Outcome after corticoamygdalohippocampectomy in patients with refractory temporal lobe epilepsy and mesial temporal sclerosis without preoperative ictal recording.
OBJECTIVE
We report on the surgical outcome obtained in patients with refractory temporal lobe epilepsy with mesial temporal sclerosis (MTS) who were evaluated preoperatively without ictal recording and were submitted to corticoamygdalohippocampectomy.


METHODS
Two hundred twelve patients with refractory temporal lobe epilepsy were evaluated by means of clinical history, neurological examination, interictal electroencephalography (EEG), magnetic resonance imaging (MRI), and neuropsychological testing. MRI disclosed unilateral MTS in all patients. All patients were submitted to corticoamygdalohippocampectomy at the side determined by MRI.


RESULTS
Interictal EEG showed unilateral temporal lobe spiking in 176 patients; in 36 patients, bilateral discharges were found. Mean follow-up time was 2.7 years. One hundred ninety-four patients (92%) were classified as Engel's class I. Eighteen patients (8%) were rated as Engel's class II. Thirty-two out of 36 patients, in whom bilateral discharges were found, were in Engel's class I. Sixty percent of the patients had an improvement in memory function related to the nonoperated temporal lobe. Fifty-nine percent of the patients had a 10-point increase in general IQ postoperatively. Verbal memory decline was noted in three patients. Pathological examination showed MTS in all patients.


CONCLUSIONS
It is possible to adequately select good surgical candidates for temporal lobe resection using MRI and interictal EEG alone. In patients with MRI-defined MTS, we should expect a 90% postoperative remission rate. Cognitive decline was very rarely seen in this patient population. The finding of MTS on MRI is the single most important prognostic factor for good outcome after temporal lobe surgery.
Cukiert
Arthur
A
Epilepsy Surgery Program, Hospital Brigadeiro, São Paulo, São Paulo, Brazil. acukiert@uol.com.br
Cukiert
Cristine Mella
CM
Argentoni
Meire
M
Baise-Zung
Carla
C
Forster
Cássio Roberto
CR
Mello
Valeria Antakli
VA
Burattini
José Augusto
JA
Mariani
Pedro Paulo
PP
D000293:Adolescent; D000328:Adult; D000679:Amygdala / Q000601:surgery*; D002648:Child; D004569:Electroencephalography / Q000379:methods; D004833:Epilepsy, Temporal Lobe / Q000473:pathology / Q000601:surgery*; D005260:Female; D006624:Hippocampus / Q000601:surgery*; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000379:methods*; D012189:Retrospective Studies; D012598:Sclerosis / Q000473:pathology / Q000601:surgery; D013702:Temporal Lobe / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult