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Tailored Temporal Lobectomy for Medically Intractable Epilepsy: Evaluation of Pathology and Predictors of Outcome

Falowski, Steven M. MD*; Wallace, David MD*; Kanner, Andres MD; Smith, Michael MD; Rossi, Michael MD; Balabanov, Antoaneta MD; Ouyang, Bichun PhD§; Byrne, Richard W. MD*

Neurosurgery:
doi: 10.1227/NEU.0b013e318262161d
Research-Human-Clinical Studies: Editor's Choice
Editor's Choice
Abstract

BACKGROUND: There have been only a few large series that have used a tailored temporal lobectomy.

OBJECTIVE: To clarify whether tailoring a temporal lobe resection will lead to equivalent epilepsy outcomes or have the same predictive factors for success when compared with standard resections.

METHODS: Retrospective analysis of 222 patients undergoing a tailored temporal lobe resection. Demographic measures and typical factors influencing outcome were evaluated.

RESULTS: Pathology included 222 cases. With a mean follow-up of 5.4 years, 70% of patients achieved Engel class I outcome. A significant factor predicting Engel class I outcome on multivariate analysis was lesional pathology (P = .04). Among patients with hippocampal sclerosis, extent of lateral neocortical resection and hippocampal resection were not statistically associated with Engel class I outcome (P = .93 and P = .24). However, an analysis of Engel class subgroups a to d showed that patients who had a complete hippocampectomy in the total series were more likely to achieve an Engel class Ia outcome (P = .04). This was also true among patients with hippocampal sclerosis (P = .03). Secondarily, generalized seizure (P = .01) predicted outcome less than Engel class I. Predictive of poor outcome was the need for preoperative electrodes (P = .02). Complications included superior quadrant visual field defects, 2 cases of permanent dysphasia, and 3 wound infections.

CONCLUSION: Predictors of successful seizure outcome for a tailored temporal lobectomy are similar to standard lobectomy. Patients with secondarily generalized epilepsy and cases in which preoperative subdural electrodes were thought necessary were less likely to achieve class I outcome. Among Engel class I cases, those who had a complete hippocampectomy were more likely to achieve Engel class Ia outcome.

ABBREVIATIONS: CI, confidence interval

EEG, electroencephalography

Author Information

*Department of Neurosurgery, Rush University, Chicago, Illinois

Department of Neurology, Rush University, Chicago, Illinois

§Department of Neuroscience, Rush University, Chicago, Illinois

Correspondence: Steven M. Falowski, MD, Department of Neurosurgery, Rush University, 1725 W Harrison St, Suite 1115, Chicago, IL 60612. E-mail: Steven_falowski@rush.edu

Received June 15, 2011

Accepted May 16, 2012

Copyright © by the Congress of Neurological Surgeons