Resection Surgery in Patients with Perirolandic Epilepsy

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‘ workplace: 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: Cesk Slov Neurol N 2011; 74/107(1): 43-48
Category: Original Paper


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

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.

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%).

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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2011 Issue 1

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