Epilepsia do lobo temporal: tratamento cirúrgico

Rassi Neto, Aziz; Campos, Carlos J. Reis de; Muszkat, Mauro; Ferraz, Fernando P.

doi:10.1590/S0004-282X1996000400011

Resumos

Os autores apresentam 32 pacientes com crises epilépticas não controladas ou intratáveis mesmo fazendo uso de medicamentos em doses adequadas. O eletrencefalograma mostrou descargas paroxísticas focais na região temporal em todos os casos. O material foi dividido em dois grupos. O primeiro é composto de 18 pacientes em que os exames por neuroimagem (ressonância magnética e tomografia computadorizada craniana) mostraram imagens compatíveis com lesões expansivas cerebrais (como gliomas, malformações artério-venosas, tumor epidermóide); foi realizada exérese da lesão em todos os casos, associada à área irritativa adjacente que foi identificada pela eletrocorticografia intraoperatória, em seis casos; só foi possível a exérese dessas áreas irritativas nos casos em que elas se localizavam em zonas não eloquentes. O segundo é composto de 14 pacientes nos quais a ressonância magnética não mostrou imagem compatível com processo expansivo cerebral; o exame histopatológico mostrou esclerose mesial temporal em nove casos e cérebro normal em cinco; todos os casos deste grupo foram submetidos a lobectomia temporal. Observamos que os casos com lesões expansivas cerebrais apresentaram melhor evolução em relação ao controle das crises epilépticas do que os casos sem estas lesões, pois 15 (83,4%) dos 18 casos do primeiro grupo evoluíram sem crises e 10 (71,4%) dos 14 casos do segundo grupo também evoluíram sem crises após a cirurgia.

epilepsia; lobo temporal; cirurgia; eletrocorticografia

The authors report the surgical management of 32 patients with medically intractable seizures. In all cases the epileptiform focus present in the temporal region was demonstrated by electroencephalography. Our report was made up of 14 male patients and 18 female patients. Their ages ranged from 9 to 62 years. The material was divided into two groups. The first, with eighteen patients with cerebral lesion (like gliomas, arteriovenous malformation, epidermoid tumor) demonstrated on the CT scan and MR imaging underwent to lesion resection: in some cases with adjacent irritative area (guided by electrocorticography) out of eloquent zone, the removal of this irritative area was done. The second, with fourteen patients without cerebral expansive lesion; the MR imaging showed mesial temporal sclerosis in eight cases; all the patients of this group underwent to temporal lobectomy; the histopatologic exam showed temporal sclerosis in nine cases and normal brain in five. The postoperative follow-up showed better results in the cases with expansive cerebral lesion (83.4% seizure free) than the cases without that lesion (71.4% seizure free).

epilepsy; temporal lobe; surgery; electrocorticography

Epilepsia do lobo temporal: tratamento cirúrgico

Temporal lobe epilepsy: surgical treatment

Aziz Rassi Neto; Carlos J. Reis de Campos; Mauro Muszkat; Fernando P. Ferraz

Departamento de Neurologia e Neurocirurgia da Universidade Federal de São Paulo-Escola Paulista de Medicina

RESUMO

Os autores apresentam 32 pacientes com crises epilépticas não controladas ou intratáveis mesmo fazendo uso de medicamentos em doses adequadas. O eletrencefalograma mostrou descargas paroxísticas focais na região temporal em todos os casos. O material foi dividido em dois grupos. O primeiro é composto de 18 pacientes em que os exames por neuroimagem (ressonância magnética e tomografia computadorizada craniana) mostraram imagens compatíveis com lesões expansivas cerebrais (como gliomas, malformações artério-venosas, tumor epidermóide); foi realizada exérese da lesão em todos os casos, associada à área irritativa adjacente que foi identificada pela eletrocorticografia intraoperatória, em seis casos; só foi possível a exérese dessas áreas irritativas nos casos em que elas se localizavam em zonas não eloquentes. O segundo é composto de 14 pacientes nos quais a ressonância magnética não mostrou imagem compatível com processo expansivo cerebral; o exame histopatológico mostrou esclerose mesial temporal em nove casos e cérebro normal em cinco; todos os casos deste grupo foram submetidos a lobectomia temporal. Observamos que os casos com lesões expansivas cerebrais apresentaram melhor evolução em relação ao controle das crises epilépticas do que os casos sem estas lesões, pois 15 (83,4%) dos 18 casos do primeiro grupo evoluíram sem crises e 10 (71,4%) dos 14 casos do segundo grupo também evoluíram sem crises após a cirurgia.

Palavras-chave: epilepsia, lobo temporal, cirurgia, eletrocorticografia.

ABSTRACT

The authors report the surgical management of 32 patients with medically intractable seizures. In all cases the epileptiform focus present in the temporal region was demonstrated by electroencephalography. Our report was made up of 14 male patients and 18 female patients. Their ages ranged from 9 to 62 years. The material was divided into two groups. The first, with eighteen patients with cerebral lesion (like gliomas, arteriovenous malformation, epidermoid tumor) demonstrated on the CT scan and MR imaging underwent to lesion resection: in some cases with adjacent irritative area (guided by electrocorticography) out of eloquent zone, the removal of this irritative area was done. The second, with fourteen patients without cerebral expansive lesion; the MR imaging showed mesial temporal sclerosis in eight cases; all the patients of this group underwent to temporal lobectomy; the histopatologic exam showed temporal sclerosis in nine cases and normal brain in five. The postoperative follow-up showed better results in the cases with expansive cerebral lesion (83.4% seizure free) than the cases without that lesion (71.4% seizure free).

Key words: epilepsy, temporal lobe, surgery, electrocorticography.

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Aceite: 3-julho-1996.

Dr. Aziz Rassi Neto - Rua Jacurici 129/112 - 01453-030 São Paulo SP - Brasil.

1. Babb TL, Brow WJ. Pathological findings in epilepsy. In Engel J Jr (ed). Surgical treatment of the epilepsies. New York: Raven Press, 1987:511-540.
2. Bergen D, Bleck T, Ramsey R, Ristanovic R, Smith M, Whisler WW. Magnetic resonance imaging as a sensitive and specif predictor of neoplasms removed for intractable epilepsy. Epilepsia 1989;30:318-321.
3. Blume WT, Girvin JP, Kaufmann JC. Childhood brain tumors presenting as chronic uncontrolled focal seizure disorders. Ann Neurol 1982;12:538-541.
4. Boon PA, Williamson PD, Fried I, Spencer DD, Novelly RA, Spencer SS, Mattson RH. Intracranial, intraaxial, space-occupying lesions in patients with intractable partial seizures: an anatomoclinical, neuropsychological, and surgical correlation. Epilepsia 1991;32:467-476.
5. Bourgeois BFD. General concepts of medical intractability. In: Luders HO, (ed). Epilepsy surgery. New York: Raven Press, 1992:77-81.
6 Crandall PR Cortical resections. In Engel J Jr, (ed). Surgical treatment of the epilepsies. New York; Raven Press, 1987:377- 403.
7. Falconer MA, Cavanagh JB. Clinico-pathological considerations of temporal lobe epilepsy due to small focal lesions: a study of cases submitted to operation. Brain 1959;82:484-504.
8. Fried I, Cascino G. Lesional surgery. In Engel J Jr., (ed). Surgical treatment of the epilepsies. New York: Raven Press, 1993:501-509.
9. Goldring S, Greg one EM. Experience with lesions that mimic gliomas in patients presenting with a chronic seizure disorder. Clin Neurosurg, 1986;3:43-69.
10. Goldring S, Rich K, Picker S. Experience with gliomas in patients presenting with a chronic seizure disorder. Clin Neurosurg 1986;2:15-69.
11. Hansebout RR. Surgery of epilepsy: current technique of cortical resection. In Schimideck HH, Sweet WH (eds). Operative neurosurgical techiques. New York: Grune & Stratum, 1982:963-979.
12. Heinz ER, Cram B J, Radke RA, Burger PC, Friedman AH, Djang WT, Wilkinson WE. MR imaging in patients with temporal lobe seizures: correlation of results with pathologic findings. AJR, 1990;155:581-586.
13. Jooma R, Yeh H, Privetera MD, Gartner M. Lesionectomy versus electrophysiologically guided resection for temporal lobe tumors manifesting with complex partial seizures. J Neurosurg 1995;83:231 -236.
14. Kirkpatrick PJ, Honavar M, J anota I, Polkey CE. Control of temporal lobe epilepsy following en bloc resection of low-grade tumors. J Neurosurg, 1993;78:19-25.
15. Lévesque MF, Nakasato N, Vinters HV, Babb TL. Surgical treatment of limbic epilepsy associated with extrahippocampal lesions: the problem of dual pathology. J Neurosurg 1991:75:364-370.
16. Longo PW, Pupo PP, Pazzanese O, Lemmi O, Pimenta AM. A eletrocorticografia como meio de orientação na terapêutica cirúrgica da epilepsia. Arq Neuropsiquiatr 1952;10:365-373.
17. Niemeyer P. The transventricular amygdalo hippocampectomy in temporal lobe epilepsy. In Baldwin, M, Bailey P, (eds). Temporal lobe epilepsy. Springfield: Thomas, 1958:461-482.
18. Penfield W, Erickson TC, Tarlov I. Relation of intracranial tumors and symptomatic epilepsy. Arch Neurol Psychiatry 1940;44:300-315.
19. Penfiled W, Flanigin H. Surgical therapy of temporal lobe seizures. Arch Neurol Psychiatry 1950:64:491-500.
20. Pilcher WH, Silbergeld DL, Berger MS, Ojemann GA. Intraoperative electrocorticography during tumor resection: impact on seizure outcome in patients with gangliogliomas. J Neurosurg 1993;78:891-902.
21. Rasmussen T. Surgery of epilepsy associated with brain tumors. Adv. Neurol, 1975;8:227-239.
22. Rich KM, Goldring S, Gado M. Computed tomography in chronic seizure disorder caused by glioma. Arch. Neurol 1985;42:26-27.
23. Spencer DD, Inserni J. Temporal lobectomy. In Luders, HO (eds). Epilepsy surgery. New York: Raven Press, 1991:533-345.
24. Spencer DD, Spencer SS, Mattson RH, Williamson PD. Intracerebral masses in patients with intractable partial epilepsy. Neurology 1984;34:432-436.
25. Taylor DC. One hundred years of epilepsy surgery: Sir Victor Horsley contribution. In Engel J Jr. (ed). Surgical treatment of epilepsies. New York: Raven Press, 1987:7-11.
26. Walczak TS. Anterior temporal lobectomy for complex patial seizures: evaluation, results, and long-term follow in 100 cases. Neurology 1990;40:413-418.
27. Wieser HG. Selective amygdalo-hippocampectomy for temporal lobe epilepsy. Epilepsia 1988;29:100-113.
28. Wieser HG, Yasargil MG. Selective amygdalo hippocampectomy as a surgical treatment of mesiobasal limbic epilepsy. Surg Neurol 1982;17:445-457.
29. Yeh HS, Tew JM Jr. Gartner M. Seizure control after surgery on cerebral arteriovenous malformations. J. Neurosurg 1993;78:12-18.

Datas de Publicação

Publicação nesta coleção
12 Nov 2010
Data do Fascículo
Dez 1996

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

[1] 1. Babb TL, Brow WJ. Pathological findings in epilepsy. In Engel J Jr (ed). Surgical treatment of the epilepsies. New York: Raven Press, 1987:511-540.

[2] 2. Bergen D, Bleck T, Ramsey R, Ristanovic R, Smith M, Whisler WW. Magnetic resonance imaging as a sensitive and specif predictor of neoplasms removed for intractable epilepsy. Epilepsia 1989;30:318-321.

[3] 3. Blume WT, Girvin JP, Kaufmann JC. Childhood brain tumors presenting as chronic uncontrolled focal seizure disorders. Ann Neurol 1982;12:538-541.

[4] 4. Boon PA, Williamson PD, Fried I, Spencer DD, Novelly RA, Spencer SS, Mattson RH. Intracranial, intraaxial, space-occupying lesions in patients with intractable partial seizures: an anatomoclinical, neuropsychological, and surgical correlation. Epilepsia 1991;32:467-476.

[5] 5. Bourgeois BFD. General concepts of medical intractability. In: Luders HO, (ed). Epilepsy surgery. New York: Raven Press, 1992:77-81.

[6] 6 Crandall PR Cortical resections. In Engel J Jr, (ed). Surgical treatment of the epilepsies. New York; Raven Press, 1987:377- 403.

[7] 7. Falconer MA, Cavanagh JB. Clinico-pathological considerations of temporal lobe epilepsy due to small focal lesions: a study of cases submitted to operation. Brain 1959;82:484-504.

[8] 8. Fried I, Cascino G. Lesional surgery. In Engel J Jr., (ed). Surgical treatment of the epilepsies. New York: Raven Press, 1993:501-509.

[9] 9. Goldring S, Greg one EM. Experience with lesions that mimic gliomas in patients presenting with a chronic seizure disorder. Clin Neurosurg, 1986;3:43-69.

[10] 10. Goldring S, Rich K, Picker S. Experience with gliomas in patients presenting with a chronic seizure disorder. Clin Neurosurg 1986;2:15-69.

[11] 11. Hansebout RR. Surgery of epilepsy: current technique of cortical resection. In Schimideck HH, Sweet WH (eds). Operative neurosurgical techiques. New York: Grune & Stratum, 1982:963-979.

[12] 12. Heinz ER, Cram B J, Radke RA, Burger PC, Friedman AH, Djang WT, Wilkinson WE. MR imaging in patients with temporal lobe seizures: correlation of results with pathologic findings. AJR, 1990;155:581-586.

[13] 13. Jooma R, Yeh H, Privetera MD, Gartner M. Lesionectomy versus electrophysiologically guided resection for temporal lobe tumors manifesting with complex partial seizures. J Neurosurg 1995;83:231 -236.

[14] 14. Kirkpatrick PJ, Honavar M, J anota I, Polkey CE. Control of temporal lobe epilepsy following en bloc resection of low-grade tumors. J Neurosurg, 1993;78:19-25.

[15] 15. Lévesque MF, Nakasato N, Vinters HV, Babb TL. Surgical treatment of limbic epilepsy associated with extrahippocampal lesions: the problem of dual pathology. J Neurosurg 1991:75:364-370.

[16] 16. Longo PW, Pupo PP, Pazzanese O, Lemmi O, Pimenta AM. A eletrocorticografia como meio de orientação na terapêutica cirúrgica da epilepsia. Arq Neuropsiquiatr 1952;10:365-373.

[17] 17. Niemeyer P. The transventricular amygdalo hippocampectomy in temporal lobe epilepsy. In Baldwin, M, Bailey P, (eds). Temporal lobe epilepsy. Springfield: Thomas, 1958:461-482.

[18] 18. Penfield W, Erickson TC, Tarlov I. Relation of intracranial tumors and symptomatic epilepsy. Arch Neurol Psychiatry 1940;44:300-315.

[19] 19. Penfiled W, Flanigin H. Surgical therapy of temporal lobe seizures. Arch Neurol Psychiatry 1950:64:491-500.

[20] 20. Pilcher WH, Silbergeld DL, Berger MS, Ojemann GA. Intraoperative electrocorticography during tumor resection: impact on seizure outcome in patients with gangliogliomas. J Neurosurg 1993;78:891-902.

[21] 21. Rasmussen T. Surgery of epilepsy associated with brain tumors. Adv. Neurol, 1975;8:227-239.

[22] 22. Rich KM, Goldring S, Gado M. Computed tomography in chronic seizure disorder caused by glioma. Arch. Neurol 1985;42:26-27.

[23] 23. Spencer DD, Inserni J. Temporal lobectomy. In Luders, HO (eds). Epilepsy surgery. New York: Raven Press, 1991:533-345.

[24] 24. Spencer DD, Spencer SS, Mattson RH, Williamson PD. Intracerebral masses in patients with intractable partial epilepsy. Neurology 1984;34:432-436.

[25] 25. Taylor DC. One hundred years of epilepsy surgery: Sir Victor Horsley contribution. In Engel J Jr. (ed). Surgical treatment of epilepsies. New York: Raven Press, 1987:7-11.

[26] 26. Walczak TS. Anterior temporal lobectomy for complex patial seizures: evaluation, results, and long-term follow in 100 cases. Neurology 1990;40:413-418.

[27] 27. Wieser HG. Selective amygdalo-hippocampectomy for temporal lobe epilepsy. Epilepsia 1988;29:100-113.

[28] 28. Wieser HG, Yasargil MG. Selective amygdalo hippocampectomy as a surgical treatment of mesiobasal limbic epilepsy. Surg Neurol 1982;17:445-457.

[29] 29. Yeh HS, Tew JM Jr. Gartner M. Seizure control after surgery on cerebral arteriovenous malformations. J. Neurosurg 1993;78:12-18.