PMCCPMCCPMCC

Search tips
Search criteria 

Advanced

 
Logo of jnnpsycJournal of Neurology, Neurosurgery and PsychiatryVisit this articleSubmit a manuscriptReceive email alertsContact usBMJ
 
J Neurol Neurosurg Psychiatry. 1995 June; 58(6): 666–673.
PMCID: PMC1073541

Surgical treatment of temporal lobe epilepsy: clinical, radiological, and histopathological findings in 178 patients.

Abstract

The surgical treatment of pharmacoresistant temporal lobe epilepsy is increasing rapidly. The correlation of preoperative MRI, histopathological findings, and postoperative seizure control is reported for 178 patients with chronic medically intractable temporal lobe epilepsy who were operated on between November 1987 and January 1993. Histopathologically there were distinct structural abnormalities in 97.2% of the surgical specimens. Signal abnormalities on MRI were present in 98.7% of patients with neoplastic lesions (n = 79), 76.6% of patients with non-neoplastic focal lesions (n = 55), and 69.2% of patients with Ammon's horn sclerosis (n = 39). Overall, structural abnormalities were detected by MRI in 82.7% of all patients. The mean postoperative follow up period was three years. Some 92% of the patients benefited from surgery: 103 patients (61.7%) were seizure free, 26 (15.5%) had no more than two seizures a year, and 24 (14.4%) showed a reduction of seizure frequency of at least 75%. Fourteen patients (8.4%) had a < 75% reduction of seizure frequency. The percentage of patients who were completely free of seizures after operation was 68.5% for patients with neoplastic lesions, 66.7% for Ammon's horn sclerosis, and 54.0% for patients with non-neoplastic focal lesions. By contrast, none of the patients in whom histopathological findings were normal became seizure free postoperatively. The data show that the presence of focal lesions or Ammon's horn sclerosis as determined by histopathological examination is associated with improved postoperative seizure control compared with patients without specific pathological findings. Brain MRI was very sensitive in detecting neoplasms; however, its sensitivity and specificity were limited with respect to non-neoplastic focal lesions and Ammon's horn sclerosis. Improvement of imaging techniques may provide a more precise definition of structural lesions in these cases and facilitate limited surgical resections of the epileptogenic area rather than standardised anatomical resections.

Full text

Full text is available as a scanned copy of the original print version. Get a printable copy (PDF file) of the complete article (2.8M), or click on a page image below to browse page by page. Links to PubMed are also available for Selected References.

Images in this article

Click on the image to see a larger version.

Selected References

These references are in PubMed. This may not be the complete list of references from this article.
  • Keränen T, Riekkinen P. Severe epilepsy: diagnostic and epidemiological aspects. Acta Neurol Scand Suppl. 1988;117:7–14. [PubMed]
  • Bergen D, Bleck T, Ramsey R, Clasen R, Ristanovic R, Smith M, Whisler WW. Magnetic resonance imaging as a sensitive and specific predictor of neoplasms removed for intractable epilepsy. Epilepsia. 1989 May-Jun;30(3):318–321. [PubMed]
  • Rosenbaum DH, Rowan AJ. Unilateral truncal seizures: frontal origin. Epilepsia. 1990 Jan-Feb;31(1):37–40. [PubMed]
  • CAVANAGH JB. On certain small tumours encountered in the temporal lobe. Brain. 1958 Sep;81(3):389–405. [PubMed]
  • Daumas-Duport C, Scheithauer BW, Chodkiewicz JP, Laws ER, Jr, Vedrenne C. Dysembryoplastic neuroepithelial tumor: a surgically curable tumor of young patients with intractable partial seizures. Report of thirty-nine cases. Neurosurgery. 1988 Nov;23(5):545–556. [PubMed]
  • FALCONER MA, SERAFETINIDES EA, CORSELLIS JA. ETIOLOGY AND PATHOGENESIS OF TEMPORAL LOBE EPILEPSY. Arch Neurol. 1964 Mar;10:233–248. [PubMed]
  • Rich KM, Goldring S, Gado M. Computed tomography in chronic seizure disorder caused by glioma. Arch Neurol. 1985 Jan;42(1):26–27. [PubMed]
  • Spencer DD, Spencer SS, Mattson RH, Williamson PD. Intracerebral masses in patients with intractable partial epilepsy. Neurology. 1984 Apr;34(4):432–436. [PubMed]
  • Tampieri D, Moumdjian R, Melanson D, Ethier R. Intracerebral gangliogliomas in patients with partial complex seizures: CT and MR imaging findings. AJNR Am J Neuroradiol. 1991 Jul-Aug;12(4):749–755. [PubMed]
  • Armstrong DD. The neuropathology of temporal lobe epilepsy. J Neuropathol Exp Neurol. 1993 Sep;52(5):433–443. [PubMed]
  • Dowd CF, Dillon WP, Barbaro NM, Laxer KD. Magnetic resonance imaging of intractable complex partial seizures: pathologic and electroencephalographic correlation. Epilepsia. 1991 Jul-Aug;32(4):454–459. [PubMed]
  • Smith AS, Weinstein MA, Quencer RM, Muroff LR, Stonesifer KJ, Li FC, Wener L, Soloman MA, Cruse RP, Rosenberg LH, et al. Association of heterotopic gray matter with seizures: MR imaging. Work in progress. Radiology. 1988 Jul;168(1):195–198. [PubMed]
  • Wolf HK, Campos MG, Zentner J, Hufnagel A, Schramm J, Elger CE, Wiestler OD. Surgical pathology of temporal lobe epilepsy. Experience with 216 cases. J Neuropathol Exp Neurol. 1993 Sep;52(5):499–506. [PubMed]
  • Berkovic SF, Andermann F, Olivier A, Ethier R, Melanson D, Robitaille Y, Kuzniecky R, Peters T, Feindel W. Hippocampal sclerosis in temporal lobe epilepsy demonstrated by magnetic resonance imaging. Ann Neurol. 1991 Feb;29(2):175–182. [PubMed]
  • Bronen RA, Cheung G, Charles JT, Kim JH, Spencer DD, Spencer SS, Sze G, McCarthy G. Imaging findings in hippocampal sclerosis: correlation with pathology. AJNR Am J Neuroradiol. 1991 Sep-Oct;12(5):933–940. [PubMed]
  • Cascino GD, Jack CR, Jr, Parisi JE, Sharbrough FW, Hirschorn KA, Meyer FB, Marsh WR, O'Brien PC. Magnetic resonance imaging-based volume studies in temporal lobe epilepsy: pathological correlations. Ann Neurol. 1991 Jul;30(1):31–36. [PubMed]
  • Falconer MA. Mesial temporal (Ammon's horn) sclerosis as a common cause of epilepsy. Aetiology, treatment, and prevention. Lancet. 1974 Sep 28;2(7883):767–770. [PubMed]
  • Dam AM. Epilepsy and neuron loss in the hippocampus. Epilepsia. 1980 Dec;21(6):617–629. [PubMed]
  • Drake J, Hoffman HJ, Kobayashi J, Hwang P, Becker LE. Surgical management of children with temporal lobe epilepsy and mass lesions. Neurosurgery. 1987 Dec;21(6):792–797. [PubMed]
  • Fried I, Kim JH, Spencer DD. Hippocampal pathology in patients with intractable seizures and temporal lobe masses. J Neurosurg. 1992 May;76(5):735–740. [PubMed]
  • Brooks BS, King DW, el Gammal T, Meador K, Yaghmai F, Gay JN, Smith JR, Flanigin HF. MR imaging in patients with intractable complex partial epileptic seizures. AJNR Am J Neuroradiol. 1990 Jan-Feb;11(1):93–99. [PubMed]
  • Elster AD, Mirza W. MR imaging in chronic partial epilepsy: role of contrast enhancement. AJNR Am J Neuroradiol. 1991 Jan-Feb;12(1):165–170. [PubMed]
  • Feindel W, Robitaille Y, Tampieri D, Goossens L, Li M, Melançon D. Electroencephalography, magnetic resonance imaging and pathology in patients treated surgically for temporal lobe epilepsy. Can J Neurol Sci. 1991 Nov;18(4 Suppl):577–579. [PubMed]
  • Jabbari B, Gunderson CH, Wippold F, Citrin C, Sherman J, Bartoszek D, Daigh JD, Mitchell MH. Magnetic resonance imaging in partial complex epilepsy. Arch Neurol. 1986 Sep;43(9):869–872. [PubMed]
  • Kilpatrick CJ, Tress BM, O'Donnell C, Rossiter SC, Hopper JL. Magnetic resonance imaging and late-onset epilepsy. Epilepsia. 1991 May-Jun;32(3):358–364. [PubMed]
  • Lencz T, McCarthy G, Bronen RA, Scott TM, Inserni JA, Sass KJ, Novelly RA, Kim JH, Spencer DD. Quantitative magnetic resonance imaging in temporal lobe epilepsy: relationship to neuropathology and neuropsychological function. Ann Neurol. 1992 Jun;31(6):629–637. [PubMed]
  • Lesser RP, Modic MT, Weinstein MA, Duchesneau PM, Lüders H, Dinner DS, Morris HH, 3rd, Estes M, Chou SM, Hahn JF. Magnetic resonance imaging (1.5 tesla) in patients with intractable focal seizures. Arch Neurol. 1986 Apr;43(4):367–371. [PubMed]
  • McLachlan RS, Nicholson RL, Black S, Carr T, Blume WT. Nuclear magnetic resonance imaging, a new approach to the investigation of refractory temporal lobe epilepsy. Epilepsia. 1985 Nov-Dec;26(6):555–562. [PubMed]
  • Sperling MR, Wilson G, Engel J, Jr, Babb TL, Phelps M, Bradley W. Magnetic resonance imaging in intractable partial epilepsy: correlative studies. Ann Neurol. 1986 Jul;20(1):57–62. [PubMed]
  • Wieser HG, Yaşargil MG. Selective amygdalohippocampectomy as a surgical treatment of mesiobasal limbic epilepsy. Surg Neurol. 1982 Jun;17(6):445–457. [PubMed]
  • Wolf HK, Wiestler OD. Surgical pathology of chronic epileptic seizure disorders. Brain Pathol. 1993 Oct;3(4):371–380. [PubMed]
  • Heinz ER, Crain BJ, Radtke RA, Burger PC, Friedman AH, Djang WT, Wilkinson WE. MR imaging in patients with temporal lobe seizures: correlation of results with pathologic findings. AJNR Am J Neuroradiol. 1990 Jul-Aug;11(4):827–832. [PubMed]
  • Ryvlin P, Garcia-Larrea L, Philippon B, Froment JC, Fischer C, Revol M, Mauguière F. High signal intensity on T2-weighted MRI correlates with hypoperfusion in temporal lobe epilepsy. Epilepsia. 1992 Jan-Feb;33(1):28–35. [PubMed]
  • Theodore WH, Dorwart R, Holmes M, Porter RJ, DiChiro G. Neuroimaging in refractory partial seizures: comparison of PET, CT, and MRI. Neurology. 1986 Jun;36(6):750–759. [PubMed]
  • Triulzi F, Franceschi M, Fazio F, Del Maschio A. Nonrefractory temporal lobe epilepsy: 1.5-T MR imaging. Radiology. 1988 Jan;166(1 Pt 1):181–185. [PubMed]
  • Turner DA, Wyler AR. Temporal lobectomy for epilepsy: mesial temporal herniation as an operative and prognostic finding. Epilepsia. 1981 Dec;22(6):623–629. [PubMed]
  • Holland BA, Kucharczyk W, Brant-Zawadzki M, Norman D, Haas DK, Harper PS. MR imaging of calcified intracranial lesions. Radiology. 1985 Nov;157(2):353–356. [PubMed]
  • Latack JT, Abou-Khalil BW, Siegel GJ, Sackellares JC, Gabrielsen TO, Aisen AM. Patients with partial seizures: evaluation by MR, CT, and PET imaging. Radiology. 1986 Apr;159(1):159–163. [PubMed]
  • Ormson MJ, Kispert DB, Sharbrough FW, Houser OW, Earnest F, 4th, Scheithauer BW, Laws ER., Jr Cryptic structural lesions in refractory partial epilepsy: MR imaging and CT studies. Radiology. 1986 Jul;160(1):215–219. [PubMed]
  • Schörner W, Meencke HJ, Felix R. Temporal-lobe epilepsy: comparison of CT and MR imaging. AJR Am J Roentgenol. 1987 Dec;149(6):1231–1239. [PubMed]
  • Cendes F, Andermann F, Gloor P, Lopes-Cendes I, Andermann E, Melanson D, Jones-Gotman M, Robitaille Y, Evans A, Peters T. Atrophy of mesial structures in patients with temporal lobe epilepsy: cause or consequence of repeated seizures? Ann Neurol. 1993 Dec;34(6):795–801. [PubMed]
  • Jack CR, Jr, Sharbrough FW, Twomey CK, Cascino GD, Hirschorn KA, Marsh WR, Zinsmeister AR, Scheithauer B. Temporal lobe seizures: lateralization with MR volume measurements of the hippocampal formation. Radiology. 1990 May;175(2):423–429. [PubMed]
  • Duncan JS, Sagar HJ. Seizure characteristics, pathology, and outcome after temporal lobectomy. Neurology. 1987 Mar;37(3):405–409. [PubMed]
  • Elwes RD, Dunn G, Binnie CD, Polkey CE. Outcome following resective surgery for temporal lobe epilepsy: a prospective follow up study of 102 consecutive cases. J Neurol Neurosurg Psychiatry. 1991 Nov;54(11):949–952. [PMC free article] [PubMed]
  • Olivier A. Relevance of removal of limbic structures in surgery for temporal lobe epilepsy. Can J Neurol Sci. 1991 Nov;18(4 Suppl):628–635. [PubMed]
  • Ojemann GA. Surgical therapy for medically intractable epilepsy. J Neurosurg. 1987 Apr;66(4):489–499. [PubMed]

Articles from Journal of Neurology, Neurosurgery, and Psychiatry are provided here courtesy of BMJ Group