Reoperation of a recurrent temporal lobe epilepsy: a technical case report

The indications for the reoperation of a recurrent temporal lobe epilepsy, the risks, and outcome have not been well documented. The invasive video electroencephalogram (EEG) monitoring and magnetic resonance imaging (MRI) techniques can reveal the residual tissues and their epileptogenic activity so that a reoperation decision can be made. A 30-year-old patient who had recurrent temporal lobe epilepsy and had undergone 2 operations at the same temporal region is presented. After both of these operations, approximately 6 months later, seizures relapsed. Postoperative neuroimaging studies showed residual mesiotemporal tissues at the operative site. The invasive video EEG monitoring revealed epileptogenic activity originating from these residual tissues. After all of these investigations, it was thought that a third operation was indicated, and the patient was operated. Postoperative course was uneventful. No postoperative deficit was observed. Pathological examination was reported as hippocampal sclerosis. He is seizure-free at his third postoperative year. Complete resection of epileptogenic mesiotemporal structures at the first operation can prevent the necessity for reoperation in defined cases. The MRI and invasive video EEG monitoring techniques can reveal the residual tissues and their epileptogenic activity in a recurrent epilepsy case.