SURGICAL AND NEUROLOGICAL COMPLICATIONS IN A SERIES OF 708 EPILEPSY SURGERY PROCEDURES

OBJECTIVE: There are few modern data on the complications of surgery f or epilepsy from the neurosurgeon's point of view. A survey of complic ations observed in a large current epilepsy surgery series is presente d to facilitate the assessment of a risk:benefit ratio, which must be known when planning for epilepsy surgery and counseling patients. METH ODS: A series of 429 consecutive patients operated on during 6.5 years in the newly established University of Bonn epilepsy surgery program was, in part, retrospectively, and, in larger part, prospectively anal yzed for complications originating from 279 invasive diagnostic proced ures and 429 therapeutic procedures. Neuropsychological and psychiatri c complications as well as the rate of failure to control seizures are not addressed in this article. RESULTS: Two hundred and seventy-nine temporal operations, 59 frontal operations, 22 other extratemporal ope rations, 33 callosotomies, 3 multilobectomies, and 33 hemispherectomie s were performed. Complications were grouped into general surgical and neurological complications. No mortality resulted from 708 invasive p rocedures. Two hundred and seventy-nine invasive diagnostic procedures (various combinations of strip, grid, and depth electrode insertions) resulted in 3.6% transient morbidity (2.9% surgical complications, 0. 7% neurological complications) and 0.7% permanent morbidity (dysphasia ). During 429 therapeutic procedures, 33 surgical complications were e ncountered. None of these resulted in permanent morbidity, except for the necessity for permanent shunt insertion in three patients. Wound i nfection was the most frequent surgical complication, but we were able to demonstrate a steady decrease during the 6.5-year observation peri od. The total rate of neurological complications in 429 therapeutic pr ocedures was 5.4%, with 3.03% causing transient morbidity and 2.33% ca using permanent morbidity. CONCLUSION: Our data indicate that epilepsy surgery can be performed with an acceptable rate of resultant morbidi ty. The indications for epilepsy surgery, the learning curve determine d, and the results from other series are discussed in the light of the se figures.