LESIONECTOMY VERSUS ELECTROPHYSIOLOGICALLY GUIDED RESECTION FOR TEMPORAL-LOBE TUMORS MANIFESTING WITH COMPLEX PARTIAL SEIZURES

Complex partial seizures associated with tumors and other mass lesions are readily diagnosed by modern imaging techniques but their optimum surgical treatment remains unresolved. Lesionectomy has been reported to produce seizure outcomes equal to outcomes after resection that abl ates the epileptogenic cortex with the lesion. However, some evidence suggests that when the lesion is in the temporal lobe, simple excision of the tumor or lesion more often fails to control seizures. After re trospectively reviewing the records of 30 patients with complex partia l seizures and temporal lobe tumors who underwent surgical treatment a t the University of Cincinnati hospitals (1985-1992), the authors divi ded them into two groups: Group A (16 patients) underwent lesionectomy only and Group B (14 patients) received surgical treatment for seizur es with electroencephalographic delineation of the epileptogenic zone and resection of the lesion. Seizure control was best achieved in Grou p B patients with 13 (92.8%) seizure free at follow up (mean 52 months ). Only three (18.8%) of the Group A patients became seizure free afte r lesionectomy at follow up (mean 33 months). In eight Group A patient s, who underwent temporal lobectomy as a second procedure after lesion ectomy failed to control seizures, five (62.5%) became seizure free. G roup B patients had a longer duration of seizures and were more likely to have lesions smaller than 2.5 cm compared with Group A. Analysis o f covariance demonstrated that the differences in outcome between the groups remained significant even with adjustment for the variation in duration of seizures (p = 0.0006) and size of tumor (p = 0.0001). Base d on this study, the authors found that the probable relief from seizu res caused by a temporal lobe lesion is greater if the region of epile ptogenicity, usually the amygdalohippocampal complex, is resected alon g with the tumor in a temporal lobectomy.