Analysis of Different Types of Resection for Pediatric Patients with Temporal Lobe Epilepsy

Clusmann, Hans; Kral, Thomas; Gleißner, Ulrike; Sassen, Robert; Urbach, Horst; Blümcke, Ingmar; Bogucki, Jacek; Schramm, Johannes

doi:10.1227/01.neu.0000114141.37640.37

Cited by 144 publications

(114 citation statements)

References 42 publications

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“…5,6,18,19,23,26,29,30,34,36,37 In pediatric cohorts, 0%-14.6% major and 5.2%-19% minor complications are presented for various kinds of procedures. 3,4,7,20,33 In a systematic review of 76 studies in which different methodologies were used, Hader et † This includes 1 patient with thalamic infarction due to perforating artery injury, 1 patient with air embolism, and 1 patient with permanent postoperative anosmia. ‡ One patient had both a hemiparesis and a cranial nerve paresis, 1 patient a cerebral abscess and a persistent hemiparesis, 1 patient a postoperative hematoma and a persistent hemiparesis, 1 patient a persistent hemianopia and a persistent sensory deficit, and 1 patient a postoperative hematoma and a persistent hemianopia.…”

Section: Discussionmentioning

confidence: 99%

Complications of epilepsy surgery in Sweden 1996–2010: a prospective, population-based study

Bjellvi

Flink

Rydenhag

et al. 2015

JNS

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OBJECT Detailed risk information is essential for presurgical patient counseling and surgical quality assessments in epilepsy surgery. This study was conducted to investigate major and minor complications related to epilepsy surgery in a large, prospective series. METHODS The Swedish National Epilepsy Surgery Register provides extensive population-based data on all patients who were surgically treated in Sweden since 1990. The authors have analyzed complication data for therapeutic epilepsy surgery procedures performed between 1996 and 2010. Complications are classified as major (affecting daily life and lasting longer than 3 months) or minor (resolving within 3 months). RESULTS A total of 865 therapeutic epilepsy surgery procedures were performed between 1996 and 2010, of which 158 were reoperations. There were no postoperative deaths. Major complications occurred in 26 procedures (3%), and minor complications in 65 (7.5%). In temporal lobe resections (n = 523), there were 15 major (2.9%) and 41 minor complications (7.8%); in extratemporal resections (n = 275) there were 9 major (3.3%) and 22 minor complications (8%); and in nonresective procedures (n = 67) there were 2 major (3%) and 2 minor complications (3%). The risk for any complication increased significantly with age (OR 1.26 per 10-year interval, 95% CI 1.09–1.45). Compared with previously published results from the same register, there is a trend toward lower complication rates, especially in patients older than 50 years. CONCLUSIONS This is the largest reported prospective series of complication data in epilepsy surgery. The complication rates comply well with published results from larger single centers, confirming that epilepsy surgery performed in the 6 Swedish centers is safe. Patient age should be taken into account when counseling patients before surgery.

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Section: Discussionmentioning

confidence: 99%

Complications of epilepsy surgery in Sweden 1996–2010: a prospective, population-based study

Bjellvi

Flink

Rydenhag

et al. 2015

JNS

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“…Selective amygdalohippocampectomy (SelAH), a procedure developed by Niemeyer in 1958, 25 produces postoperative seizure outcomes that are comparable to those attained after ATL. 26,39 Moreover, some studies have indicated that SelAH has better neuropsychological outcomes 6,14 and a lower risk of visual field defects 22 than ATL. On the other hand, some investigators have recorded neocortical epileptiform spikes with cortical electrodes, 1,35 indicating that tailored resection of the temporal neocortex is Selective amygdalohippocampectomy versus anterior temporal lobectomy in the management of mesial temporal lobe epilepsy: a meta-analysis of comparative studies essential for MTLE.…”

Section: ©Aans 2013mentioning

confidence: 99%

Selective amygdalohippocampectomy versus anterior temporal lobectomy in the management of mesial temporal lobe epilepsy: a meta-analysis of comparative studies

Zhang

et al. 2013

JNS

132

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Object. Whether selective amygdalohippocampectomy (SelAH) has similar seizure outcomes and better neuropsychological outcomes compared with anterior temporal lobectomy (ATL) is a matter of debate. The aim of this study was to compare the 2 types of surgery with respect to seizure outcomes and changes in IQ scores.Methods. PubMed, Embase, and the Cochrane Library were searched for relevant studies published between January 1990 and September 2012. Studies comparing SelAH and ATL with respect to seizure and intelligence outcomes were included. Two reviewers assessed the quality of the included studies and independently extracted the data. Odds ratios and standardized mean deviations with 95% confidence intervals were used to compare pooled proportions of freedom from seizures and changes in IQ scores between the SelAH and ATL groups.Results. Three prospective and 10 retrospective studies were identified involving 745 and 766 patients who underwent SelAH and ATL, respectively. The meta-analysis demonstrated a statistically significant reduction in the odds of seizure freedom for patients who underwent SelAH compared with those who underwent ATL (OR 0.65 [95% CI 0.51-0.82], p = 0.0005). The differences between the changes in all IQ scores after the 2 types of surgery were not statistically significant, regardless of the side of resection.Conclusions. Selective amygdalohippocampectomy statistically reduced the odds of being seizure free compared with ATL, but the clinical significance of this reduction needs to be further validated by well-designed randomized trials. Selective amygdalohippocampectomy did not have better outcomes than ATL with respect to intelligence. (http://thejns.org/doi/abs/10.3171/2013.8.JNS121854) Key WorDs • temporal lobe epilepsy • anterior temporal lobectomy • selective amygdalohippocampectomy • meta-analysis 1089Abbreviations used in this paper: ATL = anterior temporal lobectomy; FCD = focal cortical dysplasia; FIQ = full-scale IQ; HS = hippocampal sclerosis; MTLE = mesial temporal lobe epilepsy; NTLE = neocortical temporal lobe epilepsy; PIQ = performance IQ; SelAH = selective amygdalohippocampectomy; SMD = standardized mean deviation; VIQ = verbal IQ.See the corresponding editorial in this issue, pp 1087-1088.

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“…Similar results were reported in a study on TLE patients; only 1 patient had poor seizure outcome of 27 patients with a lateral temporal lobe tumor who received lesionectomy (13 patients) or ATL (14 patients), whereas 2 of 7 patients who received lateral tumor resection with amygdalohippocampectomy had poor outcomes. 20 Tumors in the posterior temporal lobe can be regarded as extratemporal tumors in many aspects. In the current study, seizure outcome was mainly affected by the completeness of tumor removal; therefore, a lesionectomy could be a safe and effective procedure for these tumors.…”

Section: Surgical Strategymentioning

confidence: 99%

Long‐term surgical outcomes of temporal lobe epilepsy associated with low‐grade brain tumors

Phi

Kim

Cho

et al. 2009

Cancer

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Analysis of Different Types of Resection for Pediatric Patients with Temporal Lobe Epilepsy

Cited by 144 publications

References 42 publications

Complications of epilepsy surgery in Sweden 1996–2010: a prospective, population-based study

Complications of epilepsy surgery in Sweden 1996–2010: a prospective, population-based study

Selective amygdalohippocampectomy versus anterior temporal lobectomy in the management of mesial temporal lobe epilepsy: a meta-analysis of comparative studies

Long‐term surgical outcomes of temporal lobe epilepsy associated with low‐grade brain tumors

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