Strategy for Additional Resection After Failed Resective Epilepsy Surgery
Abstract number :
V.088
Submission category :
9. Surgery / 9C. All Ages
Year :
2021
Submission ID :
1825949
Source :
www.aesnet.org
Presentation date :
12/9/2021 12:00:00 PM
Published date :
Nov 22, 2021, 06:51 AM
Authors :
Akihiko Kondo, MD - Shizuoka Institute of Epilepsy and Neurological Disorders; Naotaka Usui – Shizuoka Institute of Epilepsy and Neurological Disorders; Hiroshi Ogawa – Shizuoka Institute of Epilepsy and Neurological Disorders; Yukitoshi Takahashi – Shizuoka Institute of Epilepsy and Neurological Disorders
Rationale: Seizure freedom is not achieved in 20-30% of epilepsy surgery cases. Although there are some reports recommending intracranial EEG for reoperation, no certain consensus has been reached. We investigated the strategy of reoperation for residual seizures at our hospital.
Methods: Of the 644 patients who underwent resective surgery between January 2008 and January 2020, we reviewed those who underwent initial and additional resections (excluding hemispherotomy) within the period and were followed up for at least 1 year.
Results: Seventeen cases, which was 2.6% of the total cases, were included. The diagnosis was temporal lobe epilepsy in 4 cases, and extratemporal, or multilobar epilepsy including temporal lobe in 13. Twelve patients underwent surgery on the right side. Six cases had no abnormality on MRI. The male-to-female ratio was 11:6. The mean age at seizure onset was 8.1 years (4 months-24 years). The mean age at initial surgery was 16.3 years (2-58 years). The mean time between the initial surgery and the last reoperation was 2.2 years (29 days-9.7 years). Seven patients underwent intracranial EEG, and it was performed in 2 patients both before the first and additional resections. The final pathology results of the 16 cases for which resection specimens were obtained revealed that 9 patients had focal cortical dysplasia, 2 had brain tumor, 1 had tuberous sclerosis, and 1 had ulegyria, and no specific findings were found in the remaining 3 cases. The mean follow-up period after the last surgery was 5.5 years (1.4-11.2 years). We achieved Engel Class I in 10 patients (58.8%), Class II in one, and Class IV in six. Of the 11 patients who achieved favorable outcome (Class I-II), only 4 patients underwent intracranial EEG. In two of the six patients with Class IV, complete resection was not performed due to overlap between the epileptogenic zone and the eloquent area. In six patients with negative MRI, three had unfavorable outcomes.
Conclusions: Reoperation resulted in seizure freedom in about 60% of patients. Intracranial EEG is not always required for reoperation.
Funding: Please list any funding that was received in support of this abstract.: none.
Surgery