Abstracts

RATIONALE: To study the frequency, distribution and the factors contributing to vascular complications following temporal lobe resection for intractable focal seizures.
METHODS: We retrospectively reviewed the records of 145 children (ages 6 months [ndash] 18 years, mean 8.4 years) who underwent temporal lobe resection at Miami Children[scquote]s Hospital from 1979 through 2001. The data reviewed included pre and post-operative imaging studies, operative reports, pathology, and clinical outcome.
RESULTS: We identified 7 (4.8%) patients, age 2 years 8 months [ndash] 17 years (mean 12.3 years) who had vascular complications characterized by a contralateral hemiparesis (n=7) or homonymous visual field defect (n=1). MRI revealed lacunar infarcts (n=3) or punctate hemorrhage (n=1) in the distribution of the anterior choroidal artery (posterior limb of the internal capsule [ndash] 2 patients, anterior thalamus [ndash] 2 patients). Three patients had infarcts in the more distal distribution of the middle cerebral artery (large middle cerebral artery infarct [ndash]1 patient, transient hemiparesis and dysphasia [ndash] normal post-op MRI [ndash] 1 patient, and an infarct in the temporo-parietal region [ndash] 1 patient). All 7 patients underwent en bloc resection of the lateral temporal structures. Five had subpial mesial temporal microsurgical dissection with suction and two had en bloc resection of the mesial structures. Two patients had prior resective surgery. Pathology revealed cortical dysplasia (n=3) and hippocampal sclerosis/subcortical white matter gliosis (n=4).
CONCLUSIONS: There is a small but significant risk of vascular complications in children undergoing temporal lobe resection. The anterior choroidal artery appears to be particularily prone to occlusive damage due to its proximity to the mesial structures and the surgical bed. An analysis of the added risk of en bloc resection of the mesial temporal lobe and reoperation will be presented.