Surgical management of intractable lesional temporal lobe epilepsies

SummaryStructural lesions are found in about 30% of patients who undergo epilepsy surgery for intractable temporal lobe epilepsy. After detailed presurgical evaluations, the concordance of semeiology, focal structural lesions, ictal and interictal epileptiform discharges and neuropsychological dysfunction may offer favorable seizure control outcome postoperatively. The temporal lobe structural lesions are classified by magnetic resonance imaging-defined location into mesial temporal and lateral temporal (extrahippocampal) groups. In the lateral temporal group, subdural grid and depth electrode implantation is mandatory to localize the epileptic cortex and the possible secondary focus in the mesial temporal structures. Different surgical strategies, such as lesionectomy alone, lesionectomy with removal of adjacent epileptic cortex, lesionectomy with removal of mesiotemporal structures, have variable seizure control outcomes. The underlying pathology and the completeness of the lesion resection also affect the outcome.