Reasons for reoperation after epilepsy surgery: a review based on a complex clinical case with three operations

Abstract

José F Téllez-Zenteno1, Farzad Moien-Afshari1, Lizbeth Hernández-Ronquillo1, Robert Griebel2, Venkat Sadanand21Department of Medicine, Division of Neurology, University of Saskatchewan, Saskatoon, Canada; 2Department of Surgery, Division of Neurosurgery, University of Saskatchewan, Saskatoon, CanadaAbstract: The results of surgical treatment of epileptic seizures have gradually improved in the past decade, approaching 60% to 90% seizure-free outcome in temporal lobe epilepsy and 45% to 66% in extratemporal lobe epilepsy. Unfortunately some patients continue with seizures after epilepsy surgery and the studies have shown that approximately the 3% to 15% of patients with a previous failed surgical procedure are reoperated. Selected patients may be candidates for further surgery, potentially leading to a significant decrease in the frequency and severity of seizures. In patients with intractable partial epilepsy there are many possible factors, alone or in combination, that could be related to the failure of resection. Some of the factors could be genetic or acquired predisposition to epileptogenicity. In this article we report a case with intractable epilepsy that required three interventions to render seizure free. We analyzed our specific case in the light of previous reports on reoperation and enumerate the potential reasons or reoperation that could apply to all patients with failure of an initial procedure.Keywords: intractable epilepsy, reoperation, epilepsy surgery, surgical failure