The Role of Neocortical Resection in Children and Adults Undergoing Temporal Lobectomy for Non-Tumor Cases.
Abstract number :
2.313
Submission category :
Year :
2001
Submission ID :
281
Source :
www.aesnet.org
Presentation date :
12/1/2001 12:00:00 AM
Published date :
Dec 1, 2001, 06:00 AM
Authors :
M.A. Sotero de Menezes, MD, Neurology, University of Washington, Seattle, WA; J. Riviello, MD, Neurology, Harvard Medical School Children[ssquote]s Hospital, Boston, MA; G.L. Holmes, MD, Neurology, Harvard Medical School Children[ssquote]s Hospital, Bosto
RATIONALE: This study aims to evaluate the role the temporal lobe neocortex removal in the recurrence of seizures after a temporal lobectomy (TL) for complex partial seizures resistant to medical therapy.
METHODS: This study analyzes the outcome of TL performed in children and young adults with medically intractable complex partial seizures in relationship with the surgical technique. After excluding the tumor and cortical dysplasia related operations, we found 28 cases in whom a TL done at The Children[ssquote]s Hospital (Boston) with a full description of the surgical procedure available for review. The resection of the mesial temporal structures was standard including amygdala and hippocampal removal posteriorly back to level tentorium crossing. The extent of the lateral neocortical resection was variable and it was compared with the degree of post-operatory seizure reduction. The neuropathological examination was normal in three cases (cell count was not performed) the rest of the patients had mesial temporal lobe sclerosis (MTLS). The average duration of follow-up after the TL for the whole group was 52 months.
RESULTS: We found a trend for larger neocortical resection to produce a higher percentage of seizure reduction operatory period (p = 0.017, correlation coefficient 0.447). This trend also reached statistical significance when patients older than 12 were analyzed separately (p = 0.0243, correlation coefficient 0.5014). In patients [gt] 6 years the chances of becoming seizure-free on long-term follow up are maximal with resections of 6 cm and do not increase after that size.
CONCLUSIONS: The extension of the neocortical resection appears to be an important factor to be considered in planing a TL in young adults and children. Our data suggest that the temporal neocortex may have some intrinsic epileptogencity in patients with MTLS. Our study also indicates the need for careful invasive monitoring of the temporal neocortex as well as the mesial temporal lobe structures in young patients with medically refractory complex partial seizures. Larger temporal neocortical resections are not always possible due to factors such as the location of eloquent cortex, especially in adolescent and adults due to limited plasticity.
Disclosure: Honoraria - Glaxo-Welcome; Other - Unrestricted grant Glaxo-Welcome