Seizure outcome following primary motor cortex-sparing resective surgery for perirolandic focal cortical dysplasia

Abstract

The surgical strategy of a primary motor cortex-sparing resective surgery for perirolandic FCD is associated with an excellent early seizure-freedom rate and no permanent neurological deficits. Since the ultimate goal of resective epilepsy surgery is seizure freedom with simultaneous functional preservation, similar long term outcome studies should ultimately guide the resection strategy.

Epilepsy surgery near or in eloquent cortex in children—Practice patterns and recommendations for minimizing and reporting deficits

“…With regard to language cortex, although most respondents accept age of 5 years as the upper limit beyond which plasticity starts to decline, a minority believed that full plasticity extended to the end of the first decade; a presumption that prompts resection strategies carrying risk of incurring long‐term deficits. Irrespective of one's biases toward the handling of EC, wider usage of protective strategies such as awake surgery when feasible, tractography and intraoperative navigation tools, and intraoperative functional mapping is justified and strongly recommended . There is also increasing emphasis on ensuring the integrity of white matter tracts via subcortical mapping to maximize preservation of eloquent function and deployment of minimally invasive surgical strategies …”

“…Irrespective of one's biases toward the handling of EC, wider usage of protective strategies such as awake surgery when feasible, tractography and intraoperative navigation tools, and intraoperative functional mapping is justified and strongly recommended. 3,20,32,33,34,35 There is also increasing emphasis on ensuring the integrity of white matter tracts via subcortical mapping to maximize preservation of eloquent function 36 and deployment of minimally invasive surgical strategies. 37 The respondents varied considerably in their expectation of the chances of seizure freedom that were considered acceptable thresholds to "justify" a new deficit ranging from 50% to exceeding 90%.…”

“…Nonetheless, significant subjectivity exists on how tests are used to define the EZ and EC, which areas are considered to be “critical” function, notions of plasticity and influence of age, and what defines a complete resection of the perceived EZ. Although some centers are conservative and favor a smaller albeit “incomplete” resection to preserve eloquent function, “complete” resections of the EZ are believed to achieve higher rates of seizure freedom and can prompt aggressive resection of EC …”

“…Nonetheless, significant subjectivity exists on how tests are used to define the EZ and EC, which areas are considered to be "critical" function, notions of plasticity and influence of age, and what defines a complete resection of the perceived EZ. Although some centers are conservative and favor a smaller albeit "incomplete" resection to preserve eloquent function, [2][3][4] "complete" resections of the EZ are believed to achieve higher rates of seizure freedom and can prompt aggressive resection of EC. 5 Most surgical series report outcomes with respect to seizure control, but the deficits incurred are generally not completely documented, [6][7][8][9][10][11][12][13][14][15][16] a consideration particularly relevant for the subset of patients in whom the EZ is close to or involves the EC.…”

High Frequency Neuromagnetic Signals: A New Biomarker for Localizing Epileptic Areas Running Title: High-Frequency Neuromagnetic Signals in Epilepsy

“…This is because many patients are not considered candidates for surgical management because a single region causing the seizures (ictogenic zone) cannot be identified [4,8,9]. Although epilepsy surgery is expensive and the overall costs of surgical or medical management are similar in the first 2 years, patients who achieve seizure freedom after surgery have significantly lower costs compared with those treated with medication over the long-term [1,10]. The impact of intractable epilepsy extends far beyond seizures themselves.…”