Tailored multilobar disconnective epilepsy surgery in the posterior quadrant

Area of Science:

• Neurosurgery
• Epileptology
• Clinical Neurology

Background:

• Drug-resistant epilepsy originating from the posterior quadrant (PQ) often necessitates extensive brain resections.
• Disconnective techniques are explored to mitigate risks associated with large tissue removal.
• Limited data exists on tailored temporoparietooccipital (TPO) disconnective approaches and their long-term outcomes.

Purpose of the Study:

• To present a tailored approach to multilobar posterior quadrant disconnections (MPQDs) for epilepsy.
• To detail patient selection, presurgical investigations, surgical techniques, and safety profiles.
• To evaluate seizure and cognitive outcomes in a large, single-center series with long-term follow-up.

Main Methods:

• Retrospective analysis of a prospectively collected database (2005-2017) of patients undergoing MPQD for drug-resistant epilepsy.
• Classification of MPQDs into four types based on disconnection extent (Type I-IV).
• Bivariate statistical analysis to identify predictors of seizure outcome (Engel class I vs. II-IV) and evaluation of cognitive profiles.

Main Results:

• Forty-two patients underwent MPQD, with 76.2% achieving Engel class I seizure freedom at a mean follow-up of 80.6 months.
• Seizure freedom was associated with occipital seizure semiology and absence of bilateral interictal epileptiform abnormalities.
• Severe complications occurred in 4.8% of patients, with postsurgical improvements noted in verbal cognitive domains.

Conclusions:

• Careful presurgical evaluation using anatomo-electro-clinical criteria enables customized surgical disconnections for PQ epilepsies.
• Tailored MPQDs demonstrate excellent seizure control and an acceptable safety profile.
• This approach offers a viable strategy for managing complex drug-resistant epilepsy.