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Reoperations After Failed Resective Surgery

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Surgical Treatment of Epilepsies

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Abstract

Resective epilepsy surgery leads to a favorable seizure outcome (Engel I–II, ILAE 1–2) in 70–90% of patients indicating that 10–30% continue to have seizures after surgery. Patients with persisting seizures may show a different course: Some achieve spontaneously seizure control by the “running down phenomenon,” others may benefit from modified anticonvulsive medication or alternative treatment options, while in a significant percentage epilepsy will persist despite various efforts. In these patients who continue to have more than rarely disabling seizures after a resective procedure corresponding to the outcome classes Engel III–IV and ILAE 3–6, epilepsy surgery is considered as a failure. In addition to persistent seizures, some of those patients may significantly decline in memory and fail to recover (“double loosers”). The main cause of failed surgery is insufficient resection, frequently not corresponding to the planning. Repeat surgery with extended resection has proven to provide seizure control in 50–70% of these patients. Due to cortical dysplasia as the most frequent pathology, reoperation is required in around 20% of very young and in 10% of older children, and seizure control is achieved in the majority (around 60%) of cases.

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  1. Freiburg im Breisgau, Baden-Württemberg, Germany

    Josef Zentner

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Zentner, J. (2020). Reoperations After Failed Resective Surgery. In: Surgical Treatment of Epilepsies. Springer, Cham. https://doi.org/10.1007/978-3-030-48748-5_12

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