Retrospective Study
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Dec 6, 2021; 9(34): 10518-10529
Published online Dec 6, 2021. doi: 10.12998/wjcc.v9.i34.10518
Resection of bilateral occipital lobe lesions during a single operation as a treatment for bilateral occipital lobe epilepsy
Yan-En Lyu, Xiao-Fei Xu, Shuang Dai, Min Feng, Shao-Ping Shen, Guo-Zhen Zhang, Hong-Yan Ju, Yao Wang, Xiao-Bo Dong, Bin Xu
Yan-En Lyu, Min Feng, Yao Wang, Seventh Clinical School of Medicine, Beijing University of Chinese Medicine, Tongchuan 727031, Shaanxi Province, China
Yan-En Lyu, Shuang Dai, Shao-Ping Shen, Guo-Zhen Zhang, Hong-Yan Ju, Xiao-Bo Dong, Bin Xu, Neurosurgery and Epilepsy Centre, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing 100700, China
Xiao-Fei Xu, Neurosurgery and Epilepsy Centre, General Hospital of Beijing Military Commanding Regain, Beijing 100700, China
Author contributions: Lyu YE and Xu XF contributed conception, design and final approval of manuscript; Lyu YE, Xu XF, Dai S, Shen SP and Dong XB performed the research; Xu B, Zhang GZ and Ju HY contributed provision of study materials or patients; Lyu YE, Xu XF, Feng M and Wang Y contributed data collection and analysis; Lyu YE, Xu XF, Dai S, Feng M and Wang Y contributed manuscript writing.
Institutional review board statement: The ethics committee of Beijing university of Chinese medicine dongzhimen hospital approved this study. All patients provided written consent for surgery after being informed of the potential benefits and risks.
Informed consent statement: Informed consent for inclusion was waived because the analysis was retrospective.
Conflict-of-interest statement: We have no financial relationships to disclose.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Xiao-Fei Xu, MD, Doctor, Neurosurgery and Epilepsy Centre, General Hospital of Beijing Military Commanding Regain, No. 5 Nancangmen, Dongcheng District, Beijing 100700, China. xuxiaofei0002@126.com
Received: June 7, 2021
Peer-review started: June 7, 2021
First decision: June 25, 2021
Revised: August 9, 2021
Accepted: October 6, 2021
Article in press: October 6, 2021
Published online: December 6, 2021
Processing time: 176 Days and 3.3 Hours
Abstract
BACKGROUND

Neurosurgical treatment of severe bilateral occipital lobe epilepsy usually involves two operations several mos apart.

AIM

To evaluate surgical resection of bilateral occipital lobe lesions during a single operation as a treatment for bilateral occipital lobe epilepsy.

METHODS

This retrospective case series included patients with drug-refractory bilateral occipital lobe epilepsy treated surgically between March 2006 and November 2015.

RESULTS

Preoperative evaluation included scalp video-electroencephalography (EEG), magnetic resonance imaging, and PET-CT. During surgery (bilateral occipital craniotomy), epileptic foci and important functional areas were identified by EEG (intracranial cortical electrodes) and cortical functional mapping, respectively. Patients were followed up for at least 5 years to evaluate treatment outcome (Engel grade) and visual function. The 20 patients (12 males) were aged 4-30 years (median age, 12 years). Time since onset was 3-20 years (median, 8 years), and episode frequency was 4-270/mo (median, 15/mo). Common manifestations were elementary visual hallucinations (65.0%), flashing lights (30.0%), blurred vision (20.0%) and visual field defects (20.0%). Most patients were free of disabling seizures (Engel grade I) postoperatively (18/20, 90.0%) and at 1 year (18/20, 90.0%), 3 years (17/20, 85.0%) and ≥ 5 years (17/20, 85.0%). No patients were classified Engel grade IV (no worthwhile improvement). After surgery, there was no change in visual function in 13/20 (65.0%), development of a new visual field defect in 3/20 (15.0%), and worsening of a preexisting defect in 4/20 (20.0%).

CONCLUSION

Resection of bilateral occipital lobe lesions during a single operation may be applicable in bilateral occipital lobe epilepsy.

Keywords: Drug-resistant epilepsy; Occipital lobe epilepsy; Bilateral lesions; One-stage surgery; Treatment outcome; Visual fields

Core Tip: The main finding of this case series of patients treated surgically for bilateral occipital lobe epilepsy is that bilateral resection during a single operation was a very effective treatment, with the vast majority of patients (85%) free of disabling seizures at 5 years after neurosurgery and no patients exhibiting no worthwhile improvement. Two interesting additional observations in this study were a reduction in the number and sizes of facial sebaceous adenoma lesions in one patient and the resolution of drug-resistant psoriatic lesions in another patient after surgery.