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Updated: Aug 24, 2025
Anteromesial Temporal Lobectomy for Medically Intractable Temporal Lobe Epilepsy: An Operative Study
Published on: August 15, 2025
Pre-surgical evaluation challenges and long-term outcome in children operated on for Low Grade Epilepsy Associated
Evelyn Karina Chávez López1, Javier Aparicio1, Carlos Valera1
1Department of Child Neurology, Epilepsy and Neurophysiology Unit, Member of the ERN EpiCARE, Hospital Sant Joan de Dèu, Passeig Sant Joan de Déu, Barcelona, Spain.
Insights
Epilepsy surgery is a safe and effective treatment for children with Low-grade Epilepsy Associated brain Tumors (LEATs), leading to seizure control and improved neurocognitive function. Comprehensive pre-surgical evaluations enhance outcomes, enabling medication discontinuation and better development.
Area of Science:
- Pediatric Neurosurgery
- Epileptology
- Pediatric Neurology
Background:
- Low-grade Epilepsy Associated brain Tumors (LEATs) are a significant cause of refractory epilepsy in children.
- Understanding the efficacy of surgical interventions and their impact on neurocognitive outcomes is crucial for treatment planning.
Purpose of the Study:
- To analyze pre-surgical evaluation methods, surgical outcomes, long-term results, and neurocognitive effects in pediatric patients with LEATs.
- To compare outcomes between pharmacosensitive and drug-resistant epilepsy groups.
Main Methods:
- Retrospective observational study of 37 children with LEATs undergoing epilepsy surgery.
- Minimum follow-up of 12 months.
- Classification into pharmacosensitive (Group 1, n=8) and drug-resistant (Group 2, n=29) epilepsy groups based on response to antiseizure medications (ASMs).
Main Results:
- The most common tumors were gangliogliomas (35.1%) and dysembryoplastic neuroepithelial tumors (DNTs, 29.7%), often associated with focal cortical dysplasia (FCD).
- Extended lesionectomy was the most frequent surgical approach (43.2%).
- At 1-year follow-up, 97.2% achieved Engel Class I seizure control. ASMs were discontinued in 100% of the pharmacosensitive group vs. 34.5% of the drug-resistant group (p=0.002). Significant improvement in verbal comprehension index was observed in the pharmacosensitive group (p=0.029).
Conclusions:
- Epilepsy surgery is a safe therapeutic option for LEATs, including in children with seizures controlled by ASMs.
- Comprehensive pre-surgical evaluation improves seizure control, facilitates early discontinuation of ASMs, and promotes neurocognitive development.
- Associated lesions are common in LEATs, underscoring the need for thorough pre-surgical assessment.
Objetive:
Analyze pre-surgical evaluation modalities, surgical failures, long-term results of surgery and neurocognitive outcome in children with Low-grade Epilepsy Associated brain Tumors (LEAT).
Methods:
Retrospective observational study of 37 children who underwent epilepsy surgery, with a minimum follow-up of 12 months. At time of surgery, pharmaco-sensitivity (Group 1; n = 8) and drug-resistance (Group 2; n = 29), were considered.
Results:
Age range of seizure onset was 5 months-14 years (mean 5.73years) and age at surgery was 2.2-18.7years (mean 10.7years). Gangliogliomas (35.1%) or DNTs (29.7%), combined or not to a focal cortical dysplasia (FCD), were the most frequent. Extended lesionectomy 16 children (43.2%) were the most frequently used surgical approach in both groups. At one year of follow-up, 36 children (97.2%) were classified as Engel I. Within the age-range studied, duration of epilepsy and time to surgery appeared to have no impact on clinical and neurocognitive outcome in both groups. It is noteworthy, however, that antiseizure medications (ASMs) were withdrawn in 100% of the pharmacosensitive group vs 34.5% of the drug-resistant group (p = 0.002). In children with a pharmaco-sensitive epilepsy, neurocognitive evaluation showed significant improvement in the verbal comprehension index (p = 0.029).
Conclusions:
Epilepsy-surgery is a safe therapeutic option for LEATs including for children with seizures controlled by ASMs. Presence of associated lesions is not rare. Comprehensive pre-surgical evaluation increases the chances for control of the seizures, the early discontinuation of medications and favours neurocognitive development.
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