Pathology and neuroimaging in pediatric temporal lobectomy for intractable epilepsy

D. B. Sinclair, M. Wheatley, K. Aronyk, Chunhai Hao, T. Snyder, W. Colmers, J. D S McKean

Research output: Contribution to journalArticle

31 Citations (Scopus)

Abstract

Objectives: Firstly, to study the pathology at surgery in children undergoing temporal lobectomy for intractable partial epilepsy. Secondly, to compare neuroimaging techniques (CT, MRI) in the preoperative detection of pathology. Lastly, to examine the surgical outcome in children. Methods: Forty-two pediatric patients undergoing temporal lobectomy for intractable epilepsy at the Comprehensive Epilepsy Program at the University of Alberta Hospital between the years 1988-1998 were studied. Patients had extensive preoperative investigations including CT and MRI. The pathology at surgery was reviewed and compared to preoperative neuroimaging. Charts were reviewed to determine surgical outcome. Results: Brain tumors were the most common pathology, found in 13/42 patients. Mesial temporal sclerosis (MTS) was found in 8 patients and dual pathology in an additional 5. Focal cortical dysplasia (FCD) was seen in 4 patients, 1 patient had a porencephalic cyst and 4 patients had tubers of tuberous sclerosis. Seven patients had no specific pathology detected. MRI was clearly more sensitive than CT in the detection of pathology. MRI was abnormal in 27/42 cases (64%), while CT scan was found to be abnormal in only 12/39 (31%). Surgical outcome was excellent, with 34/42 patients (80%) having an Engel class I outcome. One patient had significant improvement with an Engel class II outcome, 3 (7%) had little improvement (Engel class III) and 4 (10%) were unchanged (Engel class IV). Three patients (7%) had surgical complications. Conclusions: A wide variety of developmental pathology is seen following temporal lobectomy for intractable epilepsy of childhood. Brain tumors, FCD and MTS are common. MRI is superior to CT in the detection of pathology, which may be subtle in children. Surgical outcome is excellent, with most children being seizure free and few complications being seen.

Original languageEnglish (US)
Pages (from-to)239-246
Number of pages8
JournalPediatric Neurosurgery
Volume35
Issue number5
DOIs
StatePublished - Dec 1 2001
Externally publishedYes

Fingerprint

Neuroimaging
Pediatrics
Pathology
Malformations of Cortical Development
Sclerosis
Brain Neoplasms
Drug Resistant Epilepsy
Alberta
Tuberous Sclerosis
Partial Epilepsy
Cysts
Epilepsy
Seizures

Keywords

  • Epilepsy surgery
  • Neuroimaging
  • Pathology
  • Pediatric epilepsy

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Clinical Neurology

Cite this

Sinclair, D. B., Wheatley, M., Aronyk, K., Hao, C., Snyder, T., Colmers, W., & McKean, J. D. S. (2001). Pathology and neuroimaging in pediatric temporal lobectomy for intractable epilepsy. Pediatric Neurosurgery, 35(5), 239-246. https://doi.org/10.1159/000050429

Pathology and neuroimaging in pediatric temporal lobectomy for intractable epilepsy. / Sinclair, D. B.; Wheatley, M.; Aronyk, K.; Hao, Chunhai; Snyder, T.; Colmers, W.; McKean, J. D S.

In: Pediatric Neurosurgery, Vol. 35, No. 5, 01.12.2001, p. 239-246.

Research output: Contribution to journalArticle

Sinclair, DB, Wheatley, M, Aronyk, K, Hao, C, Snyder, T, Colmers, W & McKean, JDS 2001, 'Pathology and neuroimaging in pediatric temporal lobectomy for intractable epilepsy', Pediatric Neurosurgery, vol. 35, no. 5, pp. 239-246. https://doi.org/10.1159/000050429
Sinclair, D. B. ; Wheatley, M. ; Aronyk, K. ; Hao, Chunhai ; Snyder, T. ; Colmers, W. ; McKean, J. D S. / Pathology and neuroimaging in pediatric temporal lobectomy for intractable epilepsy. In: Pediatric Neurosurgery. 2001 ; Vol. 35, No. 5. pp. 239-246.
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abstract = "Objectives: Firstly, to study the pathology at surgery in children undergoing temporal lobectomy for intractable partial epilepsy. Secondly, to compare neuroimaging techniques (CT, MRI) in the preoperative detection of pathology. Lastly, to examine the surgical outcome in children. Methods: Forty-two pediatric patients undergoing temporal lobectomy for intractable epilepsy at the Comprehensive Epilepsy Program at the University of Alberta Hospital between the years 1988-1998 were studied. Patients had extensive preoperative investigations including CT and MRI. The pathology at surgery was reviewed and compared to preoperative neuroimaging. Charts were reviewed to determine surgical outcome. Results: Brain tumors were the most common pathology, found in 13/42 patients. Mesial temporal sclerosis (MTS) was found in 8 patients and dual pathology in an additional 5. Focal cortical dysplasia (FCD) was seen in 4 patients, 1 patient had a porencephalic cyst and 4 patients had tubers of tuberous sclerosis. Seven patients had no specific pathology detected. MRI was clearly more sensitive than CT in the detection of pathology. MRI was abnormal in 27/42 cases (64{\%}), while CT scan was found to be abnormal in only 12/39 (31{\%}). Surgical outcome was excellent, with 34/42 patients (80{\%}) having an Engel class I outcome. One patient had significant improvement with an Engel class II outcome, 3 (7{\%}) had little improvement (Engel class III) and 4 (10{\%}) were unchanged (Engel class IV). Three patients (7{\%}) had surgical complications. Conclusions: A wide variety of developmental pathology is seen following temporal lobectomy for intractable epilepsy of childhood. Brain tumors, FCD and MTS are common. MRI is superior to CT in the detection of pathology, which may be subtle in children. Surgical outcome is excellent, with most children being seizure free and few complications being seen.",
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AB - Objectives: Firstly, to study the pathology at surgery in children undergoing temporal lobectomy for intractable partial epilepsy. Secondly, to compare neuroimaging techniques (CT, MRI) in the preoperative detection of pathology. Lastly, to examine the surgical outcome in children. Methods: Forty-two pediatric patients undergoing temporal lobectomy for intractable epilepsy at the Comprehensive Epilepsy Program at the University of Alberta Hospital between the years 1988-1998 were studied. Patients had extensive preoperative investigations including CT and MRI. The pathology at surgery was reviewed and compared to preoperative neuroimaging. Charts were reviewed to determine surgical outcome. Results: Brain tumors were the most common pathology, found in 13/42 patients. Mesial temporal sclerosis (MTS) was found in 8 patients and dual pathology in an additional 5. Focal cortical dysplasia (FCD) was seen in 4 patients, 1 patient had a porencephalic cyst and 4 patients had tubers of tuberous sclerosis. Seven patients had no specific pathology detected. MRI was clearly more sensitive than CT in the detection of pathology. MRI was abnormal in 27/42 cases (64%), while CT scan was found to be abnormal in only 12/39 (31%). Surgical outcome was excellent, with 34/42 patients (80%) having an Engel class I outcome. One patient had significant improvement with an Engel class II outcome, 3 (7%) had little improvement (Engel class III) and 4 (10%) were unchanged (Engel class IV). Three patients (7%) had surgical complications. Conclusions: A wide variety of developmental pathology is seen following temporal lobectomy for intractable epilepsy of childhood. Brain tumors, FCD and MTS are common. MRI is superior to CT in the detection of pathology, which may be subtle in children. Surgical outcome is excellent, with most children being seizure free and few complications being seen.

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