gms | German Medical Science

65th Annual Meeting of the German Society of Neurosurgery (DGNC)

German Society of Neurosurgery (DGNC)

11 - 14 May 2014, Dresden

Epilepsy surgery of focal cortical dysplasia with or without hippocampal sclerosis – a retrospective analysis of perioperative aspects, epileptologic outcome and the value of intraoperative ECoG

Meeting Abstract

  • Julia M. Nakagawa - Klinik für Neurochirurgie, Universitätsklinikum Freiburg
  • Christian Scheiwe - Klinik für Neurochirurgie, Universitätsklinikum Freiburg
  • Georgia Ramantani - Epilepsiezentrum, Universitätsklinikum Freiburg
  • Thomas Bast - Epilepsieklinik für Kinder und Jugendliche, Epilepsiezentrum Kork
  • Josef Zentner - Klinik für Neurochirurgie, Universitätsklinikum Freiburg

Deutsche Gesellschaft für Neurochirurgie. 65. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC). Dresden, 11.-14.05.2014. Düsseldorf: German Medical Science GMS Publishing House; 2014. DocMI.16.05

doi: 10.3205/14dgnc364, urn:nbn:de:0183-14dgnc3646

Published: May 13, 2014

© 2014 Nakagawa et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.



Objective: Focal cortical dysplasia (FCD) is regarded as a major cause of pharmaco-resistant focal epilepsy thus frequently becoming object to neurosurgical treatment. Following extensive preoperative assessment lesionectomy, lobectomy or multilobectomy was performed. In this study we aim to give an overview on our experience in resective epilepsy surgery in 253 procedures on 241 patients with FCD.

Method: In the period of 1998-2013 241 patients (mean age 22,7 years) with neuropathologically confirmed FCD with or without hippocampal sclerosis (HS) underwent epilepsy surgery. FCD (n=253) was localized extratemporal in n=124/49%, temporal in n=92/36,4% and combined temporal/extratemporal in n=37/14,6%; dual pathology of FCD and HS (DP) was proven in n=35/13,8%. Lesionectomy contained parts of a single lobe in n=216/85,4%, of two lobes in n=22/8,7% and of three lobes in n=4/1,6%. An extended multilobectomy of two and more lobes was performed in n=11/4,3%. Analysis of perioperative complications and epileptological outcome was carried out in 114 patients (FCD n=101, DP n=13), who were followed-up in our institution for at least 3 months up to 10 years. Furthermore we analyzed the impact of intraoperative ECoG-monitoring on the extent of resection and the epileptologic outcome.

Results: The overall outcome of the patients available for long-term follow-up was favorable. In extratemporal FCD 60,9% of the patients were seizure-free 3 months postoperatively, in temporal FCD even 85,7% gained seizure-freedom compared to 46,2% in combined temporal/extratemporal FCD and 71,7% following extensive multilobectomy. In DP seizure-freedom was achieved in 71,9%. The remaining patients had a significant reduction of seizure activity. There was no operative mortality. Perioperative complications were rare and predominantly not permanent. ECoG was used for intraoperative evaluation in n=77 and lead to further resection in 64,9%. Outcome was correlated to age at surgery, pathology and intraoperative use of ECoG. The long-term outcome of the patients available for follow-up largely stayed favorable.

Conclusions: Based on our experience resective surgery of FCD is a favorable therapeutic option in pharmaco-resistant epilepsy. The use of intraoperative ECoG facilitates the complete resection of the epileptogenic lesion.