Temporal Lobe Resective Surgery for Medically Intractable Epilepsy: A Review of Complications and Side Effects

Georgiadis, Iordanis; Kapsalaki, Eftychia; Fountas, Kostas N.

doi:10.1155/2013/752195

Cited by 63 publications

(77 citation statements)

References 62 publications

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“…Recent reviews of complications in epilepsy surgery point out that the differences in definitions and data collection may influence the marked variations in published complication rates. 13,15 The aim of the present study was to analyze data from the prospective, population-based Swedish National Epilepsy Surgery Register (SNESUR) accrued between 1996 and 2010 regarding major and minor complications, and to search for possible risk factors for complications.…”

mentioning

confidence: 99%

Complications of epilepsy surgery in Sweden 1996–2010: a prospective, population-based study

Bjellvi

Flink

Rydenhag

et al. 2015

JNS

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OBJECT Detailed risk information is essential for presurgical patient counseling and surgical quality assessments in epilepsy surgery. This study was conducted to investigate major and minor complications related to epilepsy surgery in a large, prospective series. METHODS The Swedish National Epilepsy Surgery Register provides extensive population-based data on all patients who were surgically treated in Sweden since 1990. The authors have analyzed complication data for therapeutic epilepsy surgery procedures performed between 1996 and 2010. Complications are classified as major (affecting daily life and lasting longer than 3 months) or minor (resolving within 3 months). RESULTS A total of 865 therapeutic epilepsy surgery procedures were performed between 1996 and 2010, of which 158 were reoperations. There were no postoperative deaths. Major complications occurred in 26 procedures (3%), and minor complications in 65 (7.5%). In temporal lobe resections (n = 523), there were 15 major (2.9%) and 41 minor complications (7.8%); in extratemporal resections (n = 275) there were 9 major (3.3%) and 22 minor complications (8%); and in nonresective procedures (n = 67) there were 2 major (3%) and 2 minor complications (3%). The risk for any complication increased significantly with age (OR 1.26 per 10-year interval, 95% CI 1.09–1.45). Compared with previously published results from the same register, there is a trend toward lower complication rates, especially in patients older than 50 years. CONCLUSIONS This is the largest reported prospective series of complication data in epilepsy surgery. The complication rates comply well with published results from larger single centers, confirming that epilepsy surgery performed in the 6 Swedish centers is safe. Patient age should be taken into account when counseling patients before surgery.

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mentioning

confidence: 99%

Complications of epilepsy surgery in Sweden 1996–2010: a prospective, population-based study

Bjellvi

Flink

Rydenhag

et al. 2015

JNS

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“…6,7,11,31,34,38,54,65,66,86 It is remarkable that severe visual field deterioration (loss of more than one-quarter) was found in only 5.2% of the patients, which is much lower than rates in the literature. This outcome might have its origin in the inclusion of functional images of the visual tracts in many patients.…”

Section: General and Neurological Complicationsmentioning

confidence: 56%

Resective surgery for medically refractory epilepsy using intraoperative MRI and functional neuronavigation: the Erlangen experience of 415 patients

Rössler¹,

Hofmann²,

Sommer³

et al. 2016

FOC

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OBJECTIVE Intraoperative overestimation of resection volume in epilepsy surgery is a well-known problem that can lead to an unfavorable seizure outcome. Intraoperative MRI (iMRI) combined with neuronavigation may help surgeons avoid this pitfall and facilitate visualization and targeting of sometimes ill-defined heterogeneous lesions or epileptogenic zones and may increase the number of complete resections and improve seizure outcome. METHODS To investigate this hypothesis, the authors conducted a retrospective clinical study of consecutive surgical procedures performed during a 10-year period for epilepsy in which they used neuronavigation combined with iMRI and functional imaging (functional MRI for speech and motor areas; diffusion tensor imaging for pyramidal, speech, and visual tracts; and magnetoencephalography and electrocorticography for spike detection). Altogether, there were 415 patients (192 female and 223 male, mean age 37.2 years; 41% left-sided lesions and 84.9% temporal epileptogenic zones). The mean preoperative duration of epilepsy was 17.5 years. The most common epilepsy-associated pathologies included hippocampal sclerosis (n = 146 [35.2%]), long-term epilepsy-associated tumor (LEAT) (n = 67 [16.1%]), cavernoma (n = 45 [10.8%]), focal cortical dysplasia (n = 31 [7.5%]), and epilepsy caused by scar tissue (n = 23 [5.5%]). RESULTS In 11.8% (n = 49) of the surgeries, an intraoperative second-look surgery (SLS) after incomplete resection verified by iMRI had to be performed. Of those incomplete resections, LEATs were involved most often (40.8% of intraoperative SLSs, 29.9% of patients with LEAT). In addition, 37.5% (6 of 16) of patients in the diffuse glioma group and 12.9% of the patients with focal cortical dysplasia underwent an SLS. Moreover, iMRI provided additional advantages during implantation of grid, strip, and depth electrodes and enabled intraoperative correction of electrode position in 13.0% (3 of 23) of the cases. Altogether, an excellent seizure outcome (Engel Class I) was found in 72.7% of the patients during a mean follow-up of 36 months (range 3 months to 10.8 years). The greatest likelihood of an Engel Class I outcome was found in patients with cavernoma (83.7%), hippocampal sclerosis (78.8%), and LEAT (75.8%). Operative revisions that resulted from infection occurred in 0.3% of the patients, from hematomas in 1.6%, and from hydrocephalus in 0.8%. Severe visual field defects were found in 5.2% of the patients, aphasia in 5.7%, and hemiparesis in 2.7%, and the total mortality rate was 0%. CONCLUSIONS Neuronavigation combined with iMRI was beneficial during surgical procedures for epilepsy and led to favorable seizure outcome with few specific complications. A significantly higher resection volume associated with a higher chance of favorable seizure outcome was found, especially in lesional epilepsy involving LEAT or diffuse glioma.

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“…Mortality after the ATL procedure is very low, with reported rates ranging from 0 to 0.5% in large series (42,43). Morbidity rates in a recent review ranged from 0 to 9.3% (42), with the most common complications being visual field disturbance, infection, and neuropsychological changes, most notably declines in verbal memory when the dominant hemisphere was resected.…”

Section: Anterior Temporal Lobectomy (Atl)mentioning

confidence: 99%

“…Morbidity rates in a recent review ranged from 0 to 9.3% (42), with the most common complications being visual field disturbance, infection, and neuropsychological changes, most notably declines in verbal memory when the dominant hemisphere was resected. In children, neuropsychological outcomes may be better, with less decline in verbal memory compared with adults and improvement in functions ascribed to the contralateral hemisphere (44).…”

Section: Anterior Temporal Lobectomy (Atl)mentioning

confidence: 99%

Surgical strategies for pediatric epilepsy

Guan

Karsy

Ducis³

et al. 2016

Transl. Pediatr.

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Pediatric epilepsy is a debilitating condition that impacts millions of patients throughout the world. Approximately 20-30% of children with recurrent seizures have drug-resistant epilepsy (DRE).For these patients, surgery offers the possibility of not just seizure freedom but significantly improved neurocognitive and behavioral outcomes. The spectrum of surgical options is vast, ranging from outpatient procedures such as vagus nerve stimulation to radical interventions including hemispherectomy. The thread connecting all of these interventions is a common goal-seizure freedom, an outcome that can be achieved safely and durably in a large proportion of patients. In this review, we discuss many of the most commonly performed surgical interventions and describe the indications, complications, and outcomes specific to each.

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Temporal Lobe Resective Surgery for Medically Intractable Epilepsy: A Review of Complications and Side Effects

Cited by 63 publications

References 62 publications

Complications of epilepsy surgery in Sweden 1996–2010: a prospective, population-based study

Complications of epilepsy surgery in Sweden 1996–2010: a prospective, population-based study

Resective surgery for medically refractory epilepsy using intraoperative MRI and functional neuronavigation: the Erlangen experience of 415 patients

Surgical strategies for pediatric epilepsy

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