Article
Long-term seizure outcome after resective temporal lobe surgery in a paediatric cohort – single-centre retrospective study
Langzeit Anfallsfreiheit nach resektiver Temporallappenchirurgie in eine pädiatrischen Kohorte – eine Single-Center retrospektive Studie
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Authors
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Matthias Tomschik
- Medizinische Universität Wien, Universitätsklinik für Neurochirurgie, Wien, Österreich
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Johannes Herta
- Medizinische Universität Wien, Universitätsklinik für Neurochirurgie, Wien, Österreich
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Jonathan Wais
- Medizinische Universität Wien, Universitätsklinik für Neurochirurgie, Wien, Österreich
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Michael Sadowicz
- Medizinische Universität Wien, Universitätsklinik für Neurochirurgie, Wien, Österreich
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Gregor Kasprian
- Medizinische Universität Wien, Universitätsklinik für Radiologie, Wien, Österreich
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Martha Feucht
- Medizinische Universität Wien, Pediatrics and Adolescent Medicine, Wien, Österreich
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Karl Rössler
- Medizinische Universität Wien, Universitätsklinik für Neurochirurgie, Wien, Österreich
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Christian Dorfer
- Medizinische Universität Wien, Universitätsklinik für Neurochirurgie, Wien, Österreich
| Published: | June 4, 2021 |
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Outline
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Objective: In therapy resistant focal epilepsy the seizure onset zone is most often located in the temporal lobe. Resective surgery has emerged as a curative option, however the extent of resection remains at the surgeons discretion. While extensive resections might impair cognitive development, freedom of disabling seizures is still the best predictor of later quality of life. We therefore wanted to evaluate the long term seizure outcome after different resective temporal lobe surgeries in a pediatric cohort.
Methods: We performed a retrospective analysis of all pediatric patients undergoing resective temporal lobe surgery for intractable epilepsy with a minimum follow up of one year. Surgery type, histological findings, and seizure outcome according to the ILAE classification were extracted from patient records. Surgeries were stratified into lesionectomy, anterior temporal lobectomie (TLR) and selective amygdalahippocampectomies (SAHE).
Results: In total, 104 pediatric patients were operated between 1993 and 2019. The median follow up period was 9 years (range 1 to 14 years). Forty-nine lesionectomies, 42 TLRs and 13 SAHEs were performed. One year after surgery, 73 patients (70.2%) were seizure free. Seizure freedom rates were significantly lower for SAHE patients compared to lesionectomies and TLR (46.2% vs. 65.3% vs. 83.3% respectively, p = 0.022) and patients that had generalized seizures before surgery (65.6% vs. 88.4% in patients with partial seizures only). The most frequent pathologies were hippocampal sclerosis (n=35, 33.7%), gangliogliomas (n=24, 23.1%), and low grade gliomas (n=19, 18.3%). At least one relapse occurred in 24 patients (23.1%) that were initially seizure free. Surgery had to be repeated in 12 patients (11.5%), five of whom had an ILAE class I outcome at their last follow up. With additional surgery and medication changes 79 patients (76%) were seizure free at their last follow up visit.
Conclusion: Pediatric patients undergoing temporal lobe surgery for intractable epilepsy have a good rates of seizure outcome overall. Surgery type is a modifiable prognostic factor for later seizure freedom. SAHE appears to be ill suited for pediatric patients and should therefore be reserved for older patients. Re-resection after failed initial surgery can still offer a good chance at seizure freedom.
