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Impact of focal cortical dysplasia Type IIIa on seizure outcome following anterior mesial temporal lobe resection for the treatment of epilepsy

Lasse Dührsen Departments of Neurosurgery,

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Thomas Sauvigny Departments of Neurosurgery,

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Patrick M. House Department of Neurology and Epileptology, Hamburg Epilepsy Center, Hamburg, Germany

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Stefan Stodieck Department of Neurology and Epileptology, Hamburg Epilepsy Center, Hamburg, Germany

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Brigitte Holst Neuroradiology,

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Jakob Matschke Neuropathology, and

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Gerhard Schön Medical Biometry and Epidemiology, University Medical Center Hamburg–Eppendorf; and

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Manfred Westphal Departments of Neurosurgery,

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Tobias Martens Departments of Neurosurgery,

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Publication Date:
28 Jul 2017
Page Range:
1668–1673
Volume/Issue:
Volume 128: Issue 6
DOI link:
https://doi.org/10.3171/2017.2.JNS161295
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OBJECTIVE

Temporal lobe epilepsy (TLE) is the most common type of pharmacoresistant focal epilepsy, for which anterior mesial temporal lobe resection (AMTLR) is a treatment option. Focal cortical dysplasia Type IIIa (FCD IIIa), a developmental lesion resulting from defects in neuronal formation and migration into the temporal pole (FCD I) combined with hippocampal sclerosis (HS), can be a neuropathological finding. In this study, the authors investigate the impact of FCD IIIa on seizure outcome in patients with TLE who underwent AMTLR.

METHODS

The authors performed a retrospective analysis of all patients with TLE who underwent AMTLR at their institution between June 2011 and April 2014. Histopathological analysis was used to determine whether patients had HS together with FCD I (FCD IIIa) or HS alone. The groups were compared with regard to age, sex, years of epilepsy, and seizure outcome using the Engel classification.

RESULTS

A total of 51 patients with TLE underwent AMTLR at the authors’ institution. FCD IIIa was diagnosed in 13 cases. The patients experienced seizures for a mean duration of 31.1 years. The mean length of follow-up after the procedure was 18 months. All patients with FCD IIIa had a favorable seizure outcome (Engel Class I or II) compared with 71% of the patients with no pathological findings in the temporal pole (p < 0.01).

CONCLUSIONS

Patients with histopathologically proven FCD IIIa had a significantly better seizure outcome after AMTLR than patients with HS alone. Further effort should be made during presurgical evaluation to detect FCD IIIa so that the most suitable resection technique can be chosen and postoperative seizure outcome can be predicted for patient counseling.

ABBREVIATIONS

AMTLR = anterior mesial temporal lobe resection; EEG = electroencephalography; FCD IIIa = focal cortical dysplasia Type IIIa; HS = hippocampal sclerosis; ILAE = International League Against Epilepsy; selAH = selective amygdalohippocampectomy; TLE = temporal lobe epilepsy.
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Contributor Notes

Correspondence Lasse Dührsen, Department of Neurosurgery, University Medical Center Hamburg–Eppendorf, Martinistraße 52, Hamburg 20246, Germany. email: l.duehrsen@uke.de.

INCLUDE WHEN CITING Published online July 28, 2017; DOI: 10.3171/2017.2.JNS161295.

Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

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