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

Area of Science:

• Neurosurgery
• Epilepsy Surgery
• Temporal Lobe Epilepsy

Background:

• Complex partial seizures can originate from anterior and inferomesial temporal lobe activity.
• Inaccessible lesions in the temporal lobe pose surgical challenges.

Purpose of the Study:

• To evaluate the efficacy of anterior temporal corticectomies for complex partial seizures in patients with difficult-to-reach temporal lesions.
• To determine if resecting the lesion alongside the epileptogenic zone impacts seizure control.

Main Methods:

• Twenty patients with temporal lobe lesions and complex partial seizures underwent anterior temporal corticectomies.
• Six patients had a second operation for extended resection.
• Surgical specimens were analyzed for mesial temporal sclerosis.

Main Results:

• Two patients achieved complete seizure freedom (>2 years).
• Three patients had >95% seizure reduction; five had >50% reduction.
• Seizure control was notably inferior compared to cases where the lesion was resected.

Conclusions:

• Anterior temporal corticectomy can offer seizure reduction for select epilepsy patients.
• Including the causative lesion in the resection is crucial for optimal seizure control outcomes.
• Surgical strategy should prioritize lesion resection when feasible.