Histopathological features and optimal operative procedure for patients with late intractable epilepsy after traumatic brain injuries

Objective To investigate the pathological features and optimal operation of the patients with late intractable epilepsy after traumatic brain injuries(TBI).Methods Fresh specimens of temporal lobe were obtained during operation from 21 patients with late intractable epilepsy after TBI to investigate the cortical structure,cellular morphology,number and distribution,and analyze the structure of hippocampus and pathological features of other tissues.Results The pathological features of brain tissue in epilepsy after TBI were encephalomalacia and hypertrophic scar,and the marked pathological changes in resected temporal lobe were hippocampal sclerosis and dysplasia of temporal cortex cells(seen in 15 of 21 cases).The therapeutic effects were assessed by a 6-month to 2-year follow-up,and satisfactory effects were obtained in 14 out of 21 patients(66.7%)(Grade Ⅰ),favorable effects were seen in 4 cases(19.0%)(Grade Ⅱ),and poor outcomes were seen in 3 cases(14.3%)(Grade Ⅲ).Conclusions Hippocampal sclerosis and construction abnormalities of temporal lobe cortex are the most common pathological features,and they always co-exist in patients with late intractable epilepsy.The resection of pathological lesion combined with standard anterior temporal lobectomy is currently the recommended operation choice for late intractable epilepsy after TBI.