engleski

Surgical treatment of pharmacoresistant temporal lobe epilepsy - four years of experience

Introduction : Surgical resection of mesial temporal structures has become the most common procedure in pharmacoresistant temporal lobe epilepsy. We present our experience in surgical treatment of temporal lobe epilepsy in the past four years. Material and Method : From November 2008 to May 2012, 160 patients with pharmacoresistant complex partial epilepsy have been surgically treated. Most of the patients (125) have had focal lesions such as AVM, or temporal lobe tumors and subsequently 35 patients were diagnosed with hippocampal sclerosis after PHD verification. Indication for surgical treatment in the group of 35 patients with hippocampal sclerosis was established according to typical epilepsy type-complex partial seizures, and MRI findings of hippocampal sclerosis with resistance to drug treatment. Preoperative assessment consisted of medical history, neurological examination, neuroradiological evaluation with 3T MRI scan with special epilepsy protocol, video EEG monitoring, and neuropsychological assessment. In all cases , surgery was performed through pterional craniotomy and transsylvic approach, with selective removal of amygdala, entorhinal cortex and hippocampus. Results : Postoperative complications were observed in eight patients (meningitis in three patient, transitory right hemiparesis which completely recovered in first three days in two patients, and chronic SDH that resolved spontaneously after three months of follow up in 3 patients). All patients were discharged from the hospital after CT scan verified satisfying postoperative results. Engel scale was used for seizure control evaluation (Engel I- 29 patients ; Engel II-3 patients ; Engel III- 3 patient.) and detailed psychological assessment was performed before and after surgery. Conclusions : Pharmacoresistant temporal lobe epilepsy with hippocampal sclerosis can be treated surgically with excellent results in seizure control and low rate of permanent postoperative complications.

temporal lobe epilepsy; pharmacoresistant

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