Characterization of Hemorrhagic Complications after Surgery for Temporal Lobe Epilepsy

Clusmann, Hans; Kral, Thomas; Marin, G.; Roost, Dirk Van; Swamy, K. Mallikarjuna; Schramm, Johannes

doi:10.1055/s-2004-822788

Cited by 24 publications

(9 citation statements)

References 21 publications

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“…Until recently, neurosurgeons and epileptologists have been reluctant to consider elderly patients as candidates for epilepsy surgery, and thus only few reports have assessed the efficacy of surgery for temporal lobe epilepsy (TLE) in the elderly (2–5). Concerns have been expressed regarding higher complication rates in older patients (6,7). Furthermore, some skepticism exists regarding the risk of deterioration in cognitive functioning and memory performance (8).…”

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confidence: 99%

Surgical Treatment for Refractory Temporal Lobe Epilepsy in the Elderly: Seizure Outcome and Neuropsychological Sequels Compared with a Younger Cohort

Grivas¹,

Schramm²,

Kral³

et al. 2006

Epilepsia

129

111

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Summary:Purpose: Surgical treatment of refractory temporal lobe epilepsy (TLE) is promising for selected patients, but only little experience has been acquired in operating on older patients, especially with limited resections. We intend to delineate clinical and surgical factors influencing outcome in patients older than 50 years at operation and to compare the results with those of a younger patient cohort.Methods: Fifty-two patients older than 50 years were operated on for intractable mesial or combined mesiolateral TLE between 1991 and 2002. The mean age at operation was 55 years, and the mean duration of epilepsy was 33 years. Forty selective amygdalohippocampectomies (33 for hippocampal sclerosis, seven for removal of a mesiotemporal lesion), five lateral temporal lesionectomies plus amygdalohippocampectomy, and seven anterior temporal lobectomies were performed. Eleven (21%) patients had undergone invasive presurgical video-EEG monitoring. The mean follow-up period was 33 months. We compared the results with those of a younger cohort operated on in the same time period.Results: Thirty-seven older patients attained complete seizure control (71% class I), and 10 patients had only rare postoperative seizures (19% class II). Four patients improved >75% (8% class III), and one patient did not improve (2% class IV). The same rate of seizure control was attained by 11 patients older than 60 years at surgery. These results were not significantly different from those in a younger patient group. A trend toward better seizure control was noted in 16 patients with an epilepsy duration of <30 years (all class I or II), and in 20 patients with a seizure frequency of fewer than five seizures per month (all class I or II). No mortality resulted from a total of 65 diagnostic and therapeutic procedures. A 3.8% permanent neurologic morbidity (dysphasia and hemiparesis) was noted. Hemianopia occurred in three (5.9%) patients. Neuropsychological testing revealed low preoperative performances and some gradual further deterioration after surgery.Conclusions: Results of surgery for TLE with mainly limited resections are promising in patients older than 50 years and older 60 years, despite the long seizure history. As expected, the risk of complications is somewhat higher compared with that in a younger control group. The impact of low neuropsychological performance is a concern.

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confidence: 99%

Surgical Treatment for Refractory Temporal Lobe Epilepsy in the Elderly: Seizure Outcome and Neuropsychological Sequels Compared with a Younger Cohort

Grivas¹,

Schramm²,

Kral³

et al. 2006

Epilepsia

129

111

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“…However, ventricular opening has been associated with distant hemorrhagic complications. 5,26 Stretching of the subdural veins is the most likely explanation. Risk is higher for patients older than 40 years who undergo mesial temporal lobe resection, although our results are not statistically significant (p = 0.193).…”

Section: Discussionmentioning

confidence: 99%

Complications after mesial temporal lobe surgery via inferiortemporal gyrus approach

Vale

Reintjes

Garcia

2013

FOC

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Object The purpose of this study was to identify the complications associated with the inferior temporal gyrus approach to anterior mesial temporal lobe resection for temporal lobe epilepsy. Methods This retrospective study examined complications experienced by 483 patients during the 3 months after surgery. All surgeries were performed during 1998–2012 by the senior author (F.L.V.). Results A total of 13 complications (2.7%) were reported. Complications were 8 delayed subdural hematomas (1.6%), 2 superficial wound infections (0.4%), 1 delayed intracranial hemorrhage (0.2%), 1 small lacunar stroke (0.2%), and 1 transient frontalis nerve palsy (0.2%). Three patients with subdural hematoma (0.6%) required readmission and surgical intervention. One patient (0.2%) with delayed intracranial hemorrhage required readmission to the neuroscience intensive care unit for observation. No deaths or severe neurological impairments were reported. Among the 8 patients with subdural hematoma, 7 were older than 40 years (87.5%); however, this finding was not statistically significant (p = 0.198). Conclusions The inferior temporal gyrus approach to mesial temporal lobe resection is a safe and effective method for treating temporal lobe epilepsy. Morbidity and mortality rates associated with this procedure are lower than those associated with other neurosurgical procedures. The finding that surgical complications seem to be more common among older patients emphasizes the need for early surgical referral of patients with medically refractory epilepsy.

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“…Atrophy (a, coronal 3D T1-weighted (W) gradient-echo image) and hyperintensity (b, coronal T2-W turbo spin-echo (TSE) image) of the right hippocampus suggest hippocampal sclerosis. Please note that increased T2 signal of the right amygdala as well (b) precipitate RCH [2][3][4]. Although the mechanism is still unclear, most authors agreed that RCH has a venous origin, because the hematomas are often bilateral almost uniformly located in the upper vermis and in the upper cerebellar folia facing the tentorium where the draining veins of the cerebellar hemispheres are located and are often bilateral [5].…”

Section: Discussionmentioning

confidence: 99%

Remote Cerebellar Hemorrhage and Iliofemoral Vein Thrombosis After Supratentorial Craniotomy

et al. 2007

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Characterization of Hemorrhagic Complications after Surgery for Temporal Lobe Epilepsy

Abstract: Although associated with a low permanent morbidity, features of postoperative hemorrhages after TLE surgery are characteristically different to complications after surgery for other indications, which has to be kept in mind for patient counseling and obtaining informed consent.

Cited by 24 publications

References 21 publications

Surgical Treatment for Refractory Temporal Lobe Epilepsy in the Elderly: Seizure Outcome and Neuropsychological Sequels Compared with a Younger Cohort

Surgical Treatment for Refractory Temporal Lobe Epilepsy in the Elderly: Seizure Outcome and Neuropsychological Sequels Compared with a Younger Cohort

Complications after mesial temporal lobe surgery via inferiortemporal gyrus approach

Remote Cerebellar Hemorrhage and Iliofemoral Vein Thrombosis After Supratentorial Craniotomy

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