Evolution of cranial epilepsy surgery complication rates: a 32-year systematic review and meta-analysis

A review

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  • 1 Department of Neurological Surgery, Weill Cornell Medical College, Cornell University, NewYork-Presbyterian Hospital; and
  • | 2 Department of Public Health, Division of Biostatistics and Epidemiology, Weill Cornell Medical College, New York, New York
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Object

Surgical interventions for medically refractory epilepsy are effective in selected patients, but they are underutilized. There remains a lack of pooled data on complication rates and their changes over a period of multiple decades. The authors performed a systematic review and meta-analysis of reported complications from intracranial epilepsy surgery from 1980 to 2012.

Methods

A literature search was performed to find articles published between 1980 and 2012 that contained at least 2 patients. Patients were divided into 3 groups depending on the procedure they underwent: A) temporal lobectomy with or without amygdalohippocampectomy, B) extratemporal lobar or multilobar resections, or C) invasive electrode placement. Articles were divided into 2 time periods, 1980–1995 and 1996–2012.

Results

Sixty-one articles with a total of 5623 patients met the study's eligibility criteria. Based on the 2 time periods, neurological deficits decreased dramatically from 41.8% to 5.2% in Group A and from 30.2% to 19.5% in Group B. Persistent neurological deficits in these 2 groups decreased from 9.7% to 0.8% and from 9.0% to 3.2%, respectively. Wound infections/meningitis decreased from 2.5% to 1.1% in Group A and from 5.3% to 1.9% in Group B. Persistent neurological deficits were uncommon in Group C, although wound infections/meningitis and hemorrhage/hematoma increased over time from 2.3% to 4.3% and from 1.9% to 4.2%, respectively. These complication rates are additive in patients undergoing implantation followed by resection.

Conclusions

Complication rates have decreased dramatically over the last 30 years, particularly for temporal lobectomy, but they remain an unavoidable consequence of epilepsy surgery. Permanent neurological deficits are rare following epilepsy surgery compared with the long-term risks of intractable epilepsy.

Abbreviations used in this paper:

AED = antiepileptic drug; CVA = cerebral vascular accident; DVT = deep vein thrombosis; PE = pulmonary embolism.

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Contributor Notes

Address correspondence to: Alexander Evins, B.S., Department of Neurological Surgery, Weill Cornell Medical College, 1300 York Ave., Rm. C-805, New York, NY 10065. email: ale2009@med.cornell.edu.

Please include this information when citing this paper: published online February 21, 2014; DOI: 10.3171/2014.1.JNS131694.

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