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Resective epilepsy surgery: assessment of randomized controlled trials

Neurosurgical Review volume 44, pages 2059–2067 (2021)Cite this article

Abstract

Epilepsy is the most common form of chronic neurologic disease. Here, we review the available randomized controlled trials (RCTs) that examined the efficacy of resective epilepsy surgery in select patients suffering from medically intractable epilepsy (defined as persistent epilepsy despite two or more antiepileptic drugs [AEDs]). Three RCTs (two adult RCTs and one pediatric RCT) consistently supported the efficacy of resective surgery as treatment for epilepsy with semiology localized to the mesial temporal lobe. In these studies, 58–100% of the patients who underwent resective surgery achieved seizure freedom, in comparison to 0–13% of medically treated patients. In another RCT, the likelihood of seizure freedom after resective surgery was independent of the surgical approach (transSylvian [64%] versus subtemporal [62%]). Two other RCTs demonstrated that hippocampal resection is essential to optimize seizure control. But, no significant gain in seizure control was achieved beyond removing 2.5 cm of the hippocampus. Across RCTs, minor complications (deficit lasting < 3 months) and major complications (deficit > 3 months) ranged 2–5% and 5–11% respectively. However, nonincapacitating superior subquadrantic visual-field defects (not typically considered a minor or major complication) were noted in up to 55% of the surgical cohort. The available RCTs provide compelling support for resective surgery as a treatment for mesial temporal lobe epilepsy and offer insights toward optimal surgical strategy.

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Affiliations

  1. Department of Neurosurgery, University of Minnesota, 420 Delaware St SE, MMC 96, D-429 Mayo Memorial Building, Minneapolis, MN, 55455, USA

    Samuel W. Cramer, Robert A. McGovern, Clark C. Chen & Michael C. Park

  2. Department of Neurology, University of Minnesota, 516 Delaware St SE, 12-100 Phillips Wangensteen Building, Minneapolis, MN, 55455, USA

    Robert A. McGovern, Sonya G. Wang & Michael C. Park

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  1. Samuel W. Cramer
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  2. Robert A. McGovern
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Correspondence to Samuel W. Cramer.

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Cramer, S.W., McGovern, R.A., Wang, S.G. et al. Resective epilepsy surgery: assessment of randomized controlled trials. Neurosurg Rev 44, 2059–2067 (2021). https://doi.org/10.1007/s10143-020-01432-x

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  • DOI: https://doi.org/10.1007/s10143-020-01432-x

Keywords

  • Epilepsy surgery
  • Resective epilepsy surgery
  • Freedom from seizures
  • Medically intractable epilepsy