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

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). 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. 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). 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.

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Déclaration de conflit d'intérêts

Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Kelsey Smith reports a relationship with CURE Epilepsy that includes: funding grants. Jamie Van Gompel has patent licensed to Cadence Neuroscience, which is co-owned by Mayo Clinic. Investigator for the Medtronic EPAS trial, SLATE trial, and Mayo Clinic Medtronic NIH Public Private Partnership (UH3-NS95495), also with consulting contract. Stock Ownership and Consulting Contract with Neuro-One Inc. Site Primary Investigator in the Polyganics ENCASE II trial. Site Primary Investigator in the NXDC Gleolan Men301 trial. Site Primary Investigator in the Insightec MRgUS EP001 trial. -Jamie Van Gompel SEER Medical – Inventor agreement-Jeffrey Britton.