Resection Surgery in Patients with Perirolandic Epilepsy
Authors:
M. Brázdil 1; R. Kuba 1; J. Chrastina 2; Z. Novák 2; J. Hemza 2; M. Hermanová 3; I. Tyrlíková 1; M. Ryzí 4; H. Ošlejšková 4; B. Slaná 3; M. Mikl 1; M. Pažourková 5; I. Rektor 1
Authors‘ workplace:
Centrum pro epilepsie Brno
I. neurologická klinika LF MU a FN u sv. Anny v Brně
1; Centrum pro epilepsie Brno
Neurochirurgická klinika LF MU a FN u sv. Anny v Brně
2; Centrum pro epilepsie Brno
Patologicko-anatomický ústav LF MU a FN u sv. Anny v Brně
3; Centrum pro epilepsie Brno
Klinika dětské neurologie LF MU a FN Brno
4; Centrum pro epilepsie Brno
Klinika zobrazovacích metod LF MU a FN u sv. Anny v Brně
5
Published in:
Cesk Slov Neurol N 2011; 74/107(1): 43-48
Category:
Original Paper
Overview
Purpose:
To assess the efficacy and safety of resective epilepsy surgery in unselected patients with both lesional and nonlesional perirolandic epilepsy.
Methods:
A group of 15 consecutive patients who had undergone perirolandic cortical resection (without multiple subpial transections) for intractable epilepsy between 1995 and 2009 was identified. This number represented 5.2% of all resective epilepsy surgeries at the Brno Epilepsy Centre. A detailed analysis was performed in 13 patients with a minimum postoperative follow-up 2 years (average 7 years). The average age at the time of surgery was 27 years (range 13–50 years). Pre-operative MRI disclosed restricted lesion in the perirolandic cortex in nine patients; in four subjects repeated and thorough neuro-imaging investigation failed to identify any structural pathology. Most patients underwent pre-operative chronic invasive video-EEG (70%). Advanced neuro-imaging (including fMRI, subtraction ictal single photon emission tomography coregistered to MRI, magnetic resonance spectroscopy, voxel-based morphometry, etc.) was progressively introduced into the pre-operative set-up and completed whenever possible.
Results:
At the last recorded follow-up, nine patients remained seizure-free – Engel class I (70%); two patients were class II (15%), and two patients class IV (15%). Postoperative neurological deficits were present in four patients (30%). In all these cases, intensive rehabilitation resulted in significant improvement, while a mild functional deficit still remained in two patients (15%).
Conclusion:
Resective epilepsy surgery is an effective and relatively safe therapeutic strategy in properly selected patients with intractable perirolandic epilepsy. This conclusion holds for both lesional and nonlesional cases.
Key words:
central region – epilepsy surgery – intractable epilepsy – focal cortical dysplasia – neuro-imaging
Sources
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Paediatric neurology Neurosurgery NeurologyArticle was published in
Czech and Slovak Neurology and Neurosurgery
2011 Issue 1
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