Surgical outcomes of temporal lobe epilepsy in children

Abstract

Objective To explore the surgical treatment and outcomes of temporal lobe epilepsy in children. Methods A retrospective analysis was conducted on 21 children with temporal lobe epilepsy admitted to Department of Neurosurgery, Children's Hospital Affiliated to Capital Institute of Pediatrics from September 2016 to June 2018. Individualized surgical treatment plan was formulated according to the semeiology, imaging and electroneurophysiological findings of the children. Standard anterior temporal lobectomy was undergone in 13 cases, enlarged resection of temporal lobe lesion in 3, selective hippocampal amygdala resection in 2, simple resection of medial temporal lobe lesion in 1, vascular malformation resection in 1, and anterior temporal lobe resection plus frontal lobe nodule resection in 1. All patients were followed up clinically after operation. The follow-up included cranial MRI, electroencephalogram and Engle rating. Results All 21 patients underwent successful operation. No serious complications occurred after surgery. The pathological results were mixed neuronal-glial tumor in 14 cases, pleomorphic xanthoastrocytoma in 1, hippocampal sclerosis in 3, focal cortical dysplasia IIb in 1, tuberous sclerosis in 1, and cerebral arteriovenous malformation in 1. The follow-up duration of 21 patients was 18.0±5.9 months (9-30 months). A review of head MRI showed that all tumors were completely resected and no recurrence was seen of the patients with tumor. A review of the EEG showed that there was still a large amount of epileptic discharges in the temporal lobe of 1 patient, and the epileptic discharges of the remaining 20 cases were significantly reduced or disappeared compared with preoperative conditions. Eighteen patients were followed up for more than 12 months. Up to the last follow-up, 17 cases were classified as Engle Ⅰ and 1 as Engle Ⅳ. Conclusion Individualized surgical procedures based on comprehensive assessment of the semeiology, imaging and electroneurophysiology of children with temporal lobe epilepsy could lead to good outcomes. Key words: Epilepsy; Temporal lobe; Child; Neurosurgical procedures; Treatment outcome