Surgical treatment of patients with single and dual pathology

Abstract

Modern neuroimaging can disclose epileptogenic lesions in many patients with partial epilepsy and, at times, display the coexistence of hippocampal atrophy in addition to an extrahippocampal lesion (dual pathology). We studied the postoperative seizure outcome of 64 patients with lesional epilepsy (median follow-up, 30 months) and considered separately the surgical results in the 51 patients with a single lesion and in the 13 who had dual pathology. In patients with a single lesion, 85% were seizure free or significantly improved (Engel's class I-II) when the lesion was totally removed compared with only 40% when there was incomplete resection (p < 0.007). All three patients with dual pathology who had both the lesion and the atrophic hippocampus removed became seizure free. In contrast, only 2 of the 10 patients with dual pathology undergoing surgery aimed at the lesion or at the hippocampus alone became seizure free (p < 0.05), although 4 of them showed significant improvement (Engel's class II). We conclude that the outcome in patients with single epileptogenic lesions is usually dependent upon the completeness of lesion resection. In patients with dual pathology, surgery should, if possible, include resection of both the lesion and the atrophic hippocampus.

Coexistent pathology in chronic epilepsy patients with neoplasms

“…[7][8][9][10] In a subset of these tumors, which are generally low-grade glial or glioneuronal neoplasms, multiple pathologies, which potentially may contribute to the genesis of these seizures, are identifiable (dual pathology). [11][12][13][14][15][16] Among these, there is a well-established association of certain neoplasms with malformations of cortical development (cortical dysplasia), particularly dysembryoplastic neuroepithelial tumors and gangliogliomas. [17][18][19][20] The purpose of this study is to systematically review one institution's experience with neoplasms associated with identifiable coexistent pathology arising in the setting of chronic epilepsy.…”

Glioma-Associated Epilepsy

“…Medially placed tumours were associated with the more dramatic changes than laterally placed tumours. Where an atrophic hippocampus has been identified, resection of both the lesion and the hippocampus is more likely to result in a seizure-free outcome [127].…”

Surgical and postmortem pathology studies: contribution for the investigation of temporal lobe epilepsy

“…In the conclusion section of their 1966 paper, Margerison and Corsellis remarked the "...need to see beyond the temporal lobes and to take into account the possible importance of damage in other parts of the brain as well" 2 . The injuries diagnosis associated with MTS has great clinical importance, due to its impact in response to clinical treatment 71 and programming of surgery 72,73 . The association of MTS plus another lesion out of the hippocampus constitutes dual pathology 73,74 , which was seen in 5 to 30% of patients with focal epilepsy and drug-resistant seizures 74 .…”

“…The injuries diagnosis associated with MTS has great clinical importance, due to its impact in response to clinical treatment 71 and programming of surgery 72,73 . The association of MTS plus another lesion out of the hippocampus constitutes dual pathology 73,74 , which was seen in 5 to 30% of patients with focal epilepsy and drug-resistant seizures 74 . MTS may be associated with several other pathologies, such as MCD, slow growth tumors, vascular malformations, porencephaly, and gliosis [72][73][74][75][76] .…”

“…The association of MTS plus another lesion out of the hippocampus constitutes dual pathology 73,74 , which was seen in 5 to 30% of patients with focal epilepsy and drug-resistant seizures 74 . MTS may be associated with several other pathologies, such as MCD, slow growth tumors, vascular malformations, porencephaly, and gliosis [72][73][74][75][76] . Macroscopic and microscopic abnormalities compatible with the diagnosis of MCD may coexist with MTS in TLE patients and constitute the most frequent type of dual pathology 74 .…”