Surgical tactics for the treatment of symptomatic temporal lobe epilepsy

: The results of treatment were analyzed in 40 patients aged 5 to 43 years who had been operated on for symptomatic temporal lobe epilepsy, among them there were 29 patients with low-grade intracerebral tumors. Local and regional lesions were observed in 27 and 13 cases, respectively. Thirteen patients with local lesions had also a local type of epileptiform activity; the remaining had a regional type. The involved area was removed in 10 patients; in 15 cases that was removed, with the areas wherein epileptform activity persisted; 15 patients underwent temporal lobectomy adapted to the data of neurophysiological study made before resection. Magnetic resonance imaging indicated that the involved area was completely removed; in 18 patients the resection borders exceeded the involved area. In local lesions accompanied by local epileptic activity, there were no significant differences between the removal in the borders of a lesion and that in a greater extent (p > 0.05). In patients with regional epileptiform activity, the results of treatment with removal in the greater extent were significantly better (p < or = 0.01). In these patients, an association was found between the significant disturbances of normal cortical rhythm outside the visualized involved area and the severe impairments in the cortical cytoarchitectonics in these areas. Persistent epileptic activity along with cortical rhythm disturbances on an electrocorticogram may be as a sign of lesion spread outside the visible borders and an indication for additional resections.