REOPERATION AFTER FAILED PRIMARY LESIONECTOMY IN PATIENTS WITH REFRACTORY EPILEPSY
Abstract number :
3.235
Submission category :
Year :
2002
Submission ID :
62
Source :
www.aesnet.org
Presentation date :
12/7/2002 12:00:00 AM
Published date :
Dec 1, 2002, 06:00 AM
Authors :
Valeria A. Mello, Cristine M. Baldauf, Meire Argentoni, Cassio R. Forster, Carla Baise, Leila Frayman, Jose A. Buratini, Joaquim O. Vieira, Arthur Cukiert, Paulo T. Brainner-Lima. Neurology and Neurosurgery, Hospital Brigadeiro, Sao Paulo, Sao Paulo, Braz
RATIONALE: The adequate management of brain lesions associated to refractory epilepsy has been intensively discussed over the years. Series favoring lesionectomy alone or including margins have been published. A recent extensive meta-analysis suggested that additional margins should be included in the resection. The method for margin determination has varied among centers but intraoperative electrocorticography has been the preferred option.
METHODS: Nine adult patients with refractory epilepsy previously submitted to lesionectomy in other center were reoperated. Three patients had meningioma (frontal convexity, sphenoid wing and parietal parasagital, respectively), 3 had temporal lobe cavernoma (1 mesial, 2 lateral) and 3 had low grade glioma (2 parietal and 1 temporal). The patients with meningioma and glioma were submitted to additional resection guided by intraoperative electrocorticography. The patients with temporal lobe cavernoma were submitted to additional corticectomy up to the level of the central artery and amygdalo-hippocampectomy, without electrocorticography. Mean seizure[ssquote]s frequency was 2/week. Mean follow-up time was 1,3 years.
RESULTS: All patients previously operated for cavernoma and meningioma have been rendered seizure-free after reoperation. Two of the patients with glioma have been seizure-free after surgery. There was only a 50% improvement in seizure[ssquote]s frequency in the third patient with glioma. This patient had a xantoastrocitoma and presented with malignant deterioration of the lesion 8 months after surgery and is now undergoing adjunctive radiotherapy and chemotherapy.
CONCLUSIONS: Lesionectomy alone may fail to eliminate seizures in patients with preoperative refractory epilepsy. Combined seizure[ssquote]s and anatomical surgery should be offered to the patient whenever technically possible. If lesionectomy alone would be performed, the patient should be aware the a second procedure might be necessary to take care of seizures.
[Supported by: Sao Paulo Secretary of State]