Abstracts

Rationale: It is controversial whether amygdalo-hippocampectomy (AH) in addition to the lesionectomy would result in better outcomes for intractable temporal lobe epilepsy associated with temporal lesions. In this study, we retrospectively review the surgical outcomes of lesional temporal lobe epilepsy. Methods: From 2000, 13 intractable temporal lobe epilepsy patients, who had temporal lesions in MRI, underwent surgical treatments of our department. Pathologies included 5 gngliogliomas cases, 5 cavernous angiomas, one astrocytoma Gd II, one dysembryoplastic neuroepithelial tumor (DNT) and one arachnoid cyst. Four patients had choronic subdural electrode studies. AH and lesionectomy were selected in 3 ganglioglioma cases located in non-dominant parahippocampal gyri and one arachnoid cyst located in the non-dominant middle fossa. In the other 9 cases, lesions were located in the dominant temporal lobe. In these cases, lesionectomy (some cases with surrounding cortex removed) without AH were performed, even if FDG-PET or intraoperative electrocorticography suggested secondary epileptogenicity in the hippocampus. They were followed for more than two years after surgery. Results: Eleven cases resulted in Engel's class Ia. One non-dominant ganglioglioma case with AH resulted in class Ic and one dominant DNT case without AH resulted in class Ib. Conclusions: We found no evidence to support the idea that lesionectomy with additional AH for lesional temporal lobe epilepsy would result in better outcomes when compared to lesionectomy alone, especially in cases of dominant side.