gms | German Medical Science

60. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
Joint Meeting mit den Benelux-Ländern und Bulgarien

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

24. - 27.05.2009, Münster

Outcome of temporal apical resection in patients with tumours and refractory temporal lobe epilepsy

Meeting Abstract

  • A. Elsharkawy - Epilepsie-Zentrum Bethel, Bielefeld
  • H. Pannek - Epilepsie-Zentrum Bethel, Bielefeld
  • F. Oppel - Epilepsie-Zentrum Bethel, Bielefeld
  • T. Ogutu - Epilepsie-Zentrum Bethel, Bielefeld
  • V. Hans - Epilepsie-Zentrum Bethel, Bielefeld
  • F. Woermann - Epilepsie-Zentrum Bethel, Bielefeld
  • A. Ebner - Epilepsie-Zentrum Bethel, Bielefeld

Deutsche Gesellschaft für Neurochirurgie. 60. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit den Benelux-Ländern und Bulgarien. Münster, 24.-27.05.2009. Düsseldorf: German Medical Science GMS Publishing House; 2009. DocMI.04-06

DOI: 10.3205/09dgnc188, URN: urn:nbn:de:0183-09dgnc1889

Veröffentlicht: 20. Mai 2009

© 2009 Elsharkawy et al.
Dieser Artikel ist ein Open Access-Artikel und steht unter den Creative Commons Lizenzbedingungen (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.de). Er darf vervielfältigt, verbreitet und öffentlich zugänglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.


Gliederung

Text

Objective: Epilepsy surgery in patients with tumours aims to remove the tumour itself and the epileptogenic zone. Our centre has developed an approach to lesions located in the apex of the temporal lobe “apical temporal resection” (aTLR); this resection is based on tailored resection of the lesion with amygdalectomy and resection of the mesial structures in the apical compartment of the temporal lobe. The aim of this work is to present the clinical, radiological and surgical outcome of the apical resections in patients with refractory temporal lobe (TLE) epilepsy due to tumours in the apical compartment of the temporal lobe.

Methods: Between 2001 and 2008, 120 tumour temporal lobe resections have been carried out; aTLR has been performed in 31 patients. All patients underwent a comprehensive presurgical evaluation including video-EEG monitoring, MRI, and neuropsychological testing. Surgical strategies were determined in an interdisciplinary case conference and tailored to the findings of the presurgical evaluation.There were 16 males, mean age at epilepsy onset was 17.8±13 years, mean age at surgery was 30.1±11.9 years, mean epilepsy duration was 12.3±10.3 years and mean follow-up duration was 2.4±1.4 years. In preoperative MRI, tumours were located in the anterior part of the apical compartment in 12 patients (38.7%), in the amygdala in 9 (29%), in the mesial side in 8 (25.8%), and one (3.2%) in the lateral side and one in 3.2% in the uncus.

Results: 30(96.8%) of 31 patients were in Engel class 1 at 6-month, 25 (92.6%) of 27 at 2 years follow-up. Surgical mortality was zero and mild transient facial pareses were seen in 1 patient, and 2 patients showed memory worsening after surgery. Histological results; 20 (64.5%) had ganglioglioma grade I, 8 (25.8%) had dysembryoplastic neuroepithelial tumour, 2 (6.5%) had xanthoastrocytoma Grad II and one (3.2%) had dermoid cyst. Postoperative MRI showed complete resection in 22 patients (71%) and incomplete in 9 patients (29%). Incomplete resection was due to inaccessible part of tumours because of the basal ganglia or important vascular structures encountered.

Conclusions: Apical temporal resection can be recommended as an adequate procedure for the surgical treatment of the refractory epilepsy due tumour in apex of temporal lobe, Apical TLR offers seizure freedom in more than 92% of patients with almost no complications.