Abstracts

Temporal lobe (TL) resection in the face of unilateral electronencephalographic (EEG) findings with a clear radiographic abnormality results in a high success rate for seizure-free outcome. Dual pathology based on magnetic resonance imaging (MRI) usually requires further evaluation with intracranial electrodes to document ictal seizure onset. We present a group of patients with electrophysiologic evidence of temporal lobe epilepsy, and radiographic suggestion of mesial temporal sclerosis and extra-temporalabnormalities that underwent standard anterior mesial TL resection without intracranial EEG recordings. A retrospective analysis was performed and out of 200 TL resections performed by the senior author (FLV), six patients were found to have ictal temporal lobe onset and ipsilateral temporal as well as extratemporal radiographic abnormalities. All six patients presented with smaller hippocampus volumes and five of them had evidence of abnormal signal of the mesial structures on FLAIR imaging. All patients presented with radiographic evidence of extensive cortical encephalomalacia (2 occipital,1 posterior temporal, and 3 frontoparietal). None had any history of trauma or meningitis.
All six patients underwent a standard anterior TL resection with at least a 12 month follow-up period. None had any post-operative complications. All patients are improved in the last clinical evaluation (5 patients Engel class I, 1 patient Engel class II). We conclude that TL resections for epilepsy based on unilateral ictal temporal lobe onset with abnormal mesial TL radiographic abnormalities is an efficacious treatment for intractable epilepsy despite dual radiographic abnormalities. Intracranial EEG seems not to be necessary in this group of patients for confirmation of seizure onset.