Reoperation after failed resective epilepsy surgery

Abstract

Purpose: Resection of the seizure focus leads to sustained seizure-freedom in intractable focal epilepsy in up to 80% of selected populations. However, surgery fails to help in a considerable proportion of patients. Reevaluation and reoperation may be considered in a selected group of patients with an unfavorable postsurgical outcome. Here, we reviewed 15 case series on reoperation after failed resective epilepsy surgery in adults in order to identify factors associated with a good chance of benefitting from a second operation.

Methods: Literature review of case series describing the outcome of epilepsy surgical re-operations.

Results: Overall, 3.8-14% of all patients who had resective epilepsy surgery underwent a second operation. A total of 402 reoperated patients were included. Reoperation was performed in average between 2 and 5.5 years after the first surgery. 36.6% of all patients were seizure-free with a minimal follow-up of 6 months to 4 years after the second operation. Postsurgical complications were observed in 13.5% and mainly consisted of visual field defects and, less frequently, of hemiparesis. The causes of failed first epilepsy surgery were heterogeneous and included incorrect localization or incomplete resection of the seizure focus, presence of additional seizure foci or progression of the underlying disease. Some features appear to indicate successful reoperation, such as concordance of postsurgical imaging and electroclinical findings as well as absence of brain trauma and cerebral infection prior to epilepsy onset.

Conclusion: Reoperation after thorough assessment of all available clinical, imaging and EEG findings can be an efficacious and reasonably safe treatment option which can achieve sustained seizure control after failed resective epilepsy surgery.

Keywords: Epilepsy surgery; Frontal lobe epilepsy; Hippocampal sclerosis; Hypothalamic hamartoma; Temporal lobe epilepsy.