BACKGROUND: Surgery is the most effective means of eliminating or reducing seizures in cases of medically refractory epilepsy. As elective surgery, however, there is little tolerance for complications. We have reviewed the early operative experience of a single epilepsy surgeon to identify the presence or absence of a surgical learning curve. METHODS: All phase II (diagnostic) and phase III (therapeutic) procedures for epilepsy surgery during the surgeon's first 8 years of practice were retrospectively reviewed. Complications were analyzed and subdivided into major or minor. Trends in complication rates were evaluated. RESULTS: During the first 8 years, there were 96 phase II and 94 phase III cases. Complications occurred in 26 (14%) of 190 cases, including 16 major (8%) and 10 minor (5%) complications. There was a decline in both the number and severity of complications associated with temporal lobectomy over time. Complications involving subdural grids shifted, over time, from those attributed to surgical technique or experience to those felt to be unavoidable risks of the procedure itself. Over time there was a decline in the proportion of major vs minor complications, but the overall complication rate remained stable. CONCLUSIONS: There appears to be a surgical learning curve for epilepsy surgery involving complications associated with removal of medial temporal lobe structures, which lessen as the surgeon's experience increases.
BACKGROUND: Surgery is the most effective means of eliminating or reducing seizures in cases of medically refractory epilepsy. As elective surgery, however, there is little tolerance for complications. We have reviewed the early operative experience of a single epilepsy surgeon to identify the presence or absence of a surgical learning curve. METHODS: All phase II (diagnostic) and phase III (therapeutic) procedures for epilepsy surgery during the surgeon's first 8 years of practice were retrospectively reviewed. Complications were analyzed and subdivided into major or minor. Trends in complication rates were evaluated. RESULTS: During the first 8 years, there were 96 phase II and 94 phase III cases. Complications occurred in 26 (14%) of 190 cases, including 16 major (8%) and 10 minor (5%) complications. There was a decline in both the number and severity of complications associated with temporal lobectomy over time. Complications involving subdural grids shifted, over time, from those attributed to surgical technique or experience to those felt to be unavoidable risks of the procedure itself. Over time there was a decline in the proportion of major vs minor complications, but the overall complication rate remained stable. CONCLUSIONS: There appears to be a surgical learning curve for epilepsy surgery involving complications associated with removal of medial temporal lobe structures, which lessen as the surgeon's experience increases.
Authors: M Hemb; T R Velasco; M S Parnes; J Y Wu; J T Lerner; J H Matsumoto; S Yudovin; W D Shields; R Sankar; N Salamon; H V Vinters; G W Mathern Journal: Neurology Date: 2010-04-28 Impact factor: 9.910
Authors: Aria Fallah; Evan Lewis; George M Ibrahim; Olivia Kola; Chi-Hong Tseng; William B Harris; Jia-Shu Chen; Kao-Min Lin; Li-Xin Cai; Qing-Zhu Liu; Jiu-Luan Lin; Wen-Jing Zhou; Gary W Mathern; Matthew D Smyth; Brent R O'Neill; Roy W R Dudley; John Ragheb; Sanjiv Bhatia; Daniel Delev; Georgia Ramantani; Josef Zentner; Anthony C Wang; Christian Dorfer; Martha Feucht; Thomas Czech; Robert J Bollo; Galymzhan Issabekov; Hongwei Zhu; Mary Connolly; Paul Steinbok; Jian-Guo Zhang; Kai Zhang; Eveline Teresa Hidalgo; Howard L Weiner; Lily Wong-Kisiel; Samuel Lapalme-Remis; Manjari Tripathi; Poodipedi Sarat Chandra; Walter Hader; Feng-Peng Wang; Yi Yao; Pierre-Olivier Champagne; Tristan Brunette-Clément; Qiang Guo; Shao-Chun Li; Marcelo Budke; Maria Angeles Pérez-Jiménez; Christian Raftopoulos; Patrice Finet; Pauline Michel; Karl Schaller; Martin N Stienen; Valentina Baro; Christian Cantillano Malone; Juan Pociecha; Noelia Chamorro; Valeria L Muro; Marec von Lehe; Silvia Vieker; Chima Oluigbo; William D Gaillard; Mashael Al-Khateeb; Faisal Al Otaibi; Niklaus Krayenbühl; Jeffrey Bolton; Phillip L Pearl; Alexander G Weil Journal: Epilepsia Date: 2021-09-12 Impact factor: 6.740