title: Analysis of different types of resection for pediatric patients with temporal lobe epilepsy.
abstract: OBJECTIVE
  Resection strategies for the treatment of temporal lobe epilepsy (TLE) are a matter of discussion. Few data on the significance of resection type are available for pediatric patients with TLE.
  
  
  METHODS
  Data for a series of 89 children who were surgically treated for TLE were analyzed. A first cohort of patients were mainly surgically treated with anterior temporal lobectomies. For a second cohort, resections were preoperatively "tailored" to the lesion and presumed epileptogenic area.
  
  
  RESULTS
  The follow-up period was 46 months (range, 14-118 mo). Seventy-seven patients (87%) attained satisfactory seizure control (82% Engel Class I and 5% Class II). For 12 patients (13%), seizure control was unsatisfactory (8% Class III and 5% Class IV). Anterior temporal lobectomies resulted in 94% satisfactory seizure control (33 patients), whereas the success rates were only 74% (20 patients) for amygdalohippocampectomy (AH) (P = 0.023) and 77% (13 patients) for lesionectomy plus hippocampectomy (not significant). All patients who underwent purely lateral temporal lesionectomies became seizure-free (14 patients). Logistic regression revealed the factors of AH (P = 0.021) and left-side surgery (P = 0.017) as significant predictors of unsatisfactory seizure control. Satisfactory seizure control was not dependent on the histopathological diagnoses. There was a low rate of verbal memory deterioration after left-side operations. Neuropsychological deterioration was rare after right temporal resections. Attentional and contralateral functions improved after surgery.
  
  
  CONCLUSIONS
  Surgery for the treatment of juvenile TLE is successful and safe, but the resection type may influence outcomes. Results after AHs were disappointing, probably because of difficulties in precise localization of the epileptogenic focus among children. Neuropsychological results demonstrated minimal rates of deterioration and significant improvements in contralateral functions. Surgical treatment of juvenile TLE should be encouraged, but the use of especially left AH should possibly be restricted.
authors.affiliation: Department of Neurosurgery, Bonn Medical Center, Sigmund-Freud-Strasse 25, 53105 Bonn, Germany. hans.clusmann@ukb.uni-bonn.de
authors.forename: Hans
authors.initials: H
authors.lastname: Clusmann
authors.forename: Thomas
authors.initials: T
authors.lastname: Kral
authors.forename: Ulrike
authors.initials: U
authors.lastname: Gleissner
authors.forename: Robert
authors.initials: R
authors.lastname: Sassen
authors.forename: Horst
authors.initials: H
authors.lastname: Urbach
authors.forename: Ingmar
authors.initials: I
authors.lastname: Blümcke
authors.forename: Jacek
authors.initials: J
authors.lastname: Bogucki
authors.forename: Johannes
authors.initials: J
authors.lastname: Schramm
mesh_terms: D000293:Adolescent; D038481:Anterior Temporal Lobectomy / Q000379:methods*; D001925:Brain Damage, Chronic / Q000175:diagnosis / Q000209:etiology; D002648:Child; D002675:Child, Preschool; D004292:Dominance, Cerebral / Q000502:physiology; D004569:Electroencephalography; D004833:Epilepsy, Temporal Lobe / Q000175:diagnosis / Q000473:pathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D008279:Magnetic Resonance Imaging; D008297:Male; D009483:Neuropsychological Tests; D011183:Postoperative Complications / Q000175:diagnosis / Q000209:etiology*; D013702:Temporal Lobe / Q000473:pathology; D016896:Treatment Outcome