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Anteromesial Temporal Lobectomy for Medically Intractable Temporal Lobe Epilepsy: An Operative Study

Anteromesial Temporal Lobectomy for Medically Intractable Temporal Lobe Epilepsy: An Operative Study

Published on: August 15, 2025

Repeat resective surgery in complex pediatric refractory epilepsy: lessons learned.

Regina S Bower¹, Elaine C Wirrell², Laurence J Eckel³

¹Departments of 1 Neurosurgery.

Journal of Neurosurgery. Pediatrics

|April 25, 2015

Summary

This summary is machine-generated.

Pediatric epilepsy reoperation offers favorable outcomes for seizure reduction, even palliatively. However, reoperation significantly increases complication risks, such as pseudomeningocele, requiring careful patient counseling.

Keywords:

EEG = electroencephalography PET = positron emission tomography SISCOM = subtraction ictal SPECT co-registered to MRI SOZ = seizure-onset zone SPECT = single photon-emission computed tomography epilepsy surgery focal cortical dysplasia iEEG = intracranial EEG pediatric epilepsy presurgical evaluation reoperation vEEG = video-EEG

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$Stereo-Electro-Encephalo-Graphy SEEG With Robotic Assistance in the Presurgical Evaluation of Medical Refractory Epilepsy: A Technical Note$

Stereo-Electro-Encephalo-Graphy SEEG With Robotic Assistance in the Presurgical Evaluation of Medical Refractory Epilepsy: A Technical Note

Published on: June 13, 2016

Area of Science:

Pediatric Neurosurgery
Epileptology
Clinical Neurology

Background:

Medically intractable epilepsy in children often necessitates surgical intervention for seizure reduction.
When initial resective surgery fails, reoperation presents a potential, albeit complex, therapeutic option.
Excluding tumoral epilepsies, understanding outcomes of repeat resections is crucial for managing refractory cases.

Purpose of the Study:

To investigate the outcomes of resective reoperation in pediatric patients with refractory epilepsy.
To analyze preoperative workup differences and identify factors influencing outcomes and complications in repeat surgeries.
To evaluate the efficacy and safety of reoperation for intractable pediatric epilepsy.

Main Methods:

Retrospective review of medical records for pediatric patients undergoing repeat resective epilepsy surgery (2005-2012).
Exclusion of tumor and vascular etiologies.
Analysis of preoperative evaluations, surgical outcomes (Engel classification), and complication rates for initial versus repeat surgeries.

Main Results:

Ten patients met inclusion criteria; median age at seizure onset was 4.5 months.
30% had no lesion on preoperative MRI; common pathologies included gliosis and cortical dysplasia.
Favorable outcomes (Engel Class I-II) were achieved in 70% of patients.
Complication rate increased from 10% for initial surgery to 50% for reoperation, with pseudomeningocele being a significant issue.

Conclusions:

Resective reoperation is a viable option for pediatric refractory epilepsy, offering favorable outcomes, including palliative benefits.
Intracranial EEG monitoring is recommended for ambiguous initial evaluations.
Surgical management of epilepsy due to cortical dysplasia can be challenging, necessitating maximal safe resection, and complication risks are higher in reoperations.