gms | German Medical Science

59th Annual Meeting of the German Society of Neurosurgery (DGNC)
3rd Joint Meeting with the Italian Neurosurgical Society (SINch)

German Society of Neurosurgery (DGNC)

1 - 4 June 2008, Würzburg

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Surgical treatment and follow-up after epilepsy surgery for Focal Cortical Dysplasias (FCD) in children

Operative Behandlung und Ergebnisse nach Epilepsiechirurgie bei Fokalen Cortikalen Dysplasien (FCD) bei Kindern

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  • corresponding author M. von Lehe - Klinik für Neurochirurgie, Universitätsklinikum Bonn
  • R. Sassen - Klinik für Epileptologie, Universitätsklinikum Bonn
  • H. Urbach - Klinik für Radiologie, Universitätsklinikum Bonn
  • M. Majores - Institut für Neuropathologie, Universitätsklinikum Bonn
  • H. Clusmann - Klinik für Neurochirurgie, Universitätsklinikum Bonn

Deutsche Gesellschaft für Neurochirurgie. Società Italiana di Neurochirurgia. 59. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e.V. (DGNC), 3. Joint Meeting mit der Italienischen Gesellschaft für Neurochirurgie (SINch). Würzburg, 01.-04.06.2008. Düsseldorf: German Medical Science GMS Publishing House; 2008. DocMO.06.10

The electronic version of this article is the complete one and can be found online at: http://www.egms.de/en/meetings/dgnc2008/08dgnc084.shtml

Published: May 30, 2008

© 2008 von Lehe et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.

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Objective: Focal cortical dysplasia (FCD) are often seen in refractory focal epilepsies, especially in children. Most series concerning surgical therapy in paediatric patients are small or examined inhomogeneous populations. Our aim was to analyze the surgical strategy and the outcome according to the ILAE classification after resection of different types of FCD in children.

Methods: 33 children and adolescents were operated for FCD between 1997 and 2007. All patients were prospectively collected in a data bank. 2 foreign patients were excluded due to a lack of follow-up information. We reviewed pre-operative clinical and neuroradiological findings. Lesions were classified according to Palmini and Lueders (2002). Seizure outcome was classified according to the ILAE classification.

Results: 31 (14 m, 17 f) patients with circumscribed FCD were included, i.e. 13.5% of all 229 children undergoing resective surgery in this time period. All patients revealed a lesion upon pre-operative MRI. 3 patients (9.7%) underwent invasive EEG monitoring with implanted electrodes. 28 patients had extended lesionectomies (14 frontal, 5 parietal, 3 occipital, 5 multilobular, 1 insular), 3 patients underwent standard temporal lobectomy, one patient had additional central MST. Histopathology revealed FCD IIa in 3 cases and FCD IIb in 25 cases, and 3 were other forms of cortical malformation. 5 patients had temporary morbidity (16%), 3 patients showed aggravation of a pre-existing hemiparesis (9.7%), there was no mortality. Mean follow-up was 32 months (range 1-115 months). According to the ILAE-classification (last available outcome) 25 patients were completely seizure free (81% ILAE 1). One patient continued to have auras (3% ILAE 2) and one patients had up to 3 seizure days per year (3% ILAE 3), resulting in 87% of patients with an overall satisfactory seizure control. Less favourable results were achieved in 4 patients (13%, ILAE 4: 4 seizure days per year to 50% reduction of the seizure frequency).

Conclusions: Surgical treatment of drug resistant epilepsy in children and adolescents with FCD is very promising with respect to seizure control. Some degree of calculated temporary and also permanent morbidity has to be recognized, especially according to the site of cortical malformation.