Epilepsy surgery involving the sensory-motor cortex

Abstract

Our aim was to assess the outcome with regard to seizures and neurological function in unselected patients undergoing resective surgery involving the perirolandic area, with or without multiple subpial transections (MSTs). All patients who underwent perirolandic cortical resection or MSTs from 1979 to 2003 at the London Health Sciences Centre were identified. Patients were included if they had seizures originating in the perirolandic area, recorded with subdural electrodes, or if they had scalp recorded seizures and a congruent discrete epileptogenic lesion on MRI in the perirolandic area. Most patients had electrocorticography (ECoG) at the time of surgery. Data collected include pre-operative and post-operative neurological deficits, MRI findings, interictal and ictal scalp EEG, interictal and ictal subdural data, ECoG findings, type and extent of surgery, neuropathologic diagnoses, and seizure outcomes. We studied 52 patients (22 females). The average age at the time of surgery was 33 years, and the average post-operative follow-up was 4.2 years. The most frequent aetiologies were neoplastic in 26 patients (50%), vascular in eight (15%), malformations of cortical development in six (12%), Rasmussen's encephalitis in three (6%) and other aetiologies in nine (17%). Surgery involved the pre-central gyrus in 17 patients, pre- and post-central gyrus in 13, the inferior central region in 11, the post-central gyrus in 7, and the pre-central gyrus and mesial frontal area in 2. At last follow-up 16 patients were in Engel class I (31%), 8 (15%) in class II, 14 (27%) in class III and 14 (27%) in class IV. Residual neurological deficits were present in 26 patients (50%), occurred more frequently in patients > or =25 years old (P < 0.05) and were mild in 14 (54%) patients. In univariate analyses, better seizure outcomes (P < 0.05) occurred in patients whose ECoG showed infrequent post-resectional spikes and no spikes distant to the resection margin, and in resections involving the pre-central and inferior rolandic cortex. In unselected patients with intractable perirolandic epilepsy, many of whom have large, complex epileptogenic lesions, various levels of seizure improvement can be achieved in almost 75% through well-planned surgical resections. New, severe post-operative neurological deficits can occur in 23% of these patients and appear to be more frequent in older patients. Whereas scalp EEG provided limited information to guide surgery, findings on interictal ECoG predicted seizure outcome.

The role of intraoperative MRI in resective epilepsy surgery for peri-eloquent cortex cortical dysplasias and heterotopias in pediatric patients

“…32 Importantly, this represents a reduction in deficits over conventional resections in our study, and in previous studies that have reported postoperative neurological deficits ranging from 50% to 83%. [1][2][3]25 Hence, our results demonstrate that iMRI-assisted resections are less prone to incurring neurological deficits. This may be due, in part, to the surgeon undertaking a more conservative extirpation with the knowledge that iMRI may provide a "second chance" to reevaluate the surgical course of action; thus in cases of FCD adjacent to eloquent cortex this minimizes the risk of damage to functional regions and enhances postoperative quality of life.…”

Surgical Treatment for Glioma: Extent of Resection Applying Functional Neurosurgery

“…3) On the other hand, in a study of patients with epilepsy undergoing resection surgery involving the primary sensorimotor cortex, post-surgical permanent deficits were reported in 50% of the study cohort. 43) All these studies employed the best available methods for mapping and monitoring to achieve safe, maximal tumor resection. Further analysis is needed to eliminate confounding factors related to surgical indications and patient selection, but these results seem to indicate that gliomas located in or near the eloquent brain areas were treated by the surgical operation relevant for the disease stage that promoted functional recovery.…”

Combining pyramidal tract mapping, microscopic-based neuronavigation, and intraoperative magnetic resonance imaging improves outcome of epilepsy foci resection in the sensorimotor cortex

“…For the 6 patients who underwent three iMRI scans, the seizure outcome is not ideal, but most of them (5 out of 6 patients) developed none-hemiparesis. Fewer times of iMRI (once and twice) were performed for the other 25 patients, most of whom achieved (18) reported that 55 patients with epilepsy involved perirolandic area underwent a resection surgery with or without multiple subpial transections (MSTs), and 50% of patients developed permanent post-surgical deficits. Despite the variation in procedures of preoperative assessment, durations of follow-up survey, and individual difference of patients (e.g.…”