Drug-resistant temporal lobe epilepsy with temporal encephaloceles: How far to resect

Kelsey M Smith; Kiran M Kanth; Karl N Krecke; Eva C Alden; Jay S Patel; Robert J Witte; Jamie J Van Gompel; Elson So; Jeffrey W Britton; Gregory D Cascino; Lily C Wong-Kisiel

doi:10.1016/j.yebeh.2023.109472

Drug-resistant temporal lobe epilepsy with temporal encephaloceles: How far to resect

Epilepsy Behav. 2023 Nov:148:109472. doi: 10.1016/j.yebeh.2023.109472. Epub 2023 Oct 20.

Authors

Affiliations

¹ Department of Neurology, Mayo Clinic, 200 1st St. SW, Rochester, MN, USA.
² Department of Neurology, University of California, Davis, Sacramento, CA, USA.
³ Depeartment of Radiology-Diagnostic, Mayo Clinic, 200 1st St. SW, Rochester, MN, USA.
⁴ Department of Psychology and Psychiatry, Mayo Clinic, 200 1st St. SW, Rochester, MN, USA.
⁵ Department of Neurologic Surgery, Mayo Clinic, 200 1st St. SW, Rochester, MN, USA.
⁶ Department of Neurology, Mayo Clinic, 200 1st St. SW, Rochester, MN, USA. Electronic address: wongkisiel.lily@mayo.edu.

PMID: 37866249
DOI: 10.1016/j.yebeh.2023.109472

Abstract

Purpose: This study sought to evaluate the impact of surgical extent on seizure outcome in drug-resistant temporal lobe epilepsy (DR-TLE) with temporal encephaloceles (TE).

Methods: This was a single-institution retrospective study of patients who underwent surgery for DR-TLE with TE between January 2008 and December 2020. The impact of surgical extent on seizure outcome was evaluated. In a subset with dominant DR-TLE, the impact of surgical extent on neuropsychometric outcome was evaluated.

Results: Thirty-four patients were identified (female, 56%; median age at surgery, 43 years). TE were frequently overlooked on initial magnetic resonance imaging (MRI), with encephaloceles only detected after repeat or expert re-review of MRI, additional multi-modal imaging, or intra-operatively in 31 (91%). Sixteen (47%) underwent limited resections, including encephalocele resection only (n = 5) and encephalocele resection with more extensive temporal corticectomy sparing the amygdala and hippocampus (n = 11). The remainder (n = 18, 53%) underwent standard anterior temporal lobectomy and amygdalohippocampectomy (ATLAH). Limited resection was performed more frequently on the left (12/17 vs. 4/17, p = 0.015). Twenty-seven patients (79%) had a favourable outcome (Engel I/II), and 17 (50%) were seizure-free at the last follow-up (median seizure-free survival of 27.3 months). There was no statistically significant difference in seizure-free outcomes between limited resection and ATLAH. In dominant DR-TLE, verbal memory decline was more likely after ATLAH than limited resection (3/4 vs. 0/9, p = 0.014).

Conclusion: Expert re-review of imaging and multi-modal advanced imaging improved TE identification. There was no statistical difference in seizure-free outcomes based on surgical extent. Preservation of verbal memory supports limited resection in dominant temporal cases.

Keywords: Anterior temporal lobectomy; Epilepsy surgery; Neuropsychology; Temporal encephalocele; Temporal lobe epilepsy.

MeSH terms

Adult
Anterior Temporal Lobectomy / methods
Drug Resistant Epilepsy* / diagnostic imaging
Drug Resistant Epilepsy* / surgery
Encephalocele / complications
Encephalocele / diagnostic imaging
Encephalocele / surgery
Epilepsy, Temporal Lobe* / complications
Epilepsy, Temporal Lobe* / diagnostic imaging
Epilepsy, Temporal Lobe* / surgery
Female
Hippocampus / diagnostic imaging
Hippocampus / surgery
Humans
Magnetic Resonance Imaging
Retrospective Studies
Seizures / surgery
Treatment Outcome