Reoperation may be an option for select patients with unsatisfactory seizure control after their first epilepsy surgery. The aim of this study was to describe the seizure-free outcome and safety of repeated epilepsy surgery in our tertiary referral center.
Thirty-eight patients with focal refractory epilepsy, who underwent repeated epilepsy surgeries and had a minimum follow-up time of 12 months after reoperation, were included. Systematic reevaluation, including comprehensive neuroimaging and noninvasive (n = 38) and invasive (n = 25, 66%) video-electroencephalography monitoring, was performed. Multimodal 3D resection maps were created for individual patients to allow personalized reoperation.
The median time between the first operation and reoperation was 74 months (range 5–324 months). The median age at reoperation was 34 years (range 1–74 years), and the median follow-up was 38 months (range 13–142 months). Repeat MRI after the first epilepsy surgery showed an epileptogenic lesion in 24 patients (63%). The reoperation was temporal in 18 patients (47%), extratemporal in 9 (24%), and multilobar in 11 (29%). The reoperation was left hemispheric in 24 patients (63%), close to eloquent cortex in 19 (50%), and distant from the initial resection in 8 (21%). Following reoperation, 27 patients (71%) became seizure free (Engel class I), while 11 (29%) continued to have seizures. There were trends toward better outcome in temporal lobe epilepsy and for unilobar resections adjacent to the initial surgery, but there was no difference between MRI lesional and nonlesional patients. In all subgroups, Engel class I outcome was at least 50%. Perioperative complications occurred in 4 patients (11%), with no fatalities.
Reoperation for refractory focal epilepsy is an effective and safe option in patients with persistent or recurrent seizures after initial epilepsy surgery. A thorough presurgical reevaluation is essential for favorable outcome.
DTI = diffusion tensor imaging; EEG = electroencephalography; EZ = epileptogenic zone; fMRI = functional MRI; ILAE = International League Against Epilepsy; sEEG = stereo-EEG.
de TisiJ, BellGS, PeacockJL, The long-term outcome of adult epilepsy surgery, patterns of seizure remission, and relapse: a cohort study. Lancet. 2011;378(9800):1388–1395.2200013610.1016/S0140-6736(11)60890-8)| false
LamberinkHJ, OtteWM, BlümckeI, BraunKPJ. Seizure outcome and use of antiepileptic drugs after epilepsy surgery according to histopathological diagnosis: a retrospective multicentre cohort study. Lancet Neurol. 2020;19(9):748–757.
LamberinkHJ, OtteWM, BlümckeI, BraunKPJ. Seizure outcome and use of antiepileptic drugs after epilepsy surgery according to histopathological diagnosis: a retrospective multicentre cohort study. Lancet Neurol. 2020;19(9):748–757.3282263510.1016/S1474-4422(20)30220-9)| false
HelmstaedterC, ElgerCE, VogtVL. Cognitive outcomes more than 5 years after temporal lobe epilepsy surgery: remarkable functional recovery when seizures are controlled. Seizure. 2018;62:116–123.3035986510.1016/j.seizure.2018.09.023)| false
HamiwkaL, MacrodimitrisS, Tellez-ZentenoJF, Social outcomes after temporal or extratemporal epilepsy surgery: a systematic review. Epilepsia. 2011;52(5):870–879.10.1111/j.1528-1167.2011.03074.x)| false
KwanP, ArzimanoglouA, BergAT, et al.Definition of drug resistant epilepsy: consensus proposal by the ad hoc Task Force of the ILAE Commission on Therapeutic Strategies. Epilepsia. 2010;51(6):1069–1077.
KwanP, ArzimanoglouA, BergAT, Definition of drug resistant epilepsy: consensus proposal by the ad hoc Task Force of the ILAE Commission on Therapeutic Strategies. Epilepsia. 2010;51(6):1069–1077.10.1111/j.1528-1167.2009.02397.x)| false
KrucoffMO, ChanAY, HarwardSC, Rates and predictors of success and failure in repeat epilepsy surgery: a meta-analysis and systematic review. Epilepsia. 2017;58(12):2133–2142.2899411310.1111/epi.13920)| false
WieserHG, BlumeWT, FishD, ILAE Commission Report. Proposal for a new classification of outcome with respect to epileptic seizures following epilepsy surgery. Epilepsia. 2001;42(2):282–286.1124060410.1046/j.1528-1157.2001.4220282.x)| false
SchmeiserB, ZentnerJ, SteinhoffBJ, The role of presurgical EEG parameters and of reoperation for seizure outcome in temporal lobe epilepsy. Seizure. 2017;51:174–179.2888821510.1016/j.seizure.2017.08.015)| false
ShawarbaJ, KasparB, RamppS, Advantages of magnetoencephalography, neuronavigation and intraoperative MRI in epilepsy surgery re-operations. Neurol Res. 2021;43(6):434–439.3340206210.1080/01616412.2020.1866384)| false
MoJJ, HuWH, ZhangC, Value of stereo-electroencephalogram in reoperation of patients with pharmacoresistant epilepsy: a single center, retrospective study. Br J Neurosurg. 2018;32(6):663–670.3031787610.1080/02688697.2018.1506095)| false