Acta Neurochirurgica

, Volume 153, Issue 2, pp 209–219

Randomized controlled trial of 2.5-cm versus 3.5-cm mesial temporal resection in temporal lobe epilepsy—part 1: intent-to-treat analysis

  • Johannes Schramm
  • T. N. Lehmann
  • J. Zentner
  • C. A. Mueller
  • J. Scorzin
  • R. Fimmers
  • H. J. Meencke
  • A. Schulze-Bonhage
  • C. E. Elger
Clinical Article

DOI: 10.1007/s00701-010-0900-6

Cite this article as:
Schramm, J., Lehmann, T.N., Zentner, J. et al. Acta Neurochir (2011) 153: 209. doi:10.1007/s00701-010-0900-6

Abstract

Background

Only one prospective randomized study on the extent of mesial resection in surgery for temporal lobe epilepsy (TLE) exists. This randomized controlled trial (RCT) examines whether 3.5-cm mesial resection is leading to a better seizure outcome than a 2.5-cm resection.

Methods

Three epilepsy surgery centers using similar MRI protocols, neuropsychological tests, and resection types for TLE surgery included 207 patients in a RCT with pre- and postoperative volumetrics. One hundred and four patients were randomized into a 2.5-cm resection group and 103 patients into a 3.5-cm resection group, i.e., an intended minimum resection length of 25 versus 35 mm for the hippocampus and parahippocampus. Primary outcome measure was seizure freedom Engel class I throughout the first year. The study was powered to detect a 20% difference in class I outcome. Seizure outcome was available for 207 patients, complete volumetric results for 179 patients. Outcome analysis was restricted to control of successful randomization and an intent-to-treat analysis of seizure outcome.

Results

The mean true resection volumes were significantly different for the 2.5-cm and 3.5-cm resection groups; thus, the randomization was successful. Median resection volume in the 2.5-cm group was 72.86% of initial volume and 83.44% in the 3.5-cm group. At 1 year, seizure outcome Engel class I was 74% in the 2.5-cm and 72.8% in the 3.5-cm resection group.

Conclusions

The primary intent-to-treat analysis did not show a different seizure freedom rate for the more posteriorly reaching 3.5-cm resection group. It appears possible that not maximal volume resection but adequate volume resection leads to good seizure freedom.

Keywords

Temporal lobe epilepsy Epilepsy surgery Randomized controlled trial Amygdalohippocampectomy 

Copyright information

© Springer-Verlag 2010

Authors and Affiliations

  • Johannes Schramm
    • 1
  • T. N. Lehmann
    • 2
  • J. Zentner
    • 3
  • C. A. Mueller
    • 1
  • J. Scorzin
    • 1
  • R. Fimmers
    • 4
  • H. J. Meencke
    • 5
  • A. Schulze-Bonhage
    • 6
  • C. E. Elger
    • 7
  1. 1.Department of NeurosurgeryUniversity of BonnBonnGermany
  2. 2.Department of Neurosurgery, Campus Virchow KlinikumCharité BerlinBerlinGermany
  3. 3.Department of NeurosurgeryUniversity of FreiburgFreiburgGermany
  4. 4.Institute of Medical Biometrics, Informatics and EpidemiologyUniversity of BonnBonnGermany
  5. 5.Department of EpileptologyEpilepsiezentrum Berlin Brandenburg and von Bodelschwinghsche Anstalten, Königin Elisabeth Hospital HerzbergeBerlinGermany
  6. 6.Epilepsy CenterUniversity Hospital of FreiburgFreiburgGermany
  7. 7.Department of EpileptologyUniversity of BonnBonnGermany

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