Failed epilepsy surgery for mesial temporal lobe sclerosis: a review of the pathophysiology

Vale, Fernando Ĺ.; Pollock, Glen; Benbadis, Selim R.

doi:10.3171/2011.12.focus11318

Cited by 29 publications

(22 citation statements)

References 52 publications

(79 reference statements)

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“…Mesial temporal sclerosis is the most common preoperative diagnosis in adults undergoing epilepsy surgery, and its results stand as a de facto gold standard for assessing surgical seizure outcomes. A recent review 35 of large modern studies revealed overall Engel Class I outcomes in 541 (78.9%) of 686 patients who had undergone surgery for this condition. Resection is, in general, somewhat more successful than other epilepsy operations, such as hemispherectomy 25 for Rasmussen encephalitis (about 70% Engel Class I), SturgeWeber syndrome (same), or hemimegalencephaly (approximately 50% Engel Class I).…”

Section: Nononcological Perspectivementioning

confidence: 99%

Seizure control after subtotal lesional resection

Gump

Skjei

Karkare

2013

FOC

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Reports on seizure outcomes following surgery for lesional epilepsy consistently cite extent of resection as a significant predictor of outcome. Unfortunately, gross-total resection is not technically feasible in all cases of medically refractory tumor-associated epilepsy. Here, the authors present the case of a 4-year-old girl whose epilepsy was medically controlled after 1-stage electrocorticography-guided subtotal resection (STR) of a large diffuse protoplasmic astrocytoma. They also review the modern literature on epilepsy associated with brain tumors. Outcomes are compared with those following surgical treatment of focal cortical dysplasia and vascular lesions. Gross-total lesional resection shows significant superiority across pathologies and anatomical regions. Despite a considerable number of STRs yielding seizure freedom, other favorable treatment factors have not been defined. Although gross-total lesional resection, if possible, is clearly superior, tailored surgery may still offer patients a significant opportunity for a good outcome. Treatment factors yielding successful seizure control following STR remain to be fully elucidated.

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Section: Nononcological Perspectivementioning

confidence: 99%

Seizure control after subtotal lesional resection

Gump

Skjei

Karkare

2013

FOC

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“…Reoperation with conventional surgery for the TLE remnant can obtain a seizure outcome rate ranging from 50% to 60%. 1,7,17,22,24 However, considering the invasiveness and comparable surgical outcomes of the conventional reoperation in those who underwent a failed temporal lobectomy, our present results suggest that GKRS can be considered an alternative treatment to open cranial reoperation in patients with MTLE-HS who had residual or recurrent seizures after ATL-AH.…”

Section: Discussionmentioning

confidence: 91%

“…22 Of these causes, incomplete resection of mesial structures is a potent and major cause of surgical failure. Although reoperation may be beneficial in highly selected patients with MTLE-HS, several reports have argued that 52%-63% of patients could be seizure free after reoperation (extension of the cortical resection along the surgical scar) for TLE.…”

mentioning

confidence: 99%

“…Although reoperation may be beneficial in highly selected patients with MTLE-HS, several reports have argued that 52%-63% of patients could be seizure free after reoperation (extension of the cortical resection along the surgical scar) for TLE. 1,7,17,22,24 Sometimes, additional invasive intracranial electroencephalography (EEG) recordings are needed to reevaluate and confirm the ictal onset zone before reoperation. Therefore, the potential for surgical morbidity and technical difficulties due to adhesion of neurovascular structures to adjacent surgical scar tissue is a concern for neurosurgeons.…”

mentioning

confidence: 99%

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Gamma Knife radiosurgery for recurrent or residual seizures after anterior temporal lobectomy in mesial temporal lobe epilepsy patients with hippocampal sclerosis: long-term follow-up results of more than 4 years

Lee

Kang

Kim

et al. 2015

JNS

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M esial temporal lobe epilepsy (TLE) with hippocampal sclerosis (MTLE-HS) is one of the most important surgically amenable epilepsies for medically intractable epilepsy patients. 19,23 Long-term seizure freedom after temporal lobe resection has been reported to be approximately 65%. 8,21 Despite significant advances in the surgical procedure and the identification of surgical candidates, approximately 20%-30% of TLE patients continue to have seizures after conventional surgery. Moreover, the probability of seizure freedom 10 years after TLE surgery is reported to range between 40% and 50%. 11Several explanations have been proffered for these surgical failures, including incomplete resection of epileptogenic structures, generation or reactivation of new epileptogenic foci, a dual pathology, or, possibly, surgical ABBREVIATIONS AED = antiepileptic drug; ATL = anterior temporal lobectomy; ATL-AH = ATL with amygdalohippocampectomy; EEG = electroencephalography; GKRS = Gamma Knife radiosurgery; MTLE = mesial temporal lobe epilepsy; MTLE-HS = MTLE hippocampal sclerosis; TLE = temporal lobe epilepsy. SUBMITTED June 9, 2014. ACCEPTED December 18, 2014. INCLUDE WHEN CITING Published online July 10, 2015; DOI: 10.3171/2014.12.JNS141280. DISCLOSURE The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper. They confirm that they have read the Journal's position on issues involved in ethical publication and affirm that this report is consistent with those guidelines. » This article has been updated from its originally published version to correct the affiliations. See the corresponding erratum notice; DOI: OBJECT Gamma Knife radiosurgery (GKRS) has proven efficacy in the treatment of drug-resistant mesial temporal lobe epilepsy with hippocampal sclerosis (MTLE-HS) and is comparable to conventional resective surgery. It may be effective as an alternative treatment to reoperation after failed temporal lobe surgery in patients with MTLE-HS. The purpose of this study was to investigate the efficacy of GKRS in patients with unilateral MTLE-HS who did not achieve seizure control or had recurrent seizures after anterior temporal lobectomy (ATL). METHODS Twelve patients (8 males; mean age 35.50 ± 9.90 years) with MTLE-HS who underwent GKRS after failed ATL (Engel Classes III-IV) were included. GKRS targets included the remnant tissue or adjacent regions of the previously performed ATL with a marginal dose of 24-25 Gy at the 50% isodose line in all patients. Final seizure outcome was assessed using Engel's modified criteria during the final 2 years preceding data analysis. A comparison between signal changes on follow-up MRI and clinical outcome was performed. RESULTS All patients were followed up for at least 4 years with a mean duration of 6.18 ± 1.77 years (range 4-8.8 years) after GKRS. At the final assessment, 6 of 12 patients were classified as seizure free (Engel Class Ia, n = 3; Ic, n = 2; and Id, n = 1) and 6 patients were classified as not seiz...

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“…25 Among patients with MTLE and mesial temporal sclerosis, surgery reduced seizures for approximately 75%. 3,12,19,23 Although this surgery is considered safe and effective, it is not free of complications. Surgical intervention has changed and will continue to change for the foreseeable future because of advances in neuroimaging, neuronavigation, and anesthesia.…”

Section: Discussionmentioning

confidence: 99%

Complications after mesial temporal lobe surgery via inferiortemporal gyrus approach

Vale

Reintjes

Garcia

2013

FOC

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Object The purpose of this study was to identify the complications associated with the inferior temporal gyrus approach to anterior mesial temporal lobe resection for temporal lobe epilepsy. Methods This retrospective study examined complications experienced by 483 patients during the 3 months after surgery. All surgeries were performed during 1998–2012 by the senior author (F.L.V.). Results A total of 13 complications (2.7%) were reported. Complications were 8 delayed subdural hematomas (1.6%), 2 superficial wound infections (0.4%), 1 delayed intracranial hemorrhage (0.2%), 1 small lacunar stroke (0.2%), and 1 transient frontalis nerve palsy (0.2%). Three patients with subdural hematoma (0.6%) required readmission and surgical intervention. One patient (0.2%) with delayed intracranial hemorrhage required readmission to the neuroscience intensive care unit for observation. No deaths or severe neurological impairments were reported. Among the 8 patients with subdural hematoma, 7 were older than 40 years (87.5%); however, this finding was not statistically significant (p = 0.198). Conclusions The inferior temporal gyrus approach to mesial temporal lobe resection is a safe and effective method for treating temporal lobe epilepsy. Morbidity and mortality rates associated with this procedure are lower than those associated with other neurosurgical procedures. The finding that surgical complications seem to be more common among older patients emphasizes the need for early surgical referral of patients with medically refractory epilepsy.

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Failed epilepsy surgery for mesial temporal lobe sclerosis: a review of the pathophysiology

Cited by 29 publications

References 52 publications

Seizure control after subtotal lesional resection

Seizure control after subtotal lesional resection

Gamma Knife radiosurgery for recurrent or residual seizures after anterior temporal lobectomy in mesial temporal lobe epilepsy patients with hippocampal sclerosis: long-term follow-up results of more than 4 years

Complications after mesial temporal lobe surgery via inferiortemporal gyrus approach

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