• A Chris Heller, Rachelle V Padilla, and Adam N Mamelak.
• Epilepsy and Brain Mapping Program, Huntington Memorial Hospital, Pasadena, CA 91105, USA. aheller@usc.edu
• Surg Neurol. 2009 Jun 1;71(6):631-7, discussion 637.

BackgroundSurgery 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.MethodsAll 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.ResultsDuring 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.ConclusionsThere 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.

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