AES 2009 Annual Course: Reoperation for medically refractory epilepsy

Area of Science:

• Neurosurgery
• Epileptology
• Clinical Neurology

Background:

• Medically refractory epilepsy often persists after initial resective surgery.
• Persistent disabling seizures significantly impact patient quality of life.

Purpose of the Study:

• To analyze the efficacy and safety of repeat resective surgery for epilepsy.
• To identify patient subgroups who may benefit from reoperation.

Main Methods:

• Systematic review of published literature on repeat resective epilepsy surgery.
• Categorization of reoperated patients into three groups: residual medial temporal structures, unresected lesions, and neocortical epilepsy.
• Analysis of seizure freedom rates and morbidity associated with reoperation.

Main Results:

• Repeat resective surgery provides a significant chance of achieving seizure freedom, though lower than initial surgery.
• The risk of significant morbidity, particularly neurological deficits, is low but increased compared to the first surgery.
• Patient selection is crucial for optimizing outcomes.

Conclusions:

• Repeat resective surgery is a viable option for carefully selected patients with refractory epilepsy.
• Palliative surgical options should be considered, especially for patients with lower seizure freedom probability or higher morbidity risk.