Abstracts

Different techniques have been used for performing cortical resections in patients with temporal lobe epilepsy and mesial temporal sclerosis. This paper describes the technique that has been used in our center over the last 10 years. Five hundreds and fifty pediatric and adult patients have been submitted to temporal lobe resections between 1996 and 2005 at the Hospital Brigadeiro and Clinica de Epilepsia Epilepsy Surgery Program (57% at the left side). The standard procedure has been performed without intraoperative electrocorticography. An almost exclusively temporal craniotomy was performed, exposing only the temporal lobe itself and the most inferior portion of the fronto-parietal convexity. A first block of partial T1, T2, T3 and fusiform gyrus cortical resection with its posterior border at the level of the exit of the central artery from the sylvian fissure was then performed. After opening of the lateral ventricle, a complete hippocampectomy and parahippocampectomy was performed. The dura was closed in a semi-water-tight fashion, together with dural analogs (duragen) and fibrin glue (beriplast). The bone was fixed with bone clamps (craniofix), a subgaleal drain was inserted and the skin closed using a stapler. Twenty-four hours antibiotic prophylaxis was used. The subgaleal drain was removed on the first post-operative day. One patient died from a remote posterior fossa hematoma. Six patients submitted to surgery had transient worsening of receptive speech after surgery; in all of them, venous posterior temporal infarcts have been document on imaging studies. Eight patients submitted to dominant temporal lobe resections had worsening of verbal memory; 4 of them belonged to the above mentioned infarct[apos]s group. One patient had meningitis and was treated with antibiotics. Overall, 87% of the patients have been rendered seizure-free, 12% had at least 90% improvement and 1% had no worthwhile benefit from the procedure. Temporal lobe resections performed according to the technical guidelines described above seem to be safe and effective. The use of proportional techniques for the determination of the posterior borders of the cortical resection seem to be better and safer then quantitative methods (i.e, measuring from the tip of the temporal lobe).