Temporal lobectomy for intractable epilepsy: experience with 58 cases over 21 years

Area of Science:

• Neurosurgery
• Epileptology
• Clinical Neurology

Background:

• Intractable complex partial seizures often originate in the temporal lobe.
• Surgical intervention, including anterior temporal lobectomy (ATL), is considered for refractory cases.
• Accurate localization of the seizure focus is crucial for successful surgical treatment.

Purpose of the Study:

• To evaluate the efficacy and safety of anterior temporal lobectomy (ATL) for intractable temporal lobe epilepsy.
• To assess the utility of chronic subdural electrocorticography (ECoG) in localizing seizure origins for surgical planning.
• To analyze postoperative outcomes and complications in patients undergoing temporal lobe resections.

Main Methods:

• Retrospective analysis of 60 patients with intractable complex partial seizures who underwent surgery between 1969 and 1990.
• 58 patients underwent temporal resection, with 39 having chronic subdural electrocorticography (ECoG) prior to anterior temporal lobectomy (ATL).
• Intraoperative ECoG was used in 14 patients with temporal structural lesions undergoing temporal resection.

Main Results:

• 55% of patients became seizure-free, 7% were almost seizure-free, and 21% showed worthwhile improvement.
• Patients with identified temporal structural lesions had particularly favorable outcomes.
• Postoperative complications included mild memory impairment in 9 patients, one severe amnestic problem, and two cases of persistent dysphasia. No surgical mortality was reported.

Conclusions:

• Anterior temporal lobectomy (ATL) is a highly effective surgical treatment for intractable epilepsy originating in the temporal lobe.
• Chronic subdural electrocorticography (ECoG) is a safe and reliable method for localizing the epileptogenic zone, guiding surgical resection.
• Temporal lobe epilepsy surgery can significantly improve seizure control with acceptable complication rates.