title: Long-term outcome of surgical disconnection of the epileptic zone as an alternative to resection for nonlesional mesial temporal epilepsy.
abstract: BACKGROUND
  Pharmacoresistant epilepsy can be treated by either resection of the epileptic focus or functional isolation of the epileptic focus through complete disconnection of the pathways of propagation of the epileptic activity.
  
  
  OBJECTIVE
  To evaluate long-term seizure outcome and complications of temporal lobe disconnection (TLD) without resection for mesial temporal lobe epilepsy (MTLE).
  
  
  METHODS
  Data of 45 patients operated on for intractable MTLE using a functional disconnection procedure have been studied. Indication of TLD surgery was retained after a standard preoperative evaluation of refractory epilepsy and using the same criteria as for standard temporal resection.
  
  
  RESULTS
  Mean follow-up duration was 3.7 years. At the last follow-up, 30 patients (67%) were completely seizure-free (Engel-Ia/International League Against Epilepsy class 1) and 39 patients (87%) remained significantly improved (Engel-I or -II) by surgery. Actuarial outcome displays a 77.7% probability of being seizure-free and an 85.4% probability of being significantly improved at 5 years. No patient died after surgery and no subdural haematoma or hygroma occurred. Permanent morbidity included hemiparesis, hemianopia and oculomotor paresis found in three, five and one patient, respectively, after TLD.
  
  
  CONCLUSIONS
  TLD is acceptable alternative surgical technique for patients with intractable MTLE. The results of TLD are in the range of morbidity and long-term seizure outcome rates after standard surgical resection. We observed a slightly higher rate of complications after TLD in comparison with usual rates of morbidity of resection procedures. TLD may be used as an alternative to resection and could reduce operating time and the risks of subdural collections.
authors.affiliation: Department of Neurosurgery, Clinic of Stereotactic and Functional Neurosurgery, ULB-Hôpital Erasme, , Brussels, Belgium.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Massager
authors.forename: Patrick
authors.initials: P
authors.lastname: Tugendhaft
authors.forename: Chantal
authors.initials: C
authors.lastname: Depondt
authors.forename: Thomas
authors.initials: T
authors.lastname: Coppens
authors.forename: Landry
authors.initials: L
authors.lastname: Drogba
authors.forename: Nadir
authors.initials: N
authors.lastname: Benmebarek
authors.forename: Olivier
authors.initials: O
authors.lastname: De Witte
authors.forename: Patrick
authors.initials: P
authors.lastname: Van Bogaert
authors.forename: Benjamin
authors.initials: B
authors.lastname: Legros
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D004351:Drug Resistance; D004833:Epilepsy, Temporal Lobe / Q000175:diagnosis / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D059906:Neuroimaging; D019635:Neurosurgical Procedures / Q000009:adverse effects / Q000379:methods*; D013702:Temporal Lobe / Q000601:surgery*; D016896:Treatment Outcome
keywords: EPILEPSY, SURGERY