Abstracts

Rationale: To investigate to seizure outcomes of reoperation after a failed resective epilepsy surgery. Methods:  We reviewed the data of the resecive epilepsy surgery in our hospital during Jan, 1988 and May, 2017. Patients whose seizures were not controlled after first surgery were evaluated if they intended to have a second operation. Re-evaluation studies included video-EEG recording, high resolution MRI and optional fluorodeoxyglucose-positron emission tomography, magnetoencephalography and fMRI-EEG. Intracranial EEG monitoring (iEEG), subdural strip/grid or stereoelectroencephalography, was performed if necessary and reoperation was decided after the multidisciplinary seizure conference. Seizure outcomes were obtained at 1 year after the surgery. Results: Among the 620 patients who underwent resective surgery, 23 (3.7%), 13 male and 10 female, aged 8-42, received reoperation for previous failed resection surgery. Ten had temporal lobe epilepsy, 9 had frontal lobe epilepsy, and 4 had multilobar involvement. Among them 20 had second surgery for incomplete resection, 2 for dual pathology, and one for incorrect localization. The average interval between two surgery was 47.4 months  (0.5-165.6 months). Six patients had iEEG in the first surgery, one had iEEG in the second surgery, and one had iEEG in both surgery. Fifteen patients had intraoperative electrocorticography in the second resection. One year after reoperation, 9 (39.1%) patients were free from seizures, 10 (43.5%) had improvement in seizure frequency and severity, and four (17.4%) showed no improvement. Five patients have been seizure-free 5 years after second operation. Three had neurological deficits and one had skull infection after reoperation. Conclusions: Reoperation after adequate reassessment of clinical and laboratory findings can improve seizure control after failed resective epilepsy surgery.   Funding: No