Authors: M Sindou M Guenot J Isnard P Ryvlin C Fischer F Mauguière
Publish Date: 2005/11/07
Volume: 148, Issue: 1, Pages: 39-45
Abstract
Methods Hundred patients were treated surgically between 1994 and 2003 for drugresistant epilepsy involving the temporomesial structures All of them underwent a comprehensive noninvasive presurgical evaluation Fourtyeight of them underwent depth electrodes recordings according to the Talairach’s StereoElectroEncephaloGraphic SEEG methodology because the noninvasive investigations were not congruent enough to identify the epileptic zone The patients presenting with any spaceoccupying lesion or with a cavernoma or with a strictly lateral neocortical epileptic focus were excluded The MRIexamination was abnormal in 87 cases displaying a hippocampal atrophy in 69 cases The extent of temporal resection was planned according to the results of the presurgical investigation in each particular patient Consequently this “tailored” resection varied from selective amygdalohippocampectomy 6 cases to anterior temporal lobectomy 76 cases or to total temporal lobectomy 18 casesFindings The mean postoperative followup period was 53 months 85 patients were found to be in Engel’s class I postoperatively free of disabling seizures among them 74 were in class Ia totally seizure free Nine patients were in Engel’s class II and six were in Engel’s class III or IV failures There was no surgical mortality Three patients had a postoperative hematoma two patients required a shunt insertion in three patients meningitis occured and two patients had postoperative ischaemia of the anterior choroidal artery territory which resulted in a mild permanent hemiparesis Neuropsychological complications are not addressed in detail in this articleConclusions These data indicate that “tailored” resective surgery for temporomesial epilepsy can be performed with a low rate of morbidity and is highly efficacious The use of invasive presurgical investigation SEEG may explain this high rate of success
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