gms | German Medical Science

Objective: To determine the incidence, topological symptoms, prognosis and clinical relevance of ischemic complications of temporomesial resection in surgery for medically refractory temporal lobe epilepsy.

Methods: A prospectively collected database of 422 cases (49.3% females, median age 36 (3–73) years) of mesial temporal lobe epilepsy surgery (312 selective amygdalohippocampectomies, 110 other procedures) was retrospectively evaluated. In cases with new neurological deficit, postoperative imaging was revisited for ischemic complications. Follow-up data after 3.5 (2–8) years were obtained in structured telephone interviews.

Results: There were 14 instances of postoperative focal ischemia (3.3%). The vascular territory involved belonged to the anterior choroidal artery in 10, to the posterior choroidal artery in 2 and to the thalamoperforating vessels in 2 cases. A new postoperative hemiparesis occurred in 9, a visual field deficit in 7, and an aphasia in 4 patients. At follow-up, 13/14 (93%) patients with surgery-related ischemic complications were independent in daily life activities, however only 8/14 (57%) had returned to work.

Conclusions: Focal ischemia is an infrequent, but significant complication in temporomesial epilepsy surgery, which occurs unpredictably through affection of minor or perforating vessels. The vascular territory and the related clinical syndromes (hemiparesis, visual field deficit) depend on the site of critical dissection (ambient cistern). Long-term morbidity is mild, however, many patients cannot return to work despite independency in daily life activities. These observations highlight the importance and implications of vascular complications in non-vascular, resective brain surgery.