title: Transsylvian-transcisternal selective lesionectomy for pediatric lesional mesial temporal lobe epilepsy.
abstract: BACKGROUND
  The optimal extent of resection for surgical treatment of lesional epilepsy is a controversial issue.
  
  
  OBJECTIVE
  For patients with mesial temporal lobe lesions visible on magnetic resonance imaging, we compared the surgical outcome of selective lesionectomy with that of standard anterior temporal lobectomy (ATL) and amygdalohippocampectomy.
  
  
  METHODS
  We conducted a retrospective analysis of the seizure outcome of 40 patients treated for lesional mesial temporal lobe epilepsy between 1993 and 2008. Before 2006, patients were managed by ATL (n=29) and from 2006 onward, by selective lesionectomy via the transsylvian-transcisternal approach (n=11).
  
  
  RESULTS
  The postoperative seizure-free rates for the 2 groups were comparable: 93% (27/29) for the ATL group and 91% (10/11) for the selective lesionectomy group (P=.814). In both groups, patients with persistent seizures commonly showed incomplete lesion resection, with complete resection often improving seizure outcome. Postoperative visual field defects were more common in the ATL group (21%) than in the selective lesionectomy group (0%) (P=.102).
  
  
  CONCLUSIONS
  Transsylvian-transcisternal selective lesionectomy is an effective and safe therapeutic modality in children with lesional mesial temporal lobe epilepsy. Completeness of resection is an important variable for seizure control regardless of surgical modality.
authors.affiliation: Division of Pediatric Neurosurgery, Seoul National University Children's Hospital, College of Medicine, Seoul, Republic of Korea.
authors.forename: Ji Yeoun
authors.initials: JY
authors.lastname: Lee
authors.forename: Ji Hoon
authors.initials: JH
authors.lastname: Phi
authors.forename: Kyu-Chang
authors.initials: KC
authors.lastname: Wang
authors.forename: Byung-Kyu
authors.initials: BK
authors.lastname: Cho
authors.forename: Seung-Ki
authors.initials: SK
authors.lastname: Kim
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D002946:Cisterna Magna / Q000601:surgery*; D004833:Epilepsy, Temporal Lobe / Q000601:surgery*; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D019635:Neurosurgical Procedures / Q000379:methods*; D016896:Treatment Outcome