title: Comprehensive preoperative work-up and surgical treatment of low grade tumor/benign lesion related temporal lobe epilepsy.
abstract: OBJECTIVE
  Generally low-grade tumor/benign lesion related temporal lobe epilepsy (LGT/BL-TLE) is considered easier to treat and has better prognosis when compared to non-lesional TLE. However, multiple disputes exist in surgical management of this epilepsy entity. This study aims to discuss comprehensive preoperative work-up, surgical strategies and outcome of it.
  
  
  METHODS
  A retrospective review of sixty LGT/BL-TLE cases which underwent comprehensive preoperative work-up and then resective surgeries was conducted. Surgical strategies were categorized into limited and expanded resections. Surgical efficacy was evaluated using Engel grading after telephone or clinic follow-up and compared statistically.
  
  
  RESULTS
  Preoperative work-up includes magnetic resonance imaging (MRI), conventional electroencephalography, semiology evaluation, positron emission tomography (PET) and 256-channel dense-array electroencephalography source imaging (256-ch dESI). In aspect of concordance with epileptic lesions demonstrated on MRI, 256-ch dESI was more accurate than PET (72.7% vs. 39.4%) (p<0.05). Limited resections were performed in 28 cases while expanded resections in 32 cases. Altogether the surgical efficacy was: Engel grade I 86.7%, I+II 95.0%. Comparison of surgical outcome showed neither the outcome between limited and expanded resection nor the outcome between mesial and neocortical TLE (mTLE & nTLE) undergoing limited resections was significantly different (p>0.05).
  
  
  CONCLUSIONS
  For LGT/BL-TLE, most surgical strategies can be made preoperatively after comprehensive work-up rather than intraoperatively. Limited and expanded strategies yield similar surgical outcome in either nTLE or mTLE as long as comprehensive work-up supports the strategy and the epileptic lesion is totally removed. 256-ch dESI which can visualize both structural and electrophysiological lesions may be contributable to surgical planning of this entity.
authors.affiliation: Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai 200040, China.
authors.forename: Rui
authors.initials: R
authors.lastname: Feng
authors.affiliation: Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai 200040, China; Department of Neurosurgery, Jing'an Branch of Huashan Hospital, Fudan University, Shanghai 200040, China. Electronic address: jiehu68@yahoo.com.
authors.forename: Jie
authors.initials: J
authors.lastname: Hu
authors.affiliation: Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai 200040, China. Electronic address: wjsongc@126.com.
authors.forename: Jinsong
authors.initials: J
authors.lastname: Wu
authors.affiliation: Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai 200040, China.
authors.forename: Liqin
authors.initials: L
authors.lastname: Lang
authors.affiliation: Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai 200040, China.
authors.forename: Chengxin
authors.initials: C
authors.lastname: Ma
authors.affiliation: Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai 200040, China.
authors.forename: Shize
authors.initials: S
authors.lastname: Jiang
authors.affiliation: Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai 200040, China.
authors.forename: Bing
authors.initials: B
authors.lastname: Sun
authors.affiliation: Department of Neurosurgery, Jing'an Branch of Huashan Hospital, Fudan University, Shanghai 200040, China.
authors.forename: Xin
authors.initials: X
authors.lastname: Gu
authors.affiliation: Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai 200040, China.
authors.forename: Li
authors.initials: L
authors.lastname: Pan
mesh_terms: D000328:Adult; D001932:Brain Neoplasms / Q000000981:diagnostic imaging* / Q000601:surgery*; D004569:Electroencephalography / Q000379:methods; D004833:Epilepsy, Temporal Lobe / Q000000981:diagnostic imaging* / Q000601:surgery*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D060787:Neoplasm Grading; D049268:Positron-Emission Tomography / Q000379:methods; D011300:Preoperative Care / Q000379:methods*; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: Dense array electroencephalography source imaging; Low grade tumor/benign lesion related temporal lobe epilepsy; Preoperative work-up; Surgical treatment