SENEC 2017: Ponencia del Profesor García de Sola: Cirugía de la Epilepsia
Ponencia Cirugía de la Epilepsia SENEC 2017
PROPOSALS AND NUANCES TO AMELIORATE THE SURGICAL RESULTS OF TEMPORAL LOBE EPILEPSY
Rafael G Sola. Professor and Chairman. Hospital de La Princesa. Autonomous University. Madrid
The temporal lobe is the most frequent location involved in Epilepsy Surgery and is also the surgical procedure with the best results: 70-90% of Engel I-II.
The methodology could apparently differ in each Epilepsy Surgical Unit (ESU), but, essentially, it consists of non-invasive and/or invasive studies, surgical treatment, pathological studies and review of results. In our ESU we prefer to perform epileptic seizure recording with foramen ovale electrodes (FOE); and Spencer’s surgical technique for temporal lobe removal, tailored according to intraoperative Electrocorticography (ECoG). We get global results of 94% in Engel I-II.
The type of lesions visualized in MRI is crucial. We classify them as surgical lesions (tumor or cavernous angioma), lesions that could guide us to the location of epileptogenic zone (mesial sclerosis, dyplasia…) and non-lesion MRI. Our results are 100%, 95% and 88% seizure-free patients, respectively. From our point of view, patients with no lesions on the MRI must not be excluded, as we could reach good results in more than 80%.
Another important issue, in our experience, is the use of semi-invasive EFO. The global results of patients explored with Video-EEG alone or with FOE could vary in almost 20 points in the percentage of seizure-free patients.
There have also been another nuances that have helped us to improved the results:
- Pharmacological activation (Etomidate) during EFO/Video-EEG and ECoG.
- Studies about synchronization clusters of interictal activity in ECoG recording.
We have found that there is a group of patients with dominant temporal lobe epilepsy, normal MRI and normal neuropsychological studies. In these cases we are considering the possibility of performing a much smaller radiosurgical lesion, based on voltage sources found in FOE recordings.
Sola RG, Miravet J. Surgical treatment for epilepsy. Results after a minimum follow-up of five years. Acta Neurochir Suppl (Wien). 1991; 52:157-60.
Pastor J, Sola RG, Hernando-Requejo V, Navarrete EG, Pulido P. Morbidity associated with the use of foramen ovale electrodes. Epilepsia. 2008; 49(3):464-9.
Pastor J, Wix R, Meilán L, Martínez-Chacón JL, de Dios E, Sola RG. Etomidate accurately localizes the epileptic area in patients with temporal lobe epilepsy. Epilepsia 2010; 51(4):602-609.
Ortega GJ, Menéndez de la Prida L, Sola RG, Pastor J. Synchronization clusters of interictal activity in the lateral temporal cortex of epileptic patients: intraoperative electrocorticographic analysis. Epilepsia. 2008;49(2):269-80.
Pastor J, de la Prida LM, Hernando V, Sola RG. Voltage sources in mesial temporal lobe epilepsy recorded with foramen ovale electrodes. Clin Neurophysiol. 2006; 117(12):2604-14.
Catedrático de Neurocirugía
Universidad Autónoma de Madrid
Jefe de Servicio de Neurocirugía
Hospital de la Princesa