The Postoperative Prognosis Following Resective Surgery in Epileptic Adults Investigated with a Non-Invasive Protocol: Experience from a Turkish Epilepsy Center.
Abstract number :
2.310
Submission category :
Year :
2001
Submission ID :
942
Source :
www.aesnet.org
Presentation date :
12/1/2001 12:00:00 AM
Published date :
Dec 1, 2001, 06:00 AM
Authors :
S. Saygi, Professor, Neurology, Hacettepe University Faculty of Medicine, Ankara, Turkey; N. Dericioglu, Specialist, Neurology, Hacettepe University Faculty of Medicine, Ankara, Turkey; N. Akalan, Professor, Neurosurgery, Hacettepe University Faculty of M
RATIONALE: Epilepsy surgery has been applied after non-invasive investigation methods in our university for 26 years. However, these methods have been used according to a standardized protocol by a specialized team since 1992. Resective surgery is performed only when patients meet certain well deliniated criteria. Here we discuss the postoperative prognosis of the adult epileptic patients in our center.
METHODS: All epileptic adults who underwent resective surgery due to intractable partial epilepsy between 1992-February 2001 were included in the study. As part of their preoperative work-up the patients were investigated with video-EEG monitoring, cranial MRI, neuropsychological and WADA tests. Interictal/ictal SPECT and intraoperative electrocorticography were applied when needed. Postoperative prognosis was based on Engel[ssquote]s classification in patients with minimum 6 months of follow-up. We investigated how lobar location and pathologic characteristics of the lesion influenced surgical outcome.
RESULTS: Seventy four patients (40 M, 34 F) underwent resective surgery. Twenty eight patients had lesionectomy (12 frontal, 11 temporal, 2 occipital, 1 parietal, 1 hypothalamic hamartoma, 1 multilobar resection) while 46 patients had temporal lobectomy due to non-lesional temporal lobe epilepsy. Sixty two patients had been followed for at least 6 months (6-87 months, mean 3 years). Prognosis ( indicated as the percentage of patients in Group I only) of the patients according to location of the surgical resection were as follows: 47 temporal lesionectomy/lobectomy-80.9 %; 11 frontal lesionectomies-63.6 %; 2 occipital lesionectomies-100 %; 1 hypothalamic hamartoma-Group II and 1 multilobar resection-Group III. When pathologic characteristics of the lesions were concerned our findings were as indicated: 35 hippocampal sclerosis-85.7 %; 8 encephalomalacia-62.5 %; 5 dysembryoplastic neuroepithelial tumor (DNET) -100 %; 4 tumor- 75 %; 3 cavernoma-100 %; 2 polymicrogyria- 50 % and 1 abscess sequela- Group II. Two patients with nonspecific findings were in Group IV.
CONCLUSIONS: The postoperative results of resective epilepsy surgery in our center are quite satisfactory and consistent with the reports in the literature. Prognosis was best in temporal and occipital lobe surgery and in lesions like DNET, cavernoma and hippocampal sclerosis where the boarders of the lesion are well circumscribed.