Open AccessIntracranial monitoring contributes to seizure freedom for temporal lobectomy patients with nonconcordant preoperative data
Author(s) -
Sokolov Elisaveta,
Sisterson Nathaniel D.,
Hussein Helweh,
Plummer Cheryl,
Corson Danielle,
Antony Arun R.,
Mettenburg Joseph M.,
Ghearing Gena R.,
Pan Jullie W.,
Urban Alexandra,
Bagić Anto,
Richardson R. Mark,
Kokkinos Vasileios
Publication year - 2022
Publication title -
epilepsia open
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.247
H-Index - 16
ISSN - 2470-9239
DOI - 10.1002/epi4.12483
Subject(s) - temporal lobe , stereoelectroencephalography , epilepsy , medicine , anterior temporal lobectomy , retrospective cohort study , temporal lobectomy , craniotomy , epilepsy surgery , electroencephalography , cohort , lateralization of brain function , surgery , radiology , audiology , psychiatry
Objective The question of whether a patient with presumed temporal lobe seizures should proceed directly to temporal lobectomy surgery versus undergo intracranial monitoring arises commonly. We evaluate the effect of intracranial monitoring on seizure outcome in a retrospective cohort of consecutive subjects who specifically underwent an anterior temporal lobectomy (ATL) for refractory temporal lobe epilepsy (TLE). Methods We performed a retrospective analysis of 85 patients with focal refractory TLE who underwent ATL following: (a) intracranial monitoring via craniotomy and subdural/depth electrodes (SDE/DE), (b) intracranial monitoring via stereotactic electroencephalography (sEEG), or (c) no intracranial monitoring (direct ATL—dATL). For each subject, the presurgical primary hypothesis for epileptogenic zone localization was characterized as unilateral TLE, unilateral TLE plus (TLE+), or TLE with bilateral/poor lateralization. Results At one‐year and most recent follow‐up, Engel Class I and combined I/II outcomes did not differ significantly between the groups. Outcomes were better in the dATL group compared to the intracranial monitoring groups for lesional cases but were similar in nonlesional cases. Those requiring intracranial monitoring for a hypothesis of TLE+had similar outcomes with either intracranial monitoring approach. sEEG was the only approach used in patients with bilateral or poorly lateralized TLE, resulting in 77.8% of patients seizure‐free at last follow‐up. Importantly, for 85% of patients undergoing SEEG, recommendation for ATL resulted from modifying the primary hypothesis based on iEEG data. Significance Our study highlights the value of intracranial monitoring in equalizing seizure outcomes in difficult‐to‐treat TLE patients undergoing ATL.