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The Korean Journal of Pathology 1996;30(5): 388-395.
Pathologic Analysis of 39 Cases of Epilepsy Surgery.
Young Mee Cho, Joong Koo Kang, Youn Mee Hwang, Jung Kyo Lee, Ghee Young Choe
1Department of Pathology, Asan Medical Center, University of Ulsan, Seoul, Korea.
2Department of Neurology, Asan Medical Center, University of Ulsan, Seoul, Korea.
3Department of Neurosurgery, Asan Medical Center, University of Ulsan, Seoul, Korea.
4Department of Pathology, Seoul City Boramae Hospital, Seoul National University College of Medicine, 110-744 Seoul, Korea.
ABSTRACT
Pharmacologic therapy is still the primary management for epilpsy; however, surgical treatment is a reasonable therapeutic option for patients suffering from medically intractable seizures, especially temporal lobe epilepsy having a documented unilateral epileptogenic area. Thirty nine patients with pharmaco-resistant complex partial seizures underwent anterior temporal lobectomy and hippocampectomy in 38 cases and frontal cortisectomy in one case. On pathological examination, hippocampal sclerosis was a predominent pathologic finding and was identified in 18 cases. Other non-neoplastic lesions consisted of 5 cases of vascular lesions(2 cavernous angiomas, 2 arteriovenous malformations and 1 angiomatosis), 3 cases of fibrous nodule, 2 cases of cicatrical changes of cerebral cortex, and 1 case of parasitic infection. Neoplasms including two cases of oligodendroglioma and one case of anaplastic astrocytoma were also noted. In seven cases, there was no detectable lesion on gross and microscopic examination. On post-operative follow-up, seizures were completely terminated in most cases(31 cases, 79%). The rest of the patients also displayed marked alleviation of symptoms. The seizures tended to recur more aften among the patients with neoplasm or no pathologically detectable lesion. In order to detect any minute pathological lesion, thorough gross and microcsopic examinations are considered to be essential.
Key Words: Temporal lobe epilepsy; Epilepsy surgery; Pathology
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