Extended resection for seizure control of pure motor strip focal cortical dysplasia during awake craniotomy: illustrative case

Abstract

BACKGROUND Focal cortical dysplasias (FCD) represent highly intrinsically epileptogenic lesions that require complete resection for seizure control. Resection of pure motor strip FCD can be challenging. Effective control of postoperative seizures is crucial and extending the boundaries of resection in an eloquent zone remains controversial. OBSERVATIONS The authors report a 52-year-old right-handed male with refractory epilepsy. The seizure phenotype was a focal crisis with preserved awareness and a clonic motor onset of right-hemibody. Epilepsy surgery protocol demonstrated a left pure motor strip FCD and a full-awake resective procedure with motor brain mapping was performed. Further resection of surgical boundaries monitoring function along intraoperative motor tasks with no direct electrical stimulation corroborated by intraoperative-neuromonitorization was completed as the final part of the surgery. In the follow-up period of 3-years, the patient has an Engel-IB seizure-control with mild distal lower limb palsy and no gate compromise. LESSONS This report represents one of the few cases with pure motor strip FCD resection. In a scenario similar to this case, the authors consider that this variation can be useful to improve seizure control and the quality of life of these patients by extending the resection of a more extensive epileptogenic zone minimizing functional damage.

An update on tests used for intraoperative monitoring of cognition during awake craniotomy

“…Patient had to indicate movement direction. * Tested in wrist, elbow, toe, foot and knee Calculation Calculation task Clock reading Clock reading [ 224 ] Language Picture naming Motor Flexion and extension of the left arm and hand Executive function Stroop task Working memory Digit span Recall [ 225 ] Language Picture naming Auditory descriptive naming Non-word repetition Single word reading Writing Face recognition Famous face naming [ 226 ] Language Object naming ( Snodgrass naming task) Reading (Working) memory Digit span forwards Digit span backwards Executive functions DKEFS; Colour-Word Interference Test : inhibition condition DKEFS; Colour-Word Interference Test : Inhibition/switching condition Visuospatial Dot counting task [ 227 ] Motor Verbal commands of voluntary movements [ 228 ] Motor Voluntary motor movement based on verbal commands [ 229 ] Language Pictured object naming Pronouncing a familiar written Japanese word Action verb generation during image presentation Spontaneous speech through continuous conversation [ 230 ] Motor Verbal commands of voluntary movements [ 231 ] Face recognition Show faces and ask for change in perception Look at objects and the presenter’s own faces to discriminate face related from object related responses [ 232 ] Motor Tapping Continuous movement of the upper limb [ 233 ] Visuospatial …”