2009
DOI: 10.1212/01.wnl.0000327825.48731.c3
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Predictors of surgical outcome and pathologic considerations in focal cortical dysplasia

Abstract: Our study shows that there is a strong tendency for patients with severe pathologic features to have MRI abnormalities, and patients with incomplete resection, mild pathologic features, or the presence of secondary tonic clonic seizures have a high chance of a poorer surgical outcome.

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Cited by 174 publications
(178 citation statements)
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“…There have been a few studies specifically assessing MRI features of CD correlated with pathology and outcome in pediatric (or mostly pediatric) patients, with the investigators using more modern pathological classification systems. 14,16,17,19,33 Most of these studies also included CD in the temporal lobe associated with hippocampal sclerosis (ILAE Type IIIa), 3 which complicates evaluation of the imaging, pathology, and outcome correlations in this population. For our study, to provide the most homogeneous cohort for evaluation, we excluded these patients, as well as patients with other brain abnormalities and CD (Types IIIb, IIIc, and dual pathology).…”
Section: Discussionmentioning
confidence: 99%
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“…There have been a few studies specifically assessing MRI features of CD correlated with pathology and outcome in pediatric (or mostly pediatric) patients, with the investigators using more modern pathological classification systems. 14,16,17,19,33 Most of these studies also included CD in the temporal lobe associated with hippocampal sclerosis (ILAE Type IIIa), 3 which complicates evaluation of the imaging, pathology, and outcome correlations in this population. For our study, to provide the most homogeneous cohort for evaluation, we excluded these patients, as well as patients with other brain abnormalities and CD (Types IIIb, IIIc, and dual pathology).…”
Section: Discussionmentioning
confidence: 99%
“…Previous studies specifically evaluating children are rare and have usually documented a higher MRI "positive rate" (38%-66% for Type I and 79%-88% for Type II). 14,16,17,19 None of these studies used a resection region-specific analysis such as used in our evaluation, and some include patients with hippocampal sclerosis and, presumably, Type IIIa CD, which was specifically excluded in this study. In a recent study, Mellerio et al, 22 utilizing a detailed evaluation approach in 71 adults and children (median age 20 years) with Type II CD, demonstrated an MRI abnormality in 59% of the patients, which was more similar to the 68% of patients identified in our study with Type II CD.…”
Section: Discussionmentioning
confidence: 99%
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“…Several clinical research groups have studied the impact of different radiological or clinicopathological factors on seizure outcome after extirpative surgery for FCD. [4][5][6][7][8][9][11][12][13][14][15]23,24,26,28,29 Recently, Rowland et al 22 reported on their meta-analysis of predictors of seizure freedom in the surgical management of FCD on the basis of results from 37 selected studies. They noted that complete resection of the anatomical or electrographic abnormality was the most important treatment-related factor predictive of seizure freedom.…”
mentioning
confidence: 99%
“…6,11,12,14,16,27 We found that iMRI allowed for the intraoperative ability to examine the extent of resection once the surgeon believed a complete surgery had been accomplished. In cases of MR-indicated residual dysplasia, iMRI became especially critical in enabling the surgeon to account for brain shift (which may distort accurate depiction of eloquent anatomical landmarks on preoperative images) and update neuronavigation for a reevaluation of the resection cavity.…”
Section: Discussionmentioning
confidence: 96%