gms | German Medical Science

Objective: Only few series have been published about epilepsy surgery in the cingulate cortex, mostly with less favorable outcome. The aim of this retrospective study is to analyze seizure outcome after lesionectomy in the cingulate cortex only or in the cingulate cortex plus frontomesial cortex.

Methods: Since 1990, all patients undergoing epilepsy surgery in this department have been prospectively entered in a data bank which was screened for patients with frontomesial and cingular lesionectomy. Clinical data files, presurgical MRI, neuropathological results, seizure outcome and postoperative antiepileptic drug treatment were reviewed.

Results: 18 patients (female: N=6, male: N=12) had a mean seizure history of 21.9±13.6 years. Most cases had presurgical invasive EEG evaluation (N=11) or intraoperative ECoG (N=3). After 8 pure cingulate resections and 10 extended frontomesial resections one bone flap infection was observed. In 3 patients additional multiple subpial transections of the ictal motor cortex was performed, two suffered from a temporary postoperative hemiparesis. The resected lesion, detected preoperatively in 16 patients (89%) in the presurgical MRI, was classified as focal cortical dysplasia (N=11), low grade glioma (N=4), cavernoma (N=2) or glial scar (N=1). After a mean follow-up of 59.7 months 14 patients (78%) were seizure free and 3 patients of these were off antiepileptic drugs for longer than 24 months. The seizure outcome was less successful in patients with pure cingulate resections (Engel class I: 63%) than in patients with extended additional frontomesial resections (Engel class I: 90%).

Conclusions: A precise localization of the ictal onset in the frontomesial cortex is possible with invasive monitoring. Seizure outcome is less successful after pure cingulate resections than after extended mesial resections.