Artikel
Focal cortical dysplasia: long-term outcome after surgical treatment
Fokale kortikale Dysplasie: Langzeitergebnisse nach einer chirurgischen Behandlung
Suche in Medline nach
Autoren
-
M. von Lehe
- Klinik für Neurochirurgie, Universitätsklinikum Bonn
-
M. Podlogar
- Klinik für Neurochirurgie, Universitätsklinikum Bonn
-
H. Clusmann
- Klinik für Neurochirurgie, Universitätsklinikum Bonn
-
H. Urbach
- Klinik für Radiologie, Universitätsklinikum Bonn
-
J. Schramm
- Klinik für Neurochirurgie, Universitätsklinikum Bonn
-
T. Kral
- Klinik für Neurochirurgie, Universitätsklinikum Bonn
| Veröffentlicht: | 4. Mai 2005 |
|---|
Gliederung
Text
Objective
Studies of long-term outcomes after epilepsy surgery of cortical malformations are rare. In this retrospective study the authors report their experience with surgical treatment and long term outcome for a subgroup of patients with a focal cortical dysplasia (FCD).
Methods
We retrospectively analysed the records of 61 patients with focal cortical malformations after surgical treatment. Patients without presurgical MRI, histological results according to the Palmini classification* and clinical follow-up according to the International League Against Epilepsy (ILAE) - classification were excluded, leaving a study population of 48 patients (female: N=24; male: N=24) with a mean age of 25 years (range: 5-47 years) and a mean duration of epilepsy of 17 years (range: 1-42 years).
Results
A structural lesion was detected on presurgical MRI in 98% of cases and 60% had presurgical invasive EEG evaluation. Additionally to lobectomy (N=7) or lesionectomy (N=41) 14 patients had multiple subpial transections of eloquent cortex. A permanent hemiparesis after ischemic insult to the internal capsule (N=1) was the main surgical complication. The resected tissue was classified as FCD type IIb in 40 cases and FCD type IIa in 8 cases. Overall 79% were seizure free (ILAE 1A or 1) after a mean follow-up of 7 years (range: 2-15 years). A year to year follow-up was available in 38 cases (79%). The rate of patients with successful outcome (ILAE 1A or 1) decreased from 73% to 62% during the first eight years of follow-up. Demographic data, FCD localisation and surgical procedure had no influence on the year to year follow-up. In cases with presurgical invasive EEG evaluation or FCD type IIa the rate of successful outcome decreased under 50% after six years of follow-up.
Conclusions
Surgical treatment of epilepsy with focal cortical dysplasia has not only a successful short-term result but also a satisfying long-term outcome.
*Palmini A, Najm I, Avanzini G, et al. Terminology and classification of the cortical dysplasias. Neurology 2004;62(6 Suppl 3):S2-8.
