Experience with orbital electrodes in the patients operated on for epilepsy--results of temporofrontal resections.
We introduced the orbital electrodes (Fb-frontobasal) in clinical practice in 1983. Since then we have operated on 112 patients for medically intractable "temporal" epileptic fits. In this series there were 45 patients (40%) with independent focal interictal EEG epileptic abnormalities over frontobasal cortex (with or without independent spiking over interomedial temporal region). In these patients we performed a small temporal lobectomy (with amygdaloectomy and resection of pes hippocampi) (TL) and resection of frontoorbital cortex (FOCR). The surgical results are as follows: There are 75 patients with follow-up one to 5 years. TL and FOCR were performed in 27 patients (36%). In this group seizure-free are 25 (93%) and 2 patients (7%) are much better. In the series of 48 patients examined by sphenoidal electrodes and operated for "temporal" fits (TL) by the same author (R.I.) (follow-up 5-13 years), seizure-free are 38 (79%), much better are 8 (17%) and unchanged are 2 (4%) patients. The difference in proportion of seizure-free patients in these two series is statistically significant (t = 2.53;p less than 0.05). Our results suggest that in some patients suffering with "temporal" seizures a well defined EEG picture suggests a new clinical entity the "temporo-frontal" epilepsy, the surgical treatment of which gives excellent results.