title: Temporal lobe surgery for intractable epilepsy in children: an analysis of outcomes in 126 children.
abstract: OBJECTIVE
  Temporal lobectomy is a well-established neurosurgical procedure for temporal lobe epilepsy. In this study, we conducted a retrospective review of children with drug-resistant temporal lobe epilepsy to evaluate seizure outcome after temporal lobe surgery.
  
  
  METHODS
  We reviewed the medical records of 126 children who had surgery for temporal lobe epilepsy at The Hospital for Sick Children between 1983 and 2003. The records were examined for preoperative and intraoperative factors that could predict patient outcome after surgery.
  
  
  RESULTS
  The mean age at seizure onset was 5.9 years. The mean seizure duration before surgery was 5.6 years. All patients had preoperative computed tomographic scans, magnetic resonance imaging scans, or both. The mean age at the time of surgery was 13.5 years. Sixty-two patients underwent left temporal resections and 64 patients underwent right temporal resections. The histopathology of the temporal resections revealed low-grade brain tumors in 65 children (52%) and cavernous malformations in four children. Ganglioglioma and astrocytoma were the most common tumors encountered. Mesial temporal sclerosis was found in 16 patients (13%), astrogliosis in 15 patients (12%), and cortical dysplasia in eight patients (7%). Postoperative follow-up of at least 2 years was available for 106 patients and ranged up to 13.0 years. Seventy-four percent of patients had an Engel Class I or II outcome. Patients with temporal lobe lesions had better outcomes compared with those without lesions (P < 0.05). Patients without a history of secondary generalization of seizures also had a better outcome when compared with those with secondary generalization. Complications in the form of contralateral homonymous hemianopsia, dysphasia, and infection were found in 5% of patients. Twelve patients had a second temporal lobe procedure for intractable recurrent seizures. After a second procedure, seven patients returned to a seizure-free state.
  
  
  CONCLUSIONS
  Temporal lobe resections for epilepsy in children are effective and safe procedures, with a favorable impact on seizure control. Repeat temporal resections for recurrent seizures may also be effective in restoring a seizure-free outcome to children.
authors.affiliation: Division of Neurosurgery, The Hospital for Sick Children, The University of Toronto, Toronto, Ontario, Canada.
authors.forename: Mony
authors.initials: M
authors.lastname: Benifla
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Otsubo
authors.forename: Ayako
authors.initials: A
authors.lastname: Ochi
authors.forename: Shelly K
authors.initials: SK
authors.lastname: Weiss
authors.forename: Elizabeth J
authors.initials: EJ
authors.lastname: Donner
authors.forename: Manohar
authors.initials: M
authors.lastname: Shroff
authors.forename: Sylvester
authors.initials: S
authors.lastname: Chuang
authors.forename: Cynthia
authors.initials: C
authors.lastname: Hawkins
authors.forename: James M
authors.initials: JM
authors.lastname: Drake
authors.forename: Irene
authors.initials: I
authors.lastname: Elliott
authors.forename: Mary Lou
authors.initials: ML
authors.lastname: Smith
authors.forename: O Carter
authors.initials: OC
authors.lastname: Snead
authors.forename: James T
authors.initials: JT
authors.lastname: Rutka
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease; D004833:Epilepsy, Temporal Lobe / Q000453:epidemiology* / Q000601:surgery*; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D019635:Neurosurgical Procedures / Q000706:statistics & numerical data*; D009864:Ontario / Q000453:epidemiology; D017063:Outcome Assessment, Health Care; D012008:Recurrence; D013702:Temporal Lobe / Q000601:surgery*; D017211:Treatment Failure; D016896:Treatment Outcome