Resective temporal lobe surgery in refractory temporal lobe epilepsy: prognostic factors of postoperative seizure outcome

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  • 1 Departments of Neurosurgery and
  • | 2 Epileptology, and
  • | 3 Institute of Neuropathology, University Hospital Bonn, Germany
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OBJECTIVE

Temporal lobe epilepsy (TLE) is one of the most common forms of epilepsy. In approximately 30% of patients, seizures are refractory to drug treatment. Despite the achievements of modern presurgical evaluation in recent years, the presurgical prediction of seizure outcome remains difficult. The aim of this study was to evaluate the seizure outcome in patients with drug-refractory TLE who underwent resective temporal lobe surgery (rTLS) and to determine features associated with unfavorable postsurgical seizure outcome.

METHODS

Patients with medically refractory TLE who underwent rTLS between 2012 and 2017 were reviewed from the prospectively collected epilepsy surgery database. A retrospective analysis of clinical, radiological, neuropsychological, histopathological, and perioperative findings of 161 patients was performed. The patients were divided into two groups according to seizure outcome (group I, International League Against Epilepsy [ILAE] class 1; group II, ILAE class ≥ 2). For identification of independent risk factors for unfavorable postoperative seizure outcome (ILAE class ≥ 2), a multivariate logistic regression analysis was performed.

RESULTS

Seizure freedom (ILAE class 1) was achieved in 121 patients (75.2%). The neuropsychological evaluation demonstrated that losses in cognitive performance were more pronounced in verbal memory after resections in the left temporal lobe and in nonverbal memory after right-sided resections, whereas attention improved after surgery. Overall, postoperative visual field deficits (VFDs) were common and occurred in 51% of patients. There was no statistically significant difference in the incidence of VFD in patients with selective surgical procedures compared to the patients with nonselective procedures. The lack of MRI lesions and placement of depth electrodes were preoperatively identified as predictors for unfavorable seizure outcome.

CONCLUSIONS

rTLS is an effective treatment method in patients with refractory TLE. However, patients with a lack of MRI lesions and placement of depth electrodes prior to rTLS are at higher risk for an unfavorable postsurgical seizure outcome.

ABBREVIATIONS

AHE = amygdalohippocampectomy; ATL = anterior temporal lobectomy; CA = cornu ammonis; CI = confidence interval; DCS-R = Diagnostikum für Zerebralschäden–Revised; EEG = electroencephalography; FCD = focal cortical dysplasia; HG = hippocampal gliosis; HS = hippocampal sclerosis; ILAE = International League Against Epilepsy; OR = odds ratio; rTLS = resective temporal lobe surgery; sAHE = selective AHE; TLE = temporal lobe epilepsy; VFD = visual field deficit; VLMT = verbal learning and memory test.

Artist’s illustration of the classic mulberry appearance of a cavernoma. This illustration represents the Seven Cavernomas series by Dr. Michael Lawton, a collection of articles defining the tenets and techniques for the treatment of cavernous malformations, a taxonomy for classifying these lesions, and the nuances of their surgical approaches. Artist: Peter M. Lawrence. Used with permission from Barrow Neurological Institute, Phoenix, Arizona. See the article by Garcia et al. (pp 671–682).

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Contributor Notes

Correspondence Valeri Borger: University Hospital Bonn, Germany. valeri.borger@ukbonn.de.

INCLUDE WHEN CITING Published online January 8, 2021; DOI: 10.3171/2020.7.JNS20284.

Disclosures Dr. Helmstaedter reports receiving honoraria from UCB, Eisai, Precisis, and GW; receiving royalties from EpiTrack and NeuroCog FX; and being a consultant to Eisai, UCB, Precisis, and GW. Ms. Taube received support of non–study-related clinical or research effort from the University Hospital Bonn Department of Epileptology (European Reference Network EpiCARE Grant).

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