Artikel
Insular resection in the surgical treatment of epilepsy caused by focal cortical dysplasia
Insuläre Resektion in der chirurgischen Behandlung von Epilepsien hervorgerufen durch fokale kortikale Dysplasien
Suche in Medline nach
Autoren
-
C. Coulin
- Neurochirurgische Universitätsklinik Freiburg
-
S. Fauser
- Neurologische Universitätsklinik Freiburg
-
A. Schulze-Bonhage
- Sektion für Prächirurgische Epilepsiediagnostik am Neurozentrum der Universitätsklinik Freiburg
-
J. Zentner
- Neurochirurgische Universitätsklinik Freiburg
| Veröffentlicht: | 11. April 2007 |
|---|
Gliederung
Text
Objective: Focal cortical dysplasias (FCD) have been increasingly recognized as lesions causing medically intractable epilepsy. Complete resection of these lesions has been shown to correspond favorably with seizure control. So far, dysplastic lesions involving eloquent areas have mostly been excluded from surgical treatment. The authors report their experience with the surgical treatment of epilepsy in patients with FCD of the insular cortex.
Methods: 11 patients (7 pediatric, 4 young adults) with suspected FCD involving the insular cortex were surgically treated for medically intractable epilepsy between 1999 and 2003. Mean age of patients was 16.8 years (5-29 years). Mean age at seizure onset was 5.9 years (0.6-18 years), and mean seizure duration was 11.1 years (0.5-26 years). Preoperative work-up included magnetic resonance (MR) imaging, surface Video-EEG monitoring, positron emission tomography (PET), single photon emission tomography (SPECT), functional MR imaging (fMRI) and WADA-Testing. All patients were either subject to invasive monitoring with subdural grid and strip electrodes and/ or intraoperative electrocorticography (EcOG).
Results: Surgical procedures were performed in all patients with no mortality and only minor morbidity in 2 patients, both showing latent hemiparesis. Operative specimen were histologically classified according to Palmini. FCD was diagnosed in 9 patients and included only type I lesions (Ia: N=7; Ib: N=2). In two patients, the diagnosis was Rasmussen's encephalitis. Mean duration of follow-up was 31.6 months (9-61 months). Marked reduction in seizure frequency was achieved in all cases, and 8 patientes (73%) were completely seizure free. However, both patients with Rasmussen´s encephalitis required second operations with functional hemispherectomy.
Conclusions: Pharmacoresistant epilepsy caused by FCD involving the insular cortex can be treated surgically with satisfying results in terms of seizure control and morbidity. Careful presurgical evaluation is crucial for planning the surgical procedure.
