Abstracts

RATIONALE: Temporal lobe resection is the most commonly used procedure in the surgical treatment of refractory epilepsy. On the other hand, the ammount of tissue to be resected as well as the surgical technique vary from one center to another. This study reports the results obtained after reoperations in patients with refractory temporal lobe epilepsy submitted to corticectomy alone in other centers. METHODS: Four patients with unilateral refractory temporal lobe epilepsy were studied. All had already been submitted to surgery in other centers. In all, resection comprised the anterior temporal neocortex, sparing the mesial structures. In 3, MRI performed after the first surgical procedure showed mesial temporal sclerosis (MTS) on the operated side and in 1 MRI was normal. The patients with MTS were submitted to an amygadalo-hippocampectomy under general anesthesia. The patient with normal MRI was implanted with subdural electrodes over the previously operated frontotemporal convexity and subsequently underwent an amygdalo-hippocampectomy and posterior temporal corticectomy. RESULTS: All patients were rendered seizure-free after reoperation. There was no surgical morbidity. CONCLUSIONS: Small cortical resections sparing the mesial structures are usually not enough in patients with refractory temporal lobe epilepsy. It is a technical mistake not to include the mesial structures within the resection in patients with MRI-defined MTS. In patients with normal MRI, invasive monitoring would often be needed for the localization of epileptogenic areas. Small corticectomies are even worse in this set of patients.