EVOLVING PRESURGICAL EVALUATION PROTOCALS: TRENDS DERIVED FROM A SERIES OF 600 PATIENTS SUBMITTED TO SURGERY
Abstract number :
3.210
Submission category :
Year :
2002
Submission ID :
58
Source :
www.aesnet.org
Presentation date :
12/7/2002 12:00:00 AM
Published date :
Dec 1, 2002, 06:00 AM
Authors :
Arthur Cukiert, Jose A. Buratini, Joaquim O. Vieira, Meire Argentoni, Cristine Baldauf, Leila Frayman, Valeria A. Mello, Cassio R. Forster, Carla Baise, Paulo T. Brainner-Lima. Neurology and Neurosurgery, Hospital Brigadeiro, Sao Paulo, Sao Paulo, Brazil;
RATIONALE: Epilepsy surgery has undergone major changes over the last 20 years. This paper reports a series of 600 epileptic patients submitted to surgery trying to stress the trends in dealing with them.
METHODS: Six hundreds patients submitted to surgery for refractory epilepsy were studied. Age ranged from 1,5 to 57 years; mean follow-up time was 3,4 years. Five hundreds and thirty-five were submitted to corticectomies; 63 to frontal, 352 to temporal, 19 to posterior quadrant, 36 to rolandic, 20 to multilobar and 21 to hemispherectomy. Sixty-five patients were submitted to callosal sections.
RESULTS: Overall, seizure-free rates were 89% for temporal, 86% for frontal, 91% for posterior quadrant, 85% for rolandic and 71% for multilobar resections. Eighty-nine percent of the patients submitted to hemispherectomy have been rendered seizure-free by surgery. The mean reduction of generalized seizures[ssquote] frequency after callosal section was 80%. Within the temporal lobe series, a marked reduction in the use of electrocorticography, Wada test and seizure[ssquote]s recording was seen over time and none are considered presently as essential items of the basic work-up in patients with MRI-defined mesial temporal sclerosis or other lesions. Within the extratemporal (ExT) series, a marked decrease in the complexity of the pre-operative work-up in patients with positive MRI findings was also seen; on the other hand, in those patients with negative MRI, who are almost always submitted to invasive recordings, an increase in the number of implanted electrodes was seen, paralleling the need for extensive cortical coverage. The number of patients with ExT epilepsy and normal MRI decreased substantially (presently around 15-20%).
CONCLUSIONS: There is a trend towards simplification of the preoperative work-up in patients with positive MRI findings. On the other hand, there remains a pool of patients with normal imaging in whom preoperative evaluation is time and resource consuming, who often have ExT or secondary generalized epilepsy and would generally need invasive recordings.
[Supported by: Sao Paulo Secretary of Health]