Epilepsy surgery in children and young adults
Mark V. Larkins, MD
Department of Neurological Surgery, The Cleveland Clinic Foundation, One Clinic Center, 9500 Euclid Avenue, Cleveland, Ohio 44195
Joseph F. Hahn, MD
SINCE 1975, a number of investigators have studied the usefulness of surgery, particularly temporal lobectomy, as a treatment for epilepsy during childhood and adolescence. Davidson and Falconer (1975) reviewed the outcome of temporal lobectomy as a means of managing temporal lobe epilepsy in 40 children. Surgically, all patients underwent en-bloc resection of temporal lobe with portions of mesial structures. In this series, 58% of nonmass lesion patients (mesial temporal sclerosis) became seizure-free over the long term. These were the best results among patients who also had tumors, hamartomas, and other mass lesions.1,2
In 1978, Goldring described his technique of extra-operative epidural electrocorticography specifically with application to children. Seventeen of 46 patients discussed were children. He records that 70% of the group benefited from surgery (i.e., no seizures, or a significant reduction in incidence of seizures.)3
Green analyzed 28 children who underwent temporal lobectomy between 1949 and 1973. Nine patients had permanent morbidity: one had left hemiparesis, four had upper quadratic hemianopsia, three had non-disabling homonymosus hemianopsia, and one had partial Kluver-Bucy syndrome. Green's study is significant in that it specifically details morbidity.4
The Mayo Clinic review done by Meyer et al5 in 1986 is perhaps one of the most complete syntheses of results from temporal lobectomy to date. These investigators reviewed 50 patients from their Mayo Clinic experience, and found that 54% were seizure free postoperatively, 10% had fewer seizures, and treatment failed in 12%. Forty percent had superior quadrantanopsia postoperatively.
Although the Cleveland Clinic series, which we report here,. . .