Non-invasive investigations successfully select patients for temporal lobe surgery
a Department of Neurology, b Department of
Neurosurgery, The Melbourne Neuroscience Centre, The Royal Melbourne
Hospital, Victoria, Australia, c Department of Neurology,, d Department of Neurosurgery, St Vincent's Hospital,
Melbourne, Victoria, Australia
Correspondence to: Dr Christine Kilpatrick, The Melbourne Neuroscience Centre, The Royal Melbourne Hospital, Grattan Street, Parkville 3050, Victoria, Australia.
Received 23 August 1996 and in revised form 7 March 1997;
Accepted 17 March 1997
OBJECTIVES
There is controversy regarding the
need for invasive monitoring in the preoperative assessment of patients
with temporal lobe epilepsy. The use of a series of non-invasive
investigations in identifying the seizure focus is reported in 75 consecutive adults referred for epilepsy surgery.
METHODSAll had video-EEG monitoring using scalp
electrodes, high resolution MRI, and neuropsychology assessment. Other
investigations included volumetric MRI, PET, and ictal and interictal
SPECT. The seizure focus was localised and surgery offered if MRI
disclosed unilateral hippocampal atrophy or a foreign tissue lesion and other investigations were either concordant or not discordant.
RESULTSIn 68 patients the seizure focus was
localised and three patients were inoperable. Sixty five patients have
been offered surgery and 50 have undergone temporal lobe surgery and
have a follow up of at least 12 months (mean 24 months). All had
pathology: hippocampal sclerosis 34, dysembryoblastic neuroepithelial
tumour six, cavernoma four, dysplasia two, low grade glioma two,
ganglioglioma two. Thirty nine patients (78%) are seizure free
postoperatively, 29/34 with hippocampal sclerosis and 10/16 with a
foreign tissue lesion. Of the 11 patients with postoperative recurrent
seizures, eight have a >90% reduction in seizure frequency and three
have <90% reduction in seizure frequency but a worthwhile improvement.
CONCLUSIONSNon-invasive investigations
successfully select most patients for temporal lobe surgery.
© 1997 by Journal of Neurology, Neurosurgery, and Psychiatry
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