Surgical Strategy and Outcomes for Epileptic Patients with Focal Cortical Dysplasia or Dysembryoplastic Neuroepithelial Tumor

Abstract

Purpose: The purpose of this study was to clarify and compare the influence of surgical strategy on relief from seizures in patients with focal cortical dysplasia (FCD) and those with dysembryoplastic neuroepithelial tumor (DNT).Methods: Six patients with FCD and five patients with DNT, all of whom underwent surgical resection for medically intractable epilepsy, were compared in terms of presurgical seizure types and frequency, location of lesions, magnetic resonance imaging (MRI), single-photon emission computed tomography (SPECT) with 99m Tc-ECD, scalp electroencephalogram (EEG), and long-term video-EEG recording. Prolonged subdural recordings and intraoperative electrocorticograms (ECoG) were analyzed. The influences of surgical strategies on seizure outcomes were retrospectively analyzed.Results: In all the FCD patients, ictal SPECT revealed hyperperfusion in the regions where MRI showed FCD. Interictal epileptiform activity and ictal seizure onset on ECoG performed with subdural electrodes were localized on the FCD

Magnetoencephalography in Patients with Tuberous Sclerosis and Localization‐related Epilepsy

“…FCD is well known to have intrinsic epileptogenicity. Our results, however, suggest that the epileptic focus in TS is not anticipated to be within lesions visible on MRI, as is the case in dysembryoplastic neuroepithelial tumor (23). Hence it cannot be assumed that tuberectomy is an ideal surgical strategy for epilepsy patients with TS.…”

Surgical outcome and predictive factors in adult patients with intractable epilepsy and focal cortical dysplasia

“…The anatomic localization of FCD may differ in pediatric and adult patients who present for evaluation of intractable epilepsy. Extratemporal FCD is more common than temporal lobe lesions in childhood (8,14,20,21). This finding has been attributed to the course of cerebral maturation (22,23).…”

[18F] Fluorodeoxyglucose–Positron-Emission Tomography and MR Imaging Coregistration for Presurgical Evaluation of Medically Refractory Epilepsy

“…32 Thus, complete removal of the tumor is not sufficient to obtain seizure-free outcomes, and finding the area of FCD is important for total seizure control. 32,34 In 1 study of patients with refractory epilepsy and gangliogliomas, 100% of patients without FCD remained seizure-free after surgery, whereas only 14% of patients with FCD remained seizure-free. 33 However, MR imaging has a sensitivity as low as 5%-14% compared with pathology for defining the borders of FCD associated with glioneural tumors.…”