Is additional mesial temporal resection necessary for intractable epilepsy with cavernous malformations in the...

Area of Science:

• Neurosurgery
• Epileptology
• Neuropathology

Background:

• Temporal neocortex cavernous malformations (CM) are a known cause of intractable epilepsy.
• The necessity of resecting additional mesial temporal structures beyond lesionectomy remains a debated surgical strategy.

Purpose of the Study:

• To evaluate the impact of extended resection (lesionectomy plus additional mesial temporal structures) versus lesionectomy alone on seizure control in patients with temporal neocortex CM.
• To clarify the optimal surgical approach for managing temporal CM-induced epilepsy.

Main Methods:

• Retrospective analysis of clinical data from 18 patients with surgically treated temporal neocortex CM.
• Comparison of outcomes between 11 patients undergoing extended resection and 7 patients undergoing lesionectomy alone.
• Inclusion of pathological assessments, intracranial EEG recordings in 6 patients, and perioperative neuropsychological testing.

Main Results:

• Excellent seizure control (Engel class I) was achieved in 94.4% of patients.
• Extended resection did not yield superior seizure outcomes compared to lesionectomy alone.
• Intracranial EEG revealed ictal onsets from various temporal regions, including the lateral cortex, mesial temporal structures, and contralateral temporal lobe.
• Neuropsychological testing showed improved IQ scores in the language-dominant hemisphere group, but some verbal memory decline was noted.

Conclusions:

• Lesionectomy alone can achieve excellent seizure outcomes for temporal neocortex CM causing intractable epilepsy.
• The addition of mesial temporal structure resection does not appear to significantly alter seizure control.
• Further large-scale studies are warranted to confirm the optimal surgical strategy for lateral temporal CM with intractable epilepsy.