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65th Annual Meeting of the German Society of Neurosurgery (DGNC)

German Society of Neurosurgery (DGNC)

11 - 14 May 2014, Dresden

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Complications and seizure outcome after reoperation in patients with failed surgery for intractable epilepsy

Meeting Abstract

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  • Alexander Grote - Department of Neurosurgery, University of Bonn, University Medical Center, Germany
  • Marec von Lehe - Department of Neurosurgery, University of Bonn, University Medical Center, Germany
  • Madeleine Pieper - Department of Neurosurgery, University of Bonn, University Medical Center, Germany
  • Johannes Schramm - Department of Neurosurgery, University of Bonn, University Medical Center, Germany
  • Daniel Delev - Department of Neurosurgery, University of Bonn, University Medical Center, Germany

Deutsche Gesellschaft für Neurochirurgie. 65. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC). Dresden, 11.-14.05.2014. Düsseldorf: German Medical Science GMS Publishing House; 2014. DocP 009

doi: 10.3205/14dgnc404, urn:nbn:de:0183-14dgnc4045

Published: May 13, 2014

© 2014 Grote 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: Resective surgery is safe and well accepted therapy for treatment of drug resistant epilepsy and leads to seizure freedom in up to 80% in selected populations. If surgery has failed reevaluation and reoperation may be considered in a selected group of patients with an unfavorable seizure outcome. The purpose of this study was to summarize the risks and benefits after second epilepsy surgery.

Method: A total of 67 (male 40, 59.7%) patients met the eligibility criteria and were included in the study. The median follow-up period was 9.8 years (range 2.3–23.5 yr). This is a retrospective study based on prospectively collected follow-up data, which comprises comprehensive data about postoperative neurological deficits, surgical complications and long time seizure outcome.

Results: All patients underwent a second operation (1989–2009) after failed first surgery. Fifty-two (77.6%) patients had surgery for temporal lobe epilepsy (TLE), whereas the remaining 15 cases showed extratemporal lobe epilepsies (ETLE). Histologic findings showed 32 (48.5%) tumor cases, 12 (18.2%) cases of dysplasia, 12 (18.2%) cases with gliosis, 8 (12.1%) hippocampal-sclerosis and 2 (3%) cavernomas. Three months after the first surgery 31 patients (47%) were completely seizure free (ILAE 1). The median time between the two operations was 3.6 years. The main reasons for seizure recurrence were incomplete resection (59.1%) of the epileptogenic lesion, followed by tumor recurrence (6.1%) and gliosis (6.1%). Twelve patients (18.2%) showed new postoperative neurological deficits after the second surgery, however, the rate of permanent deficits increased from 3% (n=2) after the initial surgery to 9.1% (n=6). The overall surgical complication rate after the second operation was also slightly increased from 6.1% (n=4) to 9.1% (n=6). After the second surgery 46 patients (69.7%) were completely seizure free (ILAE1) at the last available follow-up.

Conclusions: Reoperation after failed first surgery for intractable epilepsy is possible and is associated with a clear benefit with circa 70% long-time seizure freedom. However there is an increased risk of permanent postoperative neurological deficits and this should be taken into consideration.