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Updated: Jul 6, 2026
Anteromesial Temporal Lobectomy for Medically Intractable Temporal Lobe Epilepsy: An Operative Study
Published on: August 15, 2025
[Pathological neocortical findings in patients with medication-resistant medial temporal lobe epilepsy submitted to
B Estupiñán-Díaz1, L M Morales-Chacón, L Lorigados-Pedre
1Laboratorio de Anatomía Patológica, Centro Internacional de Restauración Neurológica, Ciudad de La Habana, Cuba. barbarae.diaz@infomed.sld.cu
Introduction:
The dual pathology consisting of hippocampal sclerosis plus focal cortical dysplasia (FCD) is often reported in patients with medication-resistant medial temporal lobe epilepsy (MTLE).
Aims:
To determine the histopathological changes that take place in the neocortex of patients with medication-resistant MTLE submitted to surgery and to evaluate the relation between the histopathological changes, pathological background and the clinical course of patients who had received surgical treatment.
Materials And Methods:
Tissue obtained by en bloc resection from the neocortex of 18 patients with MTLE refractory to medical treatment was processed histologically and a tailored temporal lobectomy was performed with electrocorticography.
Results:
Dual pathology was diagnosed in 13 patients (72.2%). Imaging studies confirmed the existence of mesial sclerosis of the temporal in 100% of cases and there was no evidence of neocortical lesions. Histologically, 46.15% and 38.46% of the patients were diagnosed as belonging to FCD type 1a and FCD type 1b, respectively. Only one patient presented FCD type 2a. A statistically significant relation was found between the presence of dual pathology and the existence of an early precipitating injury (p = 0.04). One year after surgery, 72.7% (8/11) patients with dual pathology were classified as belonging to Engel class I.
Conclusions:
In patients with MTLE there are microscopic FCD-type alterations in the neocortex. There is an association between these alterations and the existence of an initial precipitating injury. Complete resection of the epileptogenic area, which is guaranteed by the lobectomy tailored by electrocorticography, allows patients to enjoy a favourable post-surgical progression one year after surgery.
Insights
Medication-resistant epilepsy patients often have dual pathology. Surgical resection of the epileptogenic zone, guided by electrocorticography, leads to favorable outcomes in most cases.
Area of Science:
- Neuroscience
- Neuropathology
- Epileptology
Context:
- Medication-resistant medial temporal lobe epilepsy (MTLE) frequently presents with dual pathology, combining hippocampal sclerosis and focal cortical dysplasia (FCD).
- Surgical intervention is often considered for patients with refractory MTLE.
- Understanding the underlying histopathological changes is crucial for optimizing surgical outcomes.
Purpose:
- To investigate the histopathological alterations in the neocortex of patients with medically refractory MTLE undergoing surgery.
- To correlate these histopathological findings with the patients' pathological background and clinical course post-surgery.
Summary:
- Histopathological analysis of neocortical tissue from 18 MTLE patients revealed dual pathology in 72.2% (13/18).
- Focal cortical dysplasia (FCD) types 1a and 1b were the most common findings.
- A significant association was observed between dual pathology and a history of early precipitating injury (p=0.04).
- Post-surgery, 72.7% of patients with dual pathology achieved favorable outcomes (Engel class I) one year after tailored lobectomy.
Impact:
- Identifies microscopic FCD-type alterations in the neocortex of MTLE patients.
- Highlights the link between neocortical alterations, precipitating injuries, and epilepsy progression.
- Demonstrates the efficacy of electrocorticography-guided tailored lobectomy in achieving favorable post-surgical outcomes for MTLE patients.
