Abstracts

Rationale: To identify the causes of failed temporal lobe resection and the role of reoperation for a successful surgical outcome. Methods: We retrospectively studied the surgical outcome after failed epilepsy surgery and reoperation in patients suffering from pharmacologically intractable temporal lobe epilepsy. Demographic data (family history, febrile seizures, major head trauma, encephalitis, age at seizure onset, seizure frequency, etc) and the results of comprehensive preoperative evaluations (ictal and interictal discharges on scalp EEG, clinical seizure semiology, MRI evaluation and neuropsychological testing) were systematically analysed before first surgery and reoperation. Postoperative outcome was assessed according to Wieser`s classification proposed by Wieser et al.(Wieser et al. ILAE Comission Report. Proposal for a new classification of outcome with respect to epileptic seizures following eoilepsy surgery. Epilepsia 2001 Feb; 42(2):282-6) Results: 288 patients underwent temporal lobe resection for the treatment of drug resistant epilepsy from 1993 to 2007. Eighteen patients (7 male, mean age 30,2y) underwent reoperation and were followed 12 to 95 months subsequently to the reoperation. Eleven patients underwent selective amygdalohippocampectomy (sAHE), whereas 4 patients underwent lesionectomy (LE), four patients had LE and sAHE, and 1 patient underwent anteromesial temporal lobe resection (AMT). The follow-up after reoperation was 12-60 months. Four out of 18 patients became completely seizure free (class 1a), 9 improved at least one class and 5 did not improve. None of the patients had worsened after reoperation. Unfortunately, the analysed demographic and clinical data did not show any predictive value concerning postoperative outcome. Conclusions: Reoperation may cause a significant improvement of the operative outcome in the case of failed epilepsy surgery. However, there was no predictive value of preoperative variables in regard to long-term seizure freedom.