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Temporal lobectomy in adults with intractable epilepsy

Y H Shih1, C H Yiu, M S Su

  • 1Department of Neurosurgery, Veterans General Hospital, Taipei, Taiwan R.O.C.

Journal of the Formosan Medical Association = Taiwan Yi Zhi
|April 1, 1994
PubMed
Summary

Anterior temporal lobectomy effectively treats intractable complex partial seizures (CPS) in adults. This surgery offers significant seizure reduction or freedom for most patients, with advanced imaging improving diagnosis.

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Area of Science:

  • Neurosurgery
  • Epileptology
  • Diagnostic Imaging

Background:

  • Intractable complex partial seizures (CPS) originating in the temporal lobe present a significant challenge in adult epilepsy management.
  • Surgical intervention, specifically anterior temporal lobectomy, is considered for patients with refractory epilepsy.
  • Understanding the efficacy and diagnostic modalities is crucial for optimizing treatment outcomes.

Purpose of the Study:

  • To evaluate the effectiveness and safety of anterior temporal lobectomy in adult patients with intractable temporal lobe CPS.
  • To compare the diagnostic accuracy of various neuroimaging techniques, including MRI, CT, FDG-PET, and SPECT.
  • To assess the predictive value of electrocorticography (ECoG) findings on surgical outcomes.

Main Methods:

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  • Retrospective analysis of 30 adult patients with intractable temporal lobe CPS undergoing anterior temporal lobectomy.
  • Follow-up duration averaged 41 months.
  • Comparison of pre-operative imaging (MRI, CT, FDG-PET, SPECT) and intra-operative/post-operative ECoG findings with seizure control outcomes.

    • Main Results:

    • 70% of patients achieved complete seizure freedom, with an additional 23% experiencing significant seizure reduction.
    • Patients without mass lesions had a younger age of onset and longer epilepsy duration.
    • High-resolution MRI and FDG-PET demonstrated superior accuracy in localizing the epileptogenic zone compared to CT and SPECT.
    • Residual spikes on postresection ECoG did not consistently correlate with poor seizure control.

    Conclusions:

    • Anterior temporal lobectomy is a safe and effective surgical option for adults with intractable temporal lobe CPS.
    • Advanced imaging like high-resolution MRI and FDG-PET enhance the accuracy of epileptogenic zone localization.
    • ECoG findings require careful interpretation in predicting post-surgical seizure control.