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Acta Neurochirurgica

, Volume 157, Issue 1, pp 63–75 | Cite as

Intractable occipital lobe epilepsy: clinical characteristics, surgical treatment, and a systematic review of the literature

  • Peng-Fan Yang
  • Yan-Zeng Jia
  • Qiao Lin
  • Zhen Mei
  • Zi-Qian Chen
  • Zhi-Yong Zheng
  • Hui-Jian Zhang
  • Jia-Sheng Pei
  • Jun Tian
  • Zhong-Hui Zhong
Clinical Article - Functional

Abstract

Purpose

We reported our experience in the surgical treatment of a relatively large cohort of patients with occipital lobe epilepsy (OLE). We also carried out a systematic review of the literature on OLE.

Methods

Thirty-five consecutive patients who underwent occipital resection for epilepsy were included. Diagnoses were made following presurgical evaluations, including magnetic resonance imaging (MRI), fluorodeoxyglucose-positron emission tomography (FDG-PET), scalp video-electroencephalogram (EEG) monitoring, and intracranial EEG monitoring. At last follow-up, seizure outcome was classified using the Engel classification scheme.

Results

Twenty-five of 35 patients experienced/had experienced ≥1 type of aura before the seizure. Invasive recordings were used to define the epileptogenic area in 30 of 35 patients (85.7 %). All patients underwent occipital lesionectomies or topectomies. Histopathology revealed: cortical dysplasias, gliosis, dysembryoplastic neuroepithelial tumor, ganglioglioma, and tuberous sclerosis. After a mean follow-up of 44 months, 25 patients (71.4 %) were seizure free (Engel class I), 3 (8.6 %) rarely had seizures (Engel class II), 5 (14.3 %) improved more than 75 % (Engel class III), and 2 (5.7 %) had no significant improvement (Engel class IV). Preoperatively, 12 of 33 patients (36.4 %) had visual field deficits. Postoperatively, 25 patients (75.8 %) had new or aggravated visual field deficits.

Conclusions

The management of OLE has been aided greatly by the availability of high-resolution diagnosis. Postoperative visual field deficits occur in a significant proportion of patients. Comprehensive intracranial EEG coverage of all occipital surfaces helps to define the epileptogenic area and preserve visual function, especially in cases of focal cortical dysplasia undetectable by MRI.

Keywords

Electroencephalogram Epilepsy Intracranial electrode Occipital lobe Surgery Visual aura 

Notes

Conflicts of interest

None.

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Copyright information

© Springer-Verlag Wien 2014

Authors and Affiliations

  • Peng-Fan Yang
    • 1
  • Yan-Zeng Jia
    • 2
  • Qiao Lin
    • 2
  • Zhen Mei
    • 2
  • Zi-Qian Chen
    • 3
  • Zhi-Yong Zheng
    • 4
  • Hui-Jian Zhang
    • 1
  • Jia-Sheng Pei
    • 1
  • Jun Tian
    • 1
  • Zhong-Hui Zhong
    • 2
  1. 1.Department of NeurosurgeryFuzhou General Hospital of Nanjing Command, PLAFuzhouChina
  2. 2.Department of EpileptologyFuzhou General Hospital of Nanjing Command, PLAFuzhouChina
  3. 3.Department of Medical ImagingFuzhou General Hospital of Nanjing Command, PLAFuzhouChina
  4. 4.Department of PathologyFuzhou General Hospital of Nanjing Command, PLAFuzhouChina

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