Surgical Management Of Lesional Temporal Lobe Epilepsy

Temporal lobe lesions constitute significant amount of surgical specimens obtained from children with intractable temporal lobe epilepsy (TLE). The most common pathological substrates are related to mesial temporal sclerosis (MTS), tumors, vascular abnormalities, gliosis, and developmental disorders. Among neoplasms, developmental tumors, such as dysembryoplastic neuroepithelial tumor (DNET), or slowly growing low-grade glial tumors and oligodendrogliomas are the most common ones. Surgical interventions for lesional TLE in children have dual therapeutic goals: stopping the seizures and removing the lesion while preserving cortical function. However, epileptogenic zone may frequently stretch beyond the anatomical boundaries of the lesion. Therefore, determining the extent of resection in lesional epilepsy patients is critical to optimize surgical outcome, and it may not always be feasible and certain compromises may be required in some cases. The factors effecting good outcome in epilepsy patients are not only dependent on the type of the lesion but also related to the location of the lesion as well as the extent of the epileptogenic zone and the area of resection. Therefore, the surgical strategy in lesional epilepsy patients is a multifaceted topic. Although there is consensus on critical significance of complete lesion resection, the importance of additional resection of adjacent cortex or the mesial temporal structures remains controversial.