Temporo-mesial epilepsy surgery: outcome and complications in 100 consecutive adult patients

Détails

ID Serval
serval:BIB_D2B2A06E7917
Type
Article: article d'un périodique ou d'un magazine.
Collection
Publications
Titre
Temporo-mesial epilepsy surgery: outcome and complications in 100 consecutive adult patients
Périodique
Acta Neurochir (Wien)
Auteur⸱e⸱s
Sindou M., Guenot M., Isnard J., Ryvlin P., Fischer C., Mauguiere F.
ISSN
0001-6268 (Print)
ISSN-L
0001-6268
Statut éditorial
Publié
Date de publication
01/2006
Volume
148
Numéro
1
Pages
39-45
Langue
anglais
Notes
Sindou, M
Guenot, M
Isnard, J
Ryvlin, P
Fischer, C
Mauguiere, F
eng
Austria
Acta Neurochir (Wien). 2006 Jan;148(1):39-45. doi: 10.1007/s00701-005-0644-x. Epub 2005 Nov 7.
Résumé
BACKGROUND: We studied the surgical outcome, and the complications in a group of 100 consecutive adult patients with medically refractory epilepsy arising from the temporo-mesial structures. METHODS: Hundred patients were treated surgically between 1994 and 2003 for drug-resistant epilepsy involving the temporo-mesial structures. All of them underwent a comprehensive noninvasive presurgical evaluation. Fourty-eight of them underwent depth electrodes recordings (according to the Talairach's StereoElectroEncephaloGraphic (SEEG) methodology) because the noninvasive investigations were not congruent enough to identify the epileptic zone. The patients presenting with any space-occupying lesion, or with a cavernoma, or with a strictly lateral neocortical epileptic focus, were excluded. The MRI-examination was abnormal in 87 cases, displaying a hippocampal atrophy in 69 cases. The extent of temporal resection was planned according to the results of the presurgical investigation in each particular patient. Consequently, this "tailored" resection varied from selective amygdalo-hippocampectomy (6 cases), to anterior temporal lobectomy (76 cases), or to total temporal lobectomy (18 cases). FINDINGS: The mean post-operative follow-up period was 53 months. 85 patients were found to be in Engel's class I post-operatively (free of disabling seizures), among them 74 were in class Ia (totally seizure free). Nine patients were in Engel's class II and six were in Engel's class III or IV (failures). There was no surgical mortality. Three patients had a postoperative hematoma; two patients required a shunt insertion; in three patients meningitis occurred; and two patients had postoperative ischaemia of the anterior choroidal artery territory, which resulted in a mild permanent hemiparesis. Neuropsychological complications are not addressed in detail in this article. CONCLUSIONS: These data indicate that "tailored" resective surgery for temporo-mesial epilepsy can be performed with a low rate of morbidity, and is highly efficacious. The use of invasive presurgical investigation (SEEG) may explain this high rate of success.
Mots-clé
Adolescent, Adult, Amygdala/surgery, Anterior Temporal Lobectomy/*adverse effects/methods, Electroencephalography, Epilepsy, Temporal Lobe/diagnosis/physiopathology/*surgery, Female, Follow-Up Studies, Hippocampus/surgery, Humans, Male, Middle Aged, Retrospective Studies, Treatment Outcome
Pubmed
Création de la notice
29/11/2018 13:37
Dernière modification de la notice
20/08/2019 16:52
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