Not to Wait Too Long After Failed Surgery for Intractable Mesial Temporal Lobe Epilepsy: Results of Reoperation at a Tertiary Hospital.

Aim: To evaluate the causes and risk factors of seizure recurrence, as well as the outcomes of reoperation in patients who did not achieve sufficient seizure control following surgery for mesial temporal lobe epilepsy (MTLE).

Material and methods: We retrospectively reviewed the hospital charts of patients with medically refractory MTLE who were operated between 1990 and 2021.

Results: A total of 240 patients (127 females and 113 males) with medically refractory mesial temporal lobe epilepsy underwent resective epilepsy surgery. Of these, 12 (5%) required reoperation due to seizure recurrence after the initial surgery. Six out of the 12 patients with available seizure outcome data were included in the study. The cause of seizure recurrence in all patients was remnant tissue. The age at reoperation ranged from 17 to 59 years, and the time between the initial and final surgery ranged from 2 to 20 years. The seizure outcome was Engel Class I in all patients, with follow-up periods ranging from 4 to 21 years.

Conclusion: Surgical failure is still prevalent in patients with MTLE, with inadequate resection frequently serving as the primary cause. Reoperation can considerably improve the seizure outcome. Delaying the opportunity for a second surgical intervention should be avoided.