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Surgical management of children with temporal lobe epilepsy and mass lesions
J Drake1, H J Hoffman, J Kobayashi
1Division of Neurosurgery, Hospital for Sick Children, Toronto, Ontario.
Insights
Temporal lobectomy in children with temporal lobe epilepsy and mass lesions led to significant seizure reduction. Many patients experienced seizure freedom or a substantial decrease in seizure frequency post-surgery.
Area of Science:
- Pediatric Neurology
- Neurosurgery
- Epileptology
Background:
- Temporal lobe epilepsy (TLE) is a common neurological disorder in children.
- Surgical intervention, such as temporal lobectomy, is considered for refractory cases.
- The presence of co-occurring mass lesions in the temporal lobe may influence surgical outcomes.
Purpose of the Study:
- To evaluate the efficacy of temporal lobectomy in pediatric patients with TLE and coexisting temporal lobe mass lesions.
- To analyze seizure outcomes and the impact of lesion type on treatment response.
Main Methods:
- Retrospective review of 48 pediatric patients who underwent temporal lobectomy for TLE.
- Analysis of pathological findings, specifically focusing on mass lesions (tumors, vascular malformations, arachnoid cysts) and hippocampal sclerosis.
- Long-term follow-up (over 1 year) to assess seizure control post-surgery.
Main Results:
- Out of 48 patients, 16 had temporal lobe mass lesions (12 tumors, 3 vascular malformations, 1 arachnoid cyst).
- Concomitant mesial temporal sclerosis was observed in 90% of patients with available hippocampal specimens not affected by tumor.
- Post-surgery, 9 out of 16 patients achieved seizure freedom (4 still on medication), and 7 experienced a >50% reduction in seizures.
Conclusions:
- Temporal lobectomy is an effective treatment for pediatric temporal lobe epilepsy, even in the presence of coexisting mass lesions.
- The presence of mass lesions does not preclude favorable seizure outcomes following temporal lobectomy.
- Further research into specific lesion types and their impact on surgical success is warranted.
Abstract:
In a review of 48 children who underwent temporal lobectomy for temporal lobe epilepsy, 16 patients had mass lesions in the temporal lobe. These mass lesions consisted of 12 tumors, 3 vascular malformations, and 1 arachnoid cyst. In 9 of 10 patients where the hippocampus was present in the pathological specimen and was not involved by tumor, there was concomitant mesial temporal sclerosis. All 16 patients have been followed for more than 1 year. Nine are free of seizures, with 4 of these 9 still on medication. Seven patients have had a greater than 50% reduction in seizures.