Abstracts

Temporal lobectomy is a well-established treatment for patients with intractable epilepsy. Most temporal lobectomy series comprise patients in their third and fourth decades, with very few studies focusing on patients age 50 or older. This study was undertaken to analyze the surgical outcomes and complications in this patient population. We reviewed our surgical database and identified patients who underwent epilepsy surgery after the age of 50 at our center (University of South Florida and Tampa General Hospital) from 2000-2002. Only patients undergoing temporal lobectomy were included in the study. All patients were evaluated by an epileptologist. After a typical presurgical evaluation (EEG-video, MRI, PET or SPECT, neuropsychological testing, and Wada testing), patients underwent anterior temporal lobectomies by a single surgeon (FLV). A total of 66 temporal lobectomies were performed over the 3-year period. Of those, 20 (30%) were 50 or older, including 3 (5%) who were 60 or older.
The average age at surgery was 53.3 years, while the average duration of epilepsy was 29.5 years. 75% of the population had MRI evidence of mesial temporal sclerosis, and 15% a normal MRI. The mean follow up was 24 months. 85% achieved class I outcomes, 10% achieved class II outcomes, and 5% achieved class III. Of the patients with MRI findings of mesial temporal sclerosis, 92% had a class I outcome.
The surgical complication rate was 10%, representing two patients. One patient (with a history of diabetes and obesity) suffered a lacunar stroke in the perioperative period. The other complication was a chronic subdural hematoma at 10 weeks postoperatively in a patient with a history of alcohol abuse, which required evacuation but did not result in any neurologic sequelae. Anterior temporal lobectomy is a safe and effective treatment after the age of 50. Results appear similar than in younger patients.