Tailored temporal lobectomy for medically intractable epilepsy:  evaluation of pathology and predictors of outcome.
BACKGROUND
There have been only a few large series that have used a tailored temporal lobectomy.


OBJECTIVE
To clarify whether tailoring a temporal lobe resection will lead to equivalent epilepsy outcomes or have the same predictive factors for success when compared with standard resections.


METHODS
Retrospective analysis of 222 patients undergoing a tailored temporal lobe resection. Demographic measures and typical factors influencing outcome were evaluated.


RESULTS
Pathology included 222 cases. With a mean follow-up of 5.4 years, 70% of patients achieved Engel class I outcome. A significant factor predicting Engel class I outcome on multivariate analysis was lesional pathology (P = .04). Among patients with hippocampal sclerosis, extent of lateral neocortical resection and hippocampal resection were not statistically associated with Engel class I outcome (P = .93 and P = .24). However, an analysis of Engel class subgroups a to d showed that patients who had a complete hippocampectomy in the total series were more likely to achieve an Engel class Ia outcome (P = .04). This was also true among patients with hippocampal sclerosis (P = .03). Secondarily, generalized seizure (P = .01) predicted outcome less than Engel class I. Predictive of poor outcome was the need for preoperative electrodes (P = .02). Complications included superior quadrant visual field defects, 2 cases of permanent dysphasia, and 3 wound infections.


CONCLUSIONS
Predictors of successful seizure outcome for a tailored temporal lobectomy are similar to standard lobectomy. Patients with secondarily generalized epilepsy and cases in which preoperative subdural electrodes were thought necessary were less likely to achieve class I outcome. Among Engel class I cases, those who had a complete hippocampectomy were more likely to achieve Engel class Ia outcome.
Department of Neurosurgery, Rush University, Chicago, Illinois 60612, USA. Steven_falowski@rush.edu
Steven M
SM
Falowski
David
D
Wallace
Andres
A
Kanner
Michael
M
Smith
Michael
M
Rossi
Antoaneta
A
Balabanov
Bichun
B
Ouyang
Richard W
RW
Byrne
D000328:Adult; D038481:Anterior Temporal Lobectomy / Q000379:methods*; D004833:Epilepsy, Temporal Lobe / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D013702:Temporal Lobe / Q000601:surgery*; D016896:Treatment Outcome