gms | German Medical Science

The study examines the surgical and epileptological outcome in adults with temporal lobe neoplasms undergoing surgery within the Innsbruck Epilepsy Surgery Program (INES).

Fourteen adult patients (mean age 40, 10 women:4 men) with temporal lobe tumors and temporal lobe epilepsy (TLE) were operated five years after presurgical evaluation to identify the correlation between epileptogenic focus and structural lesion. Surgical strategies were tailored to the problem and included temporal lobe resection, extended lesionectomy and extended lesionectomy with resection of the temporomesial structures (amygdala, hippocampus and gyrus parahippocampalis). All patients were available for follow-up at regular intervals after three, six, twelwe months and yearly thereafter. Epileptological outcome was classified according to Engel 1993.

One patient underwent invasive EEG recording after implantation of subdural and depth electrodes. Ten patients were operated on the left side, four on the right side. In three patients, a temporal lobe resection was carried out, in four an extended lesionectomy and in seven an extended lesionectomy including the resection of temporomesial structures. One patient with an astrocytoma III underwent second and third surgical procedures for recurrent disease. Histological examination showed an astrozytoma in five patients, a ganglioglioma/gangliocytoma in five patients, an oligodendroglioma in two patients and single cases of an ependymoma and a dysembryoplastic neuroepithelial tumor respectively. The duration of postoperative follow-up was 15 to 74 months with a mean of 37 months. Epileptological outcome was class I A in eight and I C in one patient. Two patients had outcome class III A and IV A respectively. In three patients, the follow-up period until abstract submission was considered to be too short. Surgical mortallity and permanent neurological morbidity were zero. The patient with the grade III astrocytoma, operated, irradiated and under chemotherapy, had to undergo revision surgery for wound dehiscence and ultimately subduroperitoneal shunting for recurrent subgaleal hygroma.

Patients with drug resistant epilepsy and temporal tumors should undergo evaluation in speicialized epilepsy surgery programs. The epileptological outcome is favourable with benign (grade I and II ) tumors.