Surgical treatment for neocortical temporal lobe epilepsy: clinical and surgical aspects and seizure outcome

Abstract

Object. The goal of this paper was to describe the clinical and surgical aspects of a group of patients suffering from drug-resistant neocortical temporal lobe epilepsy (TLE), as well as seizure outcomes and factors affecting seizure outcomes in these patients. Methods. This study was based on data prospectively collected and retrospectively evaluated. Sixty-two patients with neocortical TLE constituted the study population. Only patients who underwent corticectomies, lesionectomies, lateral anterior lobe resections, and/or multiple subpial transections were included. The pathological areas resected in these patients could be separated into three groups composed of 35 neoplastic lesions, 23 nonneoplastic lesions, and three nonlesional areas. The mean duration of follow-up review in these patients was 21.9 ± 14 months. Outcomes were categorized according to Engel classes. Class I was found in 79% of the patients and Class II in 11%. Invasive presurgical evaluation was performed in 43% of the patients. There were only temporary complications (3.3% surgical and 1.6% neurological) and no deaths. In summary, lesions confirmed on histological examination were rarely found in patients with neocortical TLE. Low-grade tumors were the most commonly found lesions in these patients and the most common tumor was ganglioglioma. Outcome was best for those patients with neoplastic lesions and was independent of the duration of their seizures. Outcome was little influenced by the type of resection performed and was found to be as good as that achieved in patients with mesial TLE. Conclusions. These results demonstrate that the concept of lateral or neocortical TLE as a distinct entity is useful. Surgery for neocortical TLE can be considered a viable treatment option that is associated with a low morbidity rate and good outcomes.