Temporoparietooccipital and parietooccipital disconnection in patients with intractable epilepsy

ABSTRACT

Objective: To assess the surgical techniques and surgical outcomes of temporoparietooccipital and parietooccipital disconnection. Methods: The authors conducted a retrospective review of clinical, neuropsychological, EEG, imaging data in 16 patients with intractable epilepsy who underwent temporoparietooccipital and parietooccipital disconnection between April 2008 and October 2011. Of the 16 cases, 12 were males and 4 were females. The age of seizure onset was from 0.1 to 27 years (average 6.6) and disease duration of 0.1 to 18 years (average 7.5). The surgery was performed between the age of 3 and 37 years (average 14.1). Nine patients underwent temporoparietooccipital disconnection, 5 patients parietooccipital disconnection and 2 patient parietooccipital disconnection and temporal lobotomy. Results: After a mean follow-up of 1.6 years (range 0.5–3.9 years), 13 patients (81%) were seizure free, 1 patient had Engel Class II seizure outcome and 2 patient had Engel class III outcome. Two patients exhibited severe brain swelling and one patients had second resective operation with good recovery. None of the patients developed new motor defi cits postoperatively and there was no mortality. Conclusion: Temporoparietooccipital and parietooccipital is a safety and effective epilepsy surgery procedure for patients with epileptic zone localization to the posterior quadrant on one side. The results of surgical disconnection for posterior quadrantic epilepsy have yielded excellent seizure outcomes in 81% of the patients, with no mortality or major morbidity.