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Updated: Jun 21, 2026
Anteromesial Temporal Lobectomy for Medically Intractable Temporal Lobe Epilepsy: An Operative Study
Published on: August 15, 2025
Outcome of surgical treatment in non-lesional intractable childhood epilepsy
Joo Hee Seo1, Byoung Ho Noh, Joon Soo Lee
1Department of Pediatrics, Institute for Handicapped Children, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
Insights
Epilepsy surgery in children with normal MRI scans can lead to seizure freedom in 67% of cases. Identifying cortical pathology through other tests is key for successful surgical outcomes in pediatric epilepsy.
Area of Science:
- Pediatric Neurology
- Neurosurgery
- Epileptology
Background:
- Intractable childhood epilepsy often requires surgical intervention.
- Non-lesional neocortical epilepsy presents diagnostic and therapeutic challenges.
- Magnetic Resonance Imaging (MRI) may not reveal structural abnormalities in some epilepsy cases.
Purpose of the Study:
- To evaluate seizure outcomes after epilepsy surgery in pediatric patients with non-lesional neocortical epilepsy.
- To identify factors associated with successful surgical outcomes in this patient population.
Main Methods:
- Retrospective analysis of 27 pediatric patients with intractable epilepsy and normal MRI.
- Surgical outcomes assessed using Engel classification at least 2 years postoperatively.
- Review of clinical data, surgical procedures, pathological findings, and neuroimaging (SPECT, PET, video-EEG).
Main Results:
- 67% of patients achieved Engel class I outcome (seizure freedom).
- Focal abnormalities were detected on ictal SPECT (67%) and PET (78%).
- Cortical dysplasia was the most common pathological finding (56%).
Conclusions:
- Epilepsy surgery is a viable option for children with intractable non-lesional neocortical epilepsy.
- Identifying underlying cortical pathology through advanced imaging and pathology is crucial for surgical success.
- Consider epilepsy surgery when other diagnostic studies reveal cortical abnormalities despite normal MRI.
Purpose:
The aim of this study is to investigate seizure outcomes following epilepsy surgery in non-lesional neocortical pediatric epilepsy.
Methods:
We performed a retrospective study on 27 patients with intractable childhood epilepsy who received epilepsy surgery between 1999 and 2006 at Sang-gye Paik Hospital and Severance Children's Hospital. None of the patients had any detectable lesions on MRI. Surgical outcome was assessed at least 2 years postoperatively; clinical characteristics, surgical outcome, pathologic findings, types of surgery, localizing features on SPECT, FDG-PET, and long-term video-EEG were reviewed.
Results:
Eighteen patients (67%) demonstrated an Engel class I outcome postoperatively. The mean follow-up duration was 4.3 years (range, 2.2-9 years). Eighteen out of 27 cases (67%) showed focal localizing features on ictal SPECT, and 21 of 27 cases (78%) showed abnormal findings on PET. Single lobectomy was the most common procedure, and was performed in 20 patients (74%). Multilobar resection was performed in seven patients (26%). Cortical dysplasia was the most common finding during pathological examination, and was observed in 15 (56%) cases. In addition, gliosis was found in two patients (7%) and non-specific pathological findings were described in 10 patients (37%).
Conclusions:
In children with intractable epilepsy and a MRI demonstrating no abnormal lesions, epileptic surgery should be strongly considered when cortical pathology can be identified from other studies.
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