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61st Annual Meeting of the German Society of Neurosurgery (DGNC) as part of the Neurowoche 2010
Joint Meeting with the Brazilian Society of Neurosurgery on the 20 September 2010

German Society of Neurosurgery (DGNC)

21 - 25 September 2010, Mannheim

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Analysis of reoperation in mesial temporal lobe epilepsy with hippocampal sclerosis

Meeting Abstract

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  • Reinhard Schulz - EpilepsiezentrumBethel, Klinik Mara, Bielefeld, Germany
  • Matthias Hoppe - EpilepsiezentrumBethel, Klinik Mara, Bielefeld, Germany
  • Heinz W. Pannek - EpilepsiezentrumBethel, Klinik Mara, Bielefeld, Germany
  • Friedrich G. Woermann - Gesellschaft für Epilepsieforschung, Bielefeld, Germany
  • Theodor May - Gesellschaft für Epilepsieforschung, Bielefeld, Germany
  • Alois Ebner - EpilepsiezentrumBethel, Klinik Mara, Bielefeld, Germany

Deutsche Gesellschaft für Neurochirurgie. 61. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC) im Rahmen der Neurowoche 2010. Mannheim, 21.-25.09.2010. Düsseldorf: German Medical Science GMS Publishing House; 2010. DocP1879

doi: 10.3205/10dgnc350, urn:nbn:de:0183-10dgnc3506

Published: September 16, 2010

© 2010 Schulz et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.

Outline

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Objective: To analyze the outcome of reoperation in cases of incomplete resection of mesial temporal lobe structures in patients with mesial temporal sclerosis (MTS) in temporal lobe epilepsy (TLE).

Methods: We analyzed 22 consecutive patients with reoperation in MTS (follow-up 23 to 112 months, mean 43.18) by evaluating noninvasive EEG/video monitoring before first and second surgery (semiology, interictal epileptiform discharges = IED, ictal EEG with special regard to secondary contralateral evolution of the EEG seizure pattern after initial regionalisation), and MRI (resection indices after first and second surgery of amygdala, hippocampus, lateral temporal lobe; in 18 out of 22 patients T2-relaxometry of the contralateral hippocampus).

Results: Nine of 22 patients became seizure-free; another four patients had a running down of seizures and have eventually become seizure-free (16 to 51 months, mean 30.3). Recurrence of seizures is associated with: 1) ictal EEG with later evolution of an independent pattern over the contralateral temporal lobe (0 of 5 patients seizure-free versus 5 of 7 patients non-seizure-free; p=0.046); 2) smaller quantity of lateral temporal lobe resection in second surgery (1.06 + 0.59 cm versus 2.18 + 1.37 cm; p=0.019). No significant correlation with outcome was found for lateralization of IED, change of semiology, other resection indices, T2-relaxometry, begin and duration of epilepsy, duration of follow-up, and side of surgery.

Conclusions: Patients have a less favourable outcome of reoperation if they show ictal scalp EEG with secondary contralateral propagation and if they undergo only a small second resection of the lateral temporal lobe.