgery 37 months) were followed by prominent motor changes (n = 7; 30 months) and were occasionally isolated (n = 3; 23 months). Epileptic spasms were noted in six patients and were frequently associated with lateralizing features. The interictal EEG was lateralizing in 15 patients and the ictal EEG was lateralizing in 18 patients. Brain MRI provided localizing value in 16 patients, ictal SPECT was concordant in 4/8 cases. Invasive EEG was employed in six cases. At mean follow-up of 5.5 years, 65% of the children were seizure-free and 15% had >90% seizure reduction. Morbidity included infection and hydrocephalus in one case and stroke-related hemiparesis in two cases. Cortical dysplasia was identified in eight children, tumors in eight including two DNET, two ganglioglioma, and four malignant tumors. Hippocampal sclerosis was present in four cases, always as dual pathology.
Conclusion:
TLE presents in early life with varied and severe manifestations. Excisional procedures in this age group are associated with favorable seizure reduction similar to older children and in adults.
