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Research paper
Long-term outcome of surgical disconnection of the epileptic zone as an alternative to resection for nonlesional mesial temporal epilepsy
  1. Nicolas Massager1,2,
  2. Patrick Tugendhaft2,3,
  3. Chantal Depondt2,3,
  4. Thomas Coppens2,3,
  5. Landry Drogba1,
  6. Nadir Benmebarek1,
  7. Olivier De Witte1,
  8. Patrick Van Bogaert2,4,
  9. Benjamin Legros2,3
  1. 1Department of Neurosurgery, Clinic of Stereotactic and Functional Neurosurgery, ULB-Hôpital Erasme, Brussels, Belgium
  2. 2Reference Center for the Treatment of Refractory Epilepsy, ULB-Hôpital Erasme, Brussels, Belgium
  3. 3Department of Neurology, ULB-Hôpital Erasme, Brussels, Belgium
  4. 4Department of Neuropediatrics, ULB-Hôpital Erasme, Brussels, Belgium
  1. Correspondence to Dr Nicolas Massager, Department of Neurosurgery, Clinic of Stereotactic and Functional Neurosurgery, University Hospital Erasme, Route de Lennik 808, Brussels B-1070, Belgium; nmassage{at}ulb.ac.be

Abstract

Background Pharmacoresistant epilepsy can be treated by either resection of the epileptic focus or functional isolation of the epileptic focus through  complete disconnection of the pathways of propagation of the epileptic activity.

Objective To evaluate long-term seizure outcome and complications of temporal lobe disconnection (TLD) without resection for mesial temporal lobe epilepsy (MTLE).

Methods Data of 45 patients operated on for intractable MTLE using a functional disconnection procedure have been studied. Indication of TLD surgery was retained after a standard preoperative evaluation of refractory epilepsy and using the same criteria as for standard temporal resection.

Results Mean follow-up duration was 3.7 years. At the last follow-up, 30 patients (67%) were completely seizure-free (Engel-Ia/International League Against Epilepsy class 1) and 39 patients (87%) remained significantly improved (Engel-I or -II) by surgery. Actuarial outcome displays a 77.7% probability of being seizure-free and an 85.4% probability of being significantly improved at 5 years. No patient died after surgery and no subdural haematoma or hygroma occurred. Permanent morbidity included hemiparesis, hemianopia and oculomotor paresis found in three, five and one patient, respectively, after TLD.

Conclusions TLD is acceptable alternative surgical technique for patients with intractable MTLE. The results of TLD are in the range of morbidity and long-term seizure outcome rates after standard surgical resection. We observed a slightly higher rate of complications after TLD in comparison with usual rates of morbidity of resection procedures. TLD may be used as an alternative to resection and could reduce operating time and the risks of subdural collections.

  • EPILEPSY, SURGERY

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