Complex partial seizures and small posterior temporal or extratemporal structural lesions: surgical management

Twenty patients with small, indolent, relatively inaccessible posterior temporal or extratemporal lesions had complex partial seizures presumably related to anterior and inferomesial temporal lobe epileptic activity. All underwent anterior temporal corticectomies, and in six the resection was extended at a second operation. There was sclerosis of mesial temporal structures in seven of the surgical specimens. Two patients became seizure free for more than 2 years; three others showed more than 95% reduction in seizure frequency, and five had moderate (greater than 50%) reduction. While cessation of seizures or improved control may occur following this surgical strategy, the results are strikingly inferior to those obtained when the lesion, as well as the epileptogenic area, can be resected. Review of this group of patients suggests that the lesion should be included in the resection if at all possible.