Additional hippocampectomy in the surgical management of intractable temporal lobe epilepsy associated with glioneuronal tumor

Takato Morioka, Kimiaki Hashiguchi, Shinji Nagata, Yasushi Miyagi, Fumiaki Yoshida, Tadahisa Shono, Futoshi Mihara, Hirofumi Koga, Tomio Sasaki

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29 Citations (Scopus)

Abstract

In surgery for epileptogenic glioneuronal tumor in the temporal lobe, whether additional hippocampectomy is needed remains in dispute. We retrospectively analysed clinical profile and seizure outcome in a consecutive series of six patients, paying special attention to pathophysiologic conditions in the ipsilateral hippocampus. Long-term video electroencephalography (EEG) monitoring showed attenuation of background activity, followed by ictal discharges in the ipsilateral temporal region in five cases. 18Fluorodeoxyglucose-positron emission tomography (FDG-PET) in five cases showed hypometabolism in the ipsilateral medial temporal lobe. Intraoperative electrocorticography (ECoG) after removal of the tumor revealed frequent paroxysmal activity or electrographic seizure activity on the hippocampus in five cases. A high incidence of hippocampal pathology, such as hippocampal sclerosis in four cases and dysgenesis in one case, was demonstrated. Five patients who underwent additional hippocampectomy along with resection of the tumor became completely seizure-free. Our findings indicated a proclivity for the epileptogenic zone to encompass the medial structures and for hippocampal pathology to be present even when no direct medial tumor involvement was identified. Thus, it is conceivable that removal of the hippocampus with the guidance of pre- and intraoperative multimodal examinations, in addition to resection of the tumor, may be recommended to achieve 'complete' freedom from seizures.

Original languageEnglish
Pages (from-to)807-815
Number of pages9
JournalNeurological Research
Volume29
Issue number8
DOIs
Publication statusPublished - Dec 2007

All Science Journal Classification (ASJC) codes

  • Neurology
  • Clinical Neurology

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    Morioka, T., Hashiguchi, K., Nagata, S., Miyagi, Y., Yoshida, F., Shono, T., Mihara, F., Koga, H., & Sasaki, T. (2007). Additional hippocampectomy in the surgical management of intractable temporal lobe epilepsy associated with glioneuronal tumor. Neurological Research, 29(8), 807-815. https://doi.org/10.1179/016164107X223566