Abstracts

Rationale: Resective surgery is an accepted option for patients with refractory temporal lobe epilepsy. Self-evaluation of complication and long-term outcome rates in individual centers is important to improve patient care. Methods: A retrospective study of all patients who have undergone temporal lobe epilepsy surgery at Hôpital Notre-Dame in the last seven years was completed. All patients underwent a comprehensive presurgical evaluation including video-EEG, MRI, SPECT, TEP and neuropsychological evaluation. Collected data included age of onset of epilepsy, risk factors for epilepsy, duration of epilepsy, age at surgery, type and frequency of seizures, seizure semiology, results of presurgical investigations, pathology of resected specimen and post-operative seizure outcome. Results: Forty-seven temporal lobe operations were performed for refractory temporal lobe epilepsy. Preoperative intracranial recording was performed in nine patients (19%). Mean age at onset of epilepsy was 16 yrs and mean duration of epilepsy prior to surgery was 21 yrs. Hippocampal sclerosis was present in 72% of patients, a vascular malformation in 6%, cortical dysplasia in 13%, and no identifiable lesion in 15%. Nineteen patients had conventional anterior temporal lobectomy, twenty-three patients had selective amygdalo-hippocampectomy and five patients had tailored lesionectomy. Eigthy-five percent of patients had a satisfactory outcome (Engel 1 and 2). Mean follow-up was 27 months. Surgical complications (mostly infections) occurred 5 patients (11%), none with permanent sequelae. Transient neurological complications occurred in 5 patients (11%) (aphasia, hemiparesis and exacerbation of preexisting psyciatric illness). 3 patients (6%) had postoperative quadranopsia. Conclusions: Long-term seizure-free rate following epilepsy surgery for refractory temporal lobe epilepsy at our center is similar to that reported in other studies.