Abstracts

Rationale: Temporal lobectomy (TL) is the ultimate procedure in treatment of medically intractable temporal lobe epilepsy. In this study, we retrospectively analyzed the presurgical evaluative data in children and adults who received TL for medically intractable seizures, and compared the outcome. Methods: We reviewed the medical records of 52 patients who received TL in Severance Hospital between January 2006 to February 2008. Patients were classified as Child-group (≤ 15 years old) and Adult-group (> 15 years old) according to the age at first seizure onset (Age-1), where 29 and 23 patients were enrolled respectively. Medical records were examined for following; duration of seizure until surgery (D), age at the time of surgery (Age-2), preoperative video-EEG monitoring, MRI, PET, and SPECT data, length of surgical margin (M), and pathologic finding. Final outcome was described in accord to the Engel’s classification of postoperative outcome. Results: (1) Out of total patients, the mean Age-1, mean Age-2 and mean D were 15.7 years, 28.6 years, and 12.7 years respectively. The mean M was 4.39 cm. Engel Class I and II outcome comprised 94% of the patients, and postoperative seizure-free (SF) rate was 70.6%. (2) In the Child-group and Adult-group, the mean Age-1 was 7.8 years and 25.7 years each, and the mean Age-2, 19.6 and 40.0 years. Mean D was 11.5 years and 14.3 years each(P>0.05). (3) The mean M of Child-group and Adult-group were 4.72 cm and 3.98 cm (P=0.003), and the mean M of patients with hippocampal sclerosis (HS) was 4.59 cm and 3.94 cm (P=0.015), indicating statistically significant difference between the two groups. (4) SF rate was 65.5% in Child-group and 73.9% in Adult-group (P>0.05). (5) HS, the most common pathologic finding in both groups, was 69.0% (20/29) in Child-group and 73.9% (17/23) in Adult-group (P>0.05). Dual pathology was found in 31.0% (9/29) of Child-group and 8.7% (2/23) of Adult-group, showing significant difference between the two (P=0.035). (6) Out of total patients, the mean D in patients with HS and without HS was statistically different at 14.7 years and 7.7 years (P=0.001). (7) Patients with relatively lower age in Age-1(≤15 years), Age-2(≤25 years), and shorter duration to D(≤10 years) had significantly larger value of mean M when compared to the older counterparts. Conclusions: HS was the most common pathologic finding in both groups. In Child-group, more frequent presence of dual pathology was noted. The mean M of Child-group was significantly larger, but the surgical outcome in both groups was favorable and showed no statistically significant differences.