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Surgical outcome in neocortical resections of type IIId focal cortical dysplasia with accompanying medial temporal pathology.

Garganis K, Kokkinos V, Zountsas B - Epilepsy Behav Case Rep (2012)

Bottom Line: Focal cortical dysplasia (FCD) type IIId is a newly proposed type associated with early-life brain insults.Such patients are often considered unsuitable for resective epilepsy surgery, given the usually wide extent of the lesion and the poor correlation of MRI to the epileptogenic pathology.Two patients with intractable epilepsy, early-life ischemic/traumatic injury and MRI findings of extensive unilateral cystic-gliotic and ipsilateral medial temporal sclerotic-malformative lesions were subjected to presurgical evaluation revealing well-localized neocortical ictal onsets.

View Article: PubMed Central - PubMed

Affiliation: Epilepsy Monitoring Unit, "St. Luke's" Hospital, Thessaloniki, Panorama, Greece.

ABSTRACT
Focal cortical dysplasia (FCD) type IIId is a newly proposed type associated with early-life brain insults. Such patients are often considered unsuitable for resective epilepsy surgery, given the usually wide extent of the lesion and the poor correlation of MRI to the epileptogenic pathology. Two patients with intractable epilepsy, early-life ischemic/traumatic injury and MRI findings of extensive unilateral cystic-gliotic and ipsilateral medial temporal sclerotic-malformative lesions were subjected to presurgical evaluation revealing well-localized neocortical ictal onsets. They underwent tailored neocortical resections sparing medial temporal areas and achieved Engel class I postsurgical outcomes. Histopathology was consistent with type IIId focal cortical dysplasia. Successful outcomes with tailored resections may be achieved in cases with this subtype of focal cortical dysplasia, in the presence of converging and well-localized semiological, EEG and functional imaging data, even on a background of complex and extensive MRI abnormalities. Medial temporal pathology, although often present in this setting, is not necessarily the site of ictal onsets, and its resection may not be always mandatory for a favorable outcome.

No MeSH data available.


Related in: MedlinePlus

Presurgical (upper row, A) and postsurgical (lower row, B) T1 MR images of patient 2.
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f0010: Presurgical (upper row, A) and postsurgical (lower row, B) T1 MR images of patient 2.

Mentions: Patient 2 was a 25-yr-old man with lifelong history of intractable seizures secondary to serious posterior left head trauma sustained at the age of 4 months. Magnetic resonance imaging (MRI) presented posterior left hemispheric atrophy, a prominent area of tissue loss and gliotic lesion over the lateral temporoparietal region and ipsilateral hippocampal atrophy plus temporal horn enlargement (Fig. 2A). Surgical treatment involved extensive resection of the lateral temporo-parieto-occipital area, including the principal gliotic region and the lateral-inferior occipital region, sparing the medial temporal area (Fig. 2B), and achieved seizure freedom.


Surgical outcome in neocortical resections of type IIId focal cortical dysplasia with accompanying medial temporal pathology.

Garganis K, Kokkinos V, Zountsas B - Epilepsy Behav Case Rep (2012)

Presurgical (upper row, A) and postsurgical (lower row, B) T1 MR images of patient 2.
© Copyright Policy - CC BY-NC-SA
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4150647&req=5

f0010: Presurgical (upper row, A) and postsurgical (lower row, B) T1 MR images of patient 2.
Mentions: Patient 2 was a 25-yr-old man with lifelong history of intractable seizures secondary to serious posterior left head trauma sustained at the age of 4 months. Magnetic resonance imaging (MRI) presented posterior left hemispheric atrophy, a prominent area of tissue loss and gliotic lesion over the lateral temporoparietal region and ipsilateral hippocampal atrophy plus temporal horn enlargement (Fig. 2A). Surgical treatment involved extensive resection of the lateral temporo-parieto-occipital area, including the principal gliotic region and the lateral-inferior occipital region, sparing the medial temporal area (Fig. 2B), and achieved seizure freedom.

Bottom Line: Focal cortical dysplasia (FCD) type IIId is a newly proposed type associated with early-life brain insults.Such patients are often considered unsuitable for resective epilepsy surgery, given the usually wide extent of the lesion and the poor correlation of MRI to the epileptogenic pathology.Two patients with intractable epilepsy, early-life ischemic/traumatic injury and MRI findings of extensive unilateral cystic-gliotic and ipsilateral medial temporal sclerotic-malformative lesions were subjected to presurgical evaluation revealing well-localized neocortical ictal onsets.

View Article: PubMed Central - PubMed

Affiliation: Epilepsy Monitoring Unit, "St. Luke's" Hospital, Thessaloniki, Panorama, Greece.

ABSTRACT
Focal cortical dysplasia (FCD) type IIId is a newly proposed type associated with early-life brain insults. Such patients are often considered unsuitable for resective epilepsy surgery, given the usually wide extent of the lesion and the poor correlation of MRI to the epileptogenic pathology. Two patients with intractable epilepsy, early-life ischemic/traumatic injury and MRI findings of extensive unilateral cystic-gliotic and ipsilateral medial temporal sclerotic-malformative lesions were subjected to presurgical evaluation revealing well-localized neocortical ictal onsets. They underwent tailored neocortical resections sparing medial temporal areas and achieved Engel class I postsurgical outcomes. Histopathology was consistent with type IIId focal cortical dysplasia. Successful outcomes with tailored resections may be achieved in cases with this subtype of focal cortical dysplasia, in the presence of converging and well-localized semiological, EEG and functional imaging data, even on a background of complex and extensive MRI abnormalities. Medial temporal pathology, although often present in this setting, is not necessarily the site of ictal onsets, and its resection may not be always mandatory for a favorable outcome.

No MeSH data available.


Related in: MedlinePlus