Resection Surgery in Patients with Perirolandic Epilepsy

Česká verzia

Authors: M. Brázdil ¹; R. Kuba ¹; J. Chrastina ²; Z. Novák ²; J. Hemza ²; M. Hermanová ³; I. Tyrlíková ¹; M. Ryzí ⁴; H. Ošlejšková ⁴; B. Slaná ³; M. Mikl ¹; M. Pažourková ⁵; I. Rektor ¹
Authors place of work: Centrum pro epilepsie Brno I. neurologická klinika LF MU a FN u sv. Anny v Brně ¹; Centrum pro epilepsie Brno Neurochirurgická klinika LF MU a FN u sv. Anny v Brně ²; Centrum pro epilepsie Brno Patologicko-anatomický ústav LF MU a FN u sv. Anny v Brně ³; Centrum pro epilepsie Brno Klinika dětské neurologie LF MU a FN Brno ⁴; Centrum pro epilepsie Brno Klinika zobrazovacích metod LF MU a FN u sv. Anny v Brně ⁵
Published in the journal: Cesk Slov Neurol N 2011; 74/107(1): 43-48
Category: Original Paper

Summary

Purpose:
To assess the efficacy and safety of resective epilepsy surgery in unselected patients with both lesional and nonlesional perirolandic epilepsy.

Methods:
A group of 15 consecutive patients who had undergone perirolandic cortical resection (without multiple subpial transections) for intractable epilepsy between 1995 and 2009 was identified. This number represented 5.2% of all resective epilepsy surgeries at the Brno Epilepsy Centre. A detailed analysis was performed in 13 patients with a minimum postoperative follow-up 2 years (average 7 years). The average age at the time of surgery was 27 years (range 13–50 years). Pre-operative MRI disclosed restricted lesion in the perirolandic cortex in nine patients; in four subjects repeated and thorough neuro-imaging investigation failed to identify any structural pathology. Most patients underwent pre-operative chronic invasive video-EEG (70%). Advanced neuro-imaging (including fMRI, subtraction ictal single photon emission tomography coregistered to MRI, magnetic resonance spectroscopy, voxel-based morphometry, etc.) was progressively introduced into the pre-operative set-up and completed whenever possible.

Results:
At the last recorded follow-up, nine patients remained seizure-free – Engel class I (70%); two patients were class II (15%), and two patients class IV (15%). Postoperative neurological deficits were present in four patients (30%). In all these cases, intensive rehabilitation resulted in significant improvement, while a mild functional deficit still remained in two patients (15%).

Conclusion:
Resective epilepsy surgery is an effective and relatively safe therapeutic strategy in properly selected patients with intractable perirolandic epilepsy. This conclusion holds for both lesional and nonlesional cases.

Key words:
central region – epilepsy surgery – intractable epilepsy – focal cortical dysplasia – neuro-imaging

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