Literature review of case series describing the outcome of epilepsy surgical re-operations.
Overall, 3.8-14 % of all patients who had resective epilepsy surgery underwent a second operation. A total of 402 reoperated patients were included. Reoperation was performed in average between 2 and 5.5 years after the first surgery. 36.6 % of all patients were seizure-free with a minimal follow-up of 6 months to 4 years after the second operation. Postsurgical complications were observed in 13.5 % and mainly consisted of visual field defects and, less frequently, of hemiparesis. The causes of failed first epilepsy surgery were heterogeneous and included incorrect localization or incomplete resection of the seizure focus, presence of additional seizure foci or progression of the underlying disease. Some features appear to indicate successful reoperation, such as concordance of postsurgical imaging and electroclinical findings as well as absence of brain trauma and cerebral infection prior to epilepsy onset.
Reoperation after thorough assessment of all available clinical, imaging and EEG findings can be an efficacious and reasonably safe treatment option which can achieve sustained seizure control after failed resective epilepsy surgery.