Tailored temporal lobectomy for medically intractable epilepsy: evaluation of pathology and predictors of outcome

Neurosurgery. 2012 Sep;71(3):703-9; discussion 709. doi: 10.1227/NEU.0b013e318262161d.


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.

Conclusion: 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.

MeSH terms

  • Adult
  • Anterior Temporal Lobectomy / methods*
  • Epilepsy, Temporal Lobe / surgery*
  • Female
  • Humans
  • Male
  • Retrospective Studies
  • Temporal Lobe / surgery*
  • Treatment Outcome