The Effect of Neocortical Pathology on Lateralization and Seizure Outcome in Lobectomy Materials in Surgically Treated Hippocampal Sclerosis Patients

Year 2019, , 69 - 81, 26.04.2019

Gönül Güvenç , Ceren Kızmazoğlu

https://doi.org/10.5505/deutfd.2019.08379

Abstract

INTRODUCTION: The aim of this study was to investigate the effect of histopathological neocortical pathology on lateralization and surgical seizure in patients with temporal epilepsy, resistant temporal epilepsy and hippocampal sclerosis.
METHODS: In our clinic, from 2008 to 2016, 18 patients with resistant temporal lobe epilepsy and hippocampal sclerosis were included in the study.
RESULTS: Thirteen patients (72.2%) right side, 5 patients (27.8%) left side amygdalohipocampectomy + anterior temporal lobectomy procedure was performed. Neocortical pathology was found histopathologically in 11 patients (61.1%) and normal in 7 patients (38.9%). Six (33.3%) of the neocortical pathology were microdisgenesia and 5 (27.8%) were cortical dysplasia. The effect of preoperative examination on lateralization was investigated according to neocortical pathology and normalization of seizure semiology (78.4%) was statistically significant (p = 0.019). The best investigations for lateralization waere cranial MRI (94.5%) and ictal EEG (94.5%). PET (83.3%) investigation was found to contribute to lateralization. Early onset seizures were remarkable in patients with neocortical pathology. In the first 5 years after surgery,according to Engel classification, 83.3% grade 1, 11.1% grade 2, 5.6% grade 3 seizure rates were obtained. There were no statistically significant differences between the patients with neocortical pathology and those with normal surgical results.
DISCUSSION AND CONCLUSION: In our study we found that the rate of pathology in neocortical tissue is high in patients with hippocampal sclerosis. This result, supports the standard temporal lobectomy surgical procedure. More studies are needed to determine the effect of the presence of pathology on lateralization value, epileptogenesis and surgical outcomes.

Keywords

Resistant temporal epilepsy, hippocampal sclerosis, neocortical anomaly, standard temporal lobectomy

Cerrahi Olarak Tedavi Edilmiş Hipokampal Sklerozlu Hastalarda Lobektomi Materyallerindeki Neokortikal Patoloji Varlığının Lateralizasyona ve Nöbete Etkisi

Abstract

GİRİŞ ve AMAÇ: Hipokampal sklerozlu dirençli temporal epilepsili, standart temporal lobektomi uygulanmış olguların histopatolojik neokortikal patoloji varlığının lateralizasyon ve cerrahi nöbetsizliğe etkisini retrospektif olarak araştırmaktır. YÖNTEM ve GEREÇLER: Kliniğimizde 2008-2016 yılları arasında epilepsi cerrahisi uygulanmış olgular arasından dirençli temporal lob epilepsili, radyolojik ve histopatolojik olarak hipokampal sklerozlu 18 olgu çalışmaya dahil edilmiştir. BULGULAR: Onüç olguya (%72.2) sağ, 5 olguya (% 27.8) sol taraf amigdalohipokampektomi + anterior temporal lobektomi prosedürü uygulandı. Onbir olguda (%61.1) neokortikal patoloji histopatolojik olarak tespit edilmiş, 7 olgu (%38.9) ise normal bulunmuştur. Neokortikal patolojinin 6’sı (%33.3) mikrodisgenezi, 5’i (%27.8) kortikal displazi idi. Neokortikal patoloji varlığının normal olan olgulara göre preoperatif incelemelerin lateralizasyona etkisi araştırılmış ve nöbet semiyolojisinin lateralize edilmesinde (%78.4) istatistiksel anlamlı farklılık (p=0,019) bulunmuştur. En iyi lateralize eden incelemelerin ise kranial MRG (%94.5) ve iktal EEG (%94.5) olduğu, PET’in yüksek oranda (%83.3) lateralizasyona katkısı olduğu görülmüştür. Neokortikal patolojisi olan olgularda erken yaşta nöbet başlangıcı ise dikkat çekiciydi. Cerrahi sonrası ilk 5 yılda Engel sınflamasına göre, ilk 5 yılda %83,3 derece 1, %11,1 derece 2, %5,6 derece 3 nöbetsizlik oranları elde edildi. Cerrahi sonuç açısından neokortikal patoloji olan ve normal olan olgular arasında istatistiksel anlamlı fark bulunmadı. TARTIŞMA ve SONUÇ: Hipokampal sklerozlu olgularda neokortikal dokuda patoloji varlığının oranının yüksek olduğu görülmektedir. Bu sonuç standart temporal lobektomi cerrahi prosedürünü desteklemektedir. Patoloji varlığının ön incelemelerin lateralizasyon değerine, epileptogenezise ve cerrahi sonuçlara etkisini tespit edebilmek için daha fazla sayıda olguda çalışmaya ihtiyaç vardır.

Keywords

Dirençli temporal epilepsi, hipokampal skleroz, neokortikal anomali, standart temporal lobektomi

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