{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,24]],"date-time":"2026-10-24T01:15:48Z","timestamp":1792804548094,"version":"4.5.0"},"reference-count":23,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,1,1]]},"abstract":"\nOBJECTIVE<\/jats:title>\nReoperation may be an option for select patients with unsatisfactory seizure control after their first epilepsy surgery. The aim of this study was to describe the seizure-free outcome and safety of repeated epilepsy surgery in our tertiary referral center.<\/jats:p>\n<\/jats:sec>\n\nMETHODS<\/jats:title>\nThirty-eight patients with focal refractory epilepsy, who underwent repeated epilepsy surgeries and had a minimum follow-up time of 12 months after reoperation, were included. Systematic reevaluation, including comprehensive neuroimaging and noninvasive (n = 38) and invasive (n = 25, 66%) video-electroencephalography monitoring, was performed. Multimodal 3D resection maps were created for individual patients to allow personalized reoperation.<\/jats:p>\n<\/jats:sec>\n\nRESULTS<\/jats:title>\nThe median time between the first operation and reoperation was 74 months (range 5\u2013324 months). The median age at reoperation was 34 years (range 1\u201374 years), and the median follow-up was 38 months (range 13\u2013142 months). Repeat MRI after the first epilepsy surgery showed an epileptogenic lesion in 24 patients (63%). The reoperation was temporal in 18 patients (47%), extratemporal in 9 (24%), and multilobar in 11 (29%). The reoperation was left hemispheric in 24 patients (63%), close to eloquent cortex in 19 (50%), and distant from the initial resection in 8 (21%). Following reoperation, 27 patients (71%) became seizure free (Engel class I), while 11 (29%) continued to have seizures. There were trends toward better outcome in temporal lobe epilepsy and for unilobar resections adjacent to the initial surgery, but there was no difference between MRI lesional and nonlesional patients. In all subgroups, Engel class I outcome was at least 50%. Perioperative complications occurred in 4 patients (11%), with no fatalities.<\/jats:p>\n<\/jats:sec>\n\nCONCLUSIONS<\/jats:title>\nReoperation for refractory focal epilepsy is an effective and safe option in patients with persistent or recurrent seizures after initial epilepsy surgery. A thorough presurgical reevaluation is essential for favorable outcome.<\/jats:p>\n<\/jats:sec>","DOI":"10.3171\/2022.4.jns212753","type":"journal-article","created":{"date-parts":[[2022,7,8]],"date-time":"2022-07-08T19:27:06Z","timestamp":1657308426000},"page":"9-18","source":"Crossref","is-referenced-by-count":11,"title":["Seizure-free outcome and safety of repeated epilepsy surgery for persistent or recurrent seizures"],"prefix":"10.3171","volume":"138","author":[{"given":"Mathias","family":"Kunz","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, University Hospital of the Ludwig-Maximilians-University of Munich;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philipp","family":"Karschnia","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University Hospital of the Ludwig-Maximilians-University of Munich;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ingo","family":"Borggraefe","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Division of Pediatric Neurology and Developmental Medicine, University Hospital of the Ludwig-Maximilians-University of Munich; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Soheyl","family":"Noachtar","sequence":"additional","affiliation":[{"name":"Department of Neurology, Epilepsy Center, University Hospital of the Ludwig-Maximilians-University of Munich, Munich, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joerg-Christian","family":"Tonn","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University Hospital of the Ludwig-Maximilians-University of Munich;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian","family":"Vollmar","sequence":"additional","affiliation":[{"name":"Department of Neurology, Epilepsy Center, University Hospital of the Ludwig-Maximilians-University of Munich, Munich, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"11","key":"b1","series-title":"Lancet Neurol","doi-asserted-by":"publisher","first-page":"1114","DOI":"10.1016\/S1474-4422(14)70156-5","article-title":"Epilepsy surgery in children and adults","volume":"13","author":"Ryvlin P","year":"2014","unstructured":"Ryvlin P, Cross JH, Rheims S. 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