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Acta Neuropathologica

, Volume 86, Issue 5, pp 433–438 | Cite as

Neuropathological findings in 224 patients with temporal lobe epilepsy

  • Karl H. Plate
  • Heinz-Gregor Wieser
  • M. Gazi Yasargil
  • Otmar D. Wiestler
Article

Abstract

During the period between 1976 and 1990, 247 patients with pharmaco-resistant complex partial seizures and a documented unilateral epileptogenic area in the mediobasal temporal lobe underwent a selective amygdalo-hippocampectomy procedure at our institution. Biopsy specimens from 224 patients (91% of the total) were available for a retrospective histopathological and immunohistochemical review. The tissue specimens of 23 patients without evidence for a macroscopic lesion have been used for neurochemical studies and could not be evaluated histopathologically. The most common temporal lobe pathology were neoplasms in 126 patients, i.e. 56%. Tumor entities observed included 23 astrocytomas (18% of all tumors), 17 gangliogliomas (13%), 15 oligodendrogliomas (12%), 15 cases of glioblastoma multiforme (12%), 13 pilocytic astrocytomas (10%), 12 oligo-astrocytomas (10%), 11 anaplastic astrocytomas (9%) and 20 tumors of various other histologies. In 23 specimens (10%), small foci of oligodendroglia-like clear cells were found. The frequent association of these foci with low-grade gliomas or neural hamartomas raises the possibility that these structures may serve as precursor lesion for neuroepithelial tumors of the temporal lobe. In 98 cases, pathological changes of non-neoplastic origin were encountered. The most common diagnoses in this group included hippocampal gliosis/sclerosis (49 cases, 22%) and vascular malformations (20 cases, 9%). Hamartomas, i.e. focal accumulations of dysplastic neuro-glial cells were diagnosed in 14 patients (6%). In only four cases have we not been able to detect any microscopic pathology. These results indicate that a high proportion of pharmaco-therapy-resistent complex-partial seizures are caused by neoplasms of the temporal lobe, some of which appear to the strikingly overrepresented in this group of patients.

Key words

Temporal lobe epilepsy Hippocampal sclerosis Ganglioglioma Hamartoma Amygdalo-hippocampectomy 

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Copyright information

© Springer-Verlag 1993

Authors and Affiliations

  • Karl H. Plate
    • 1
  • Heinz-Gregor Wieser
    • 2
  • M. Gazi Yasargil
    • 3
  • Otmar D. Wiestler
    • 1
  1. 1.Department of Pathology (Neuropathology)University of ZürichZürichSwitzerland
  2. 2.Departments of NeurologyUniversity of ZürichZürichSwitzerland
  3. 3.Department of NeurosurgeryUniversity of ZürichZürichSwitzerland

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