Comprehensive preoperative work-up and surgical treatment of low grade tumor/benign lesion related temporal lobe epilepsy. (May 2017)

• Record Type: Journal Article
• Authors: Feng, Rui; Hu, Jie; Wu, Jinsong; Lang, Liqin; Ma, Chengxin; Jiang, Shize; Sun, Bing; Gu, Xin; Pan, Li
• Is Part Of: Journal of clinical neuroscience. Volume 39(2017:May)
• Page Start: 203
• Page End: 208
• Publication Date: 2017-05
• Subjects: Low grade tumor/benign lesion related temporal lobe epilepsy -- Preoperative work-up -- Surgical treatment -- Dense array electroencephalography source imaging; Brain -- Surgery -- Periodicals; Neurosciences -- Periodicals; Nervous system -- Surgery -- Periodicals; Brain -- surgery -- Periodicals; Neurosurgical Procedures -- Periodicals; Neurosciences -- Periodicals; Electronic journals; 616.8
• DOI: 10.1016/j.jocn.2017.01.013
• Languages: English
• ISSNs: 0967-5868

Abstract

Highlights: Application of high-resolution EEG source imaging technique is introduced. Comprehensive categories of LGT/BL related epilepsy are involved in this series. Disputes in surgical management of LGT/BL related epilepsy are discussed. Abstract: Objective: Generally low-grade tumor/benign lesion related temporal lobe epilepsy (LGT/BL-TLE) is considered easier to treat and has better prognosis when compared to non-lesional TLE. However, multiple disputes exist in surgical management of this epilepsy entity. This study aims to discuss comprehensive preoperative work-up, surgical strategies and outcome of it. Methods: A retrospective review of sixty LGT/BL-TLE cases which underwent comprehensive preoperative work-up and then resective surgeries was conducted. Surgical strategies were categorized into limited and expanded resections. Surgical efficacy was evaluated using Engel grading after telephone or clinic follow-up and compared statistically. Results: Preoperative work-up includes magnetic resonance imaging (MRI), conventional electroencephalography, semiology evaluation, positron emission tomography (PET) and 256-channel dense-array electroencephalography source imaging (256-ch dESI). In aspect of concordance with epileptic lesions demonstrated on MRI, 256-ch dESI was more accurate than PET (72.7% vs. 39.4%) ( p < 0.05). Limited resections were performed in 28 cases while expanded resections in 32 cases. Altogether the surgical efficacy was: Engel grade I 86.7%, I + II 95.0%. Comparison of surgical outcome showed neither the outcome between limited and expanded resection nor the outcome between mesial and neocortical TLE (mTLE & nTLE) undergoing limited resections was significantly different ( p > 0.05). Conclusions: For LGT/BL-TLE, most surgical strategies can be made preoperatively after comprehensive work-up rather than intraoperatively. Limited and expanded strategies yield similar surgical outcome in either nTLE or mTLE as long as comprehensive work-up supports the strategy and the epileptic lesion is totally removed. 256-ch dESI which can visualize both structural and electrophysiological lesions may be contributable to surgical planning of this entity.