Brain, Vol. 122, No. 5, 799-805,
May 1999
© 1999 Oxford University Press
Surgical outcome in patients with epilepsy and dual pathology
1 Department of Neurology and Neurosurgery, Montreal Neurological Institute and Hospital, McGill University, Montreal, Canada, 2 Department of Neurology, Wayne State University, School of Medicine, Detroit, Michigan, USA, 3 Epilepsy Research Group, Institute of Neurology, National Hospital for Neurology and Neurosurgery, London, UK and 4 Royal Melbourne Hospital and 5 Austin and Repatriation Medical Center, Melbourne, Australia
Correspondence to:
Dr Frederick Andermann, Montreal Neurological Institute and Hospital, 3801 University Street, Montreal, Quebec, Canada H3A 2B4
High-resolution MRI can detect dual pathology (an extrahippocampal lesion plus hippocampal atrophy) in about 5–20% of patients with refractory partial epilepsy referred for surgical evaluation. We report the results of 41 surgical interventions in 38 adults (mean age 31 years, range 14–63 years) with dual pathology. Three patients had two operations. The mean postoperative follow-up was 37 months (range 12–180 months). The extrahippocampal lesions were cortical dysgenesis in 15, tumour in 10, contusion/infarct in eight and vascular malformation in five patients. The surgical approach aimed to remove what was considered to be the most epileptogenic lesion, and the 41 operations were classified into lesionectomy (removal of an extrahippocampal lesion); mesial temporal resection (removal of an atrophic hippocampus); and lesionectomy plus mesial temporal resection (removal of both the lesion and the atrophic hippocampus). Lesionectomy plus mesial temporal resection resulted in complete freedom from seizures in 11/15 (73%) patients, while only 2/10 (20%) patients who had mesial temporal resection alone and 2/16 (12.5%) who had a lesionectomy alone were seizure-free (P < 0.001). When classes I and II were considered together results improved to 86, 30 and 31%, respectively. Our findings indicate that in patients with dual pathology removal of both the lesion and the atrophic hippocampus is the best surgical approach and should be considered whenever possible.
hippocampal sclerosis; dual pathology; epilepsy; surgery; outcome
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