A comparative study of lesionectomy versus corticectomy in patients with temporal lobe lesional epilepsy

We performed a retrospective study comparing surgical outcome of anterior temporal lobectomy (n = 20) and stereotactic lesionectomy (n = 14) in 34 consecutive patients with intractable partial epilepsy evaluated at this institution between June 1986 and June 1992. All patients had medically refractory partial seizures and a neuroimaging-identified temporal lobe foreign-tissue lesion. Patients underwent a pre- and postoperative comprehensive evaluation. In all patients, postoperative neuroimaging studies indicated complete lesion resection. Seventy-one percent of lesionectomy patients and 90% of lobectomy patients, respectively, experienced a worthwhile reduction in seizure tendency. Forty-three percent of lesionectomy patients and 85% of lobectomy patients, respectively, were seizure-free postoperatively. Mean duration of follow-up was 51 months (range, 21-83 months). Morbidity occurred in three patients who underwent corticectomy: complete homonymous hemianopsia (1) and dysphasia (2). No significant morbidity was associated with lesionectomy. Results of this study have altered the surgical strategy at this institution for patients with temporal lobe lesional epilepsy and have proved useful in counseling patients regarding neurologic outcome.