Abstract Details

Title Presurgical Evaluation and Surgical Outcomes in Medically Refractory Epilepsy and Temporal Encephalocele

Topic Epilepsy/Clinical Neurophysiology (EEG)

Presentation(s) S31 - Epilepsy/Clinical Neurophysiology (EEG) 3 (4:18 PM-4:30 PM)

Poster/Presentation
Number 005

Objective This study assessed short-term surgical outcomes in patients with medically refractory temporal lobe epilepsy (MRTLE) due to temporal encephalocele (TE).

Background Clinical equipoise exists in regards to the utility of pre-operative imaging and intraoperative electrocorticography (ECoG) in guiding resection and the extent of surgical resection required for good seizure control.

Design/Methods Patients with MRTLE who underwent surgical intervention for TE at an epilepsy center between January 2008 and December 2018 were identified. Additional patients were found retrospectively on re-review of FDG-PET by an experienced neuroradiologist.

Results Twenty-one patients were identified (female 67%, median age 40.7 years, interquartile range (IQR) 19.6-53.6). TE (left 8, right 6, bilateral 7) was identified in 13 patients preoperatively, from radiology re-review in 7, and intraoperatively in 1. Initial MRI was not suggestive of TE in 20 patients, yet temporal hypometabolism was present on FDG-PET in 10 of 14 patients. ECoG showed widespread temporal discharges in 17 of 20 patients. Eight patients (38%) underwent focal TE resection, 12 patients (57%) anterior temporal lobectomy (ATL), and 1 patient amygdalohippocampal laser ablation. Eleven patients (55%) were seizure-free at last follow-up (median follow-up duration 16.8 months, IQR 7.0-41.2, 5 focal TE resection, 6 ATL). Focal TE was performed only in recent years (median duration of follow-up in focal TE resection 7.4 months versus ATL 30.0 months), which limited comparison of surgical outcomes between surgical groups. At last follow-up, seizure reduction (Engel class I and II) was achieved in 5 of 8 focal TE resection (62.5%) and in 11 of 12 ATL patients (91.7%) (p > 0.05).

Conclusions TE is an easily overlooked etiology of MRTLE. FDG-PET provides additional information when MRI is unrevealing. ECoG should be interpreted with caution as short-term follow-up remained favorable despite widespread epileptogenic discharges. Long-term follow-up is needed to clarify which surgical approach optimizes seizure outcome while minimizing resection.

Authors/Disclosures
Kiran M. Kanth, MD (UC Davis Medical Center Department of Neurology) PRESENTER	Dr. Kanth has nothing to disclose.
Jeffrey W. Britton, MD, FAAN (Mayo Graduate School of Medicine)	Dr. Britton has received personal compensation in the range of $0-$499 for serving as a Online course with American Clinical Neurophysiology Society.
Gregory D. Cascino, MD, FAAN (Mayo Clinic)	Dr. Cascino has received personal compensation in the range of $5,000-$9,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for International League Against Epilepsy . Dr. Cascino has received intellectual property interests from a discovery or technology relating to health care. Dr. Cascino has received publishing royalties from a publication relating to health care. Dr. Cascino has received publishing royalties from a publication relating to health care.
Karl Krecke	Karl Krecke has nothing to disclose.
Jamie J. Van Gompel, MD	Jamie J. Van Gompel, MD has stock in Neuroone.
	No disclosure on file
Lily Wong-Kisiel, MD, FAAN (Mayo Clinic)	Dr. Wong-Kisiel has nothing to disclose.

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