Decision-making in temporal lobe epilepsy surgery based on invasive stereo-electroencephalography (sEEG)
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ORIGINAL ARTICLE
Decision-making in temporal lobe epilepsy surgery based on invasive stereo-electroencephalography (sEEG) Lasse Dührsen 1 & Thomas Sauvigny 1,2 & Franz L. Ricklefs 1 & Wolfgang Hamel 1 & Johannes A. Koeppen 1 & Jonas M. Hebel 3 & Michael Lanz 3 & Tobias Martens 1 Received: 20 May 2019 / Revised: 29 August 2019 / Accepted: 3 September 2019 # Springer-Verlag GmbH Germany, part of Springer Nature 2019
Abstract In medical refractory temporal lobe epilepsy (TLE), the epileptogenic zone can be difficult to identify and therefore difficult to treat, especially in the absence of clear MRI pathologies and specific results from presurgical evaluation. Invasive monitoring with stereo-electroencephalography (sEEG) is a tool for a better determination of the epileptogenic zone. Here, we investigate the impact of sEEG on decision-making in temporal lobe epilepsy surgery. We reviewed patients with TLE who underwent further investigation with sEEG in our epilepsy unit. We examined specifically how sEEG findings influenced our decision regarding indication for a surgical procedure and resection volume. From 2013 to 2017, we performed 152 temporal resections in epilepsy patients. Twenty-one of these patients were designated for further preoperative investigation with sEEG due to incongruent findings in presurgical evaluation. Six patients were implanted bitemporally. In five cases, the hypothesis for the epileptogenic zone and localization had to be changed due to sEEG findings and resulted in a different tailored resection than intended. In three cases, sEEG findings led to the cancelation of the originally intended temporal resection as the epileptogenic zone was not definable or bilateral. In another three cases, the prognosis for reduction of seizures postoperatively had to be reduced due to the sEEG findings. However, the resection was performed after interdisciplinary discussion and informed consent of the patient. The examination by sEEG led to a change of plan for further treatment in 13 patients (61.9%) suffering TLE in total. Invasive monitoring with sEEG electrodes had a strong impact on decision-making for further treatment in patients suffering from temporal lobe epilepsy with incongruent findings in presurgical examination designated for epilepsy surgery. This applies to resection volumes as well as to prediction of seizure outcome. Keywords Temporal lobe epilepsy (TLE) . Epilepsy surgery . Stereo-encephalography (sEEG) . Bilateral
Introduction Refractory temporal lobe epilepsy (TLE) is generally a domain of epilepsy surgery due to good seizure outcome. Parts of this work were presented at the annual meetings of the German Society of Neurosurgery (DGNC) and Epilepsy (DGfE) 2018. * Lasse Dührsen [email protected] 1
Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany
2
Center for Molecular Neurobiology, Institute for Molecular and Cellular Cognition, Hamburg, Germany
3
Hamburg Epilepsy Center, Protestant Hospital Alsterdorf, Hamburg, Ge
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