Surgical Treatment of Epilepsy in Children Caused by Focal Cortical Dysplasia

Focal cortical dysplasia (FCD) is a congenital disorder of neuronal migration that is increasingly recognized as a common cause of seizures in children, occurring in 20–30% of all surgically treated cases of epilepsy in the pediatric population. Advances in neuroimaging have contributed to recogniti...

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Bibliographic Details
Published inPediatric neurosurgery Vol. 41; no. 2; pp. 70 - 76
Main Authors Hudgins, Roger J., Flamini, J. Robert, Palasis, Susan, Cheng, Raymond, Burns, Thomas G., Gilreath, C. Lynn
Format Journal Article
LanguageEnglish
Published Basel, Switzerland S. Karger AG 01.03.2005
Subjects
Adolescent
Adult
Cerebral Cortex - abnormalities
Cerebral Cortex - pathology
Cerebral Cortex - surgery
Child
Child, Preschool
Children & youth
Clinical outcomes
Convulsions & seizures
Craniotomy
Electroencephalography
Epilepsy
Epilepsy - etiology
Epilepsy - surgery
Female
Humans
Infant
Magnetic Resonance Imaging
Male
Neurosurgery
NMR
Nuclear magnetic resonance
Original Paper
Pediatrics
Stereotaxic Techniques
Surgical techniques
Treatment Outcome
Frameless stereotaxy
Focal cortical dysplasia
Magnetic resonance imaging
Epilepsy
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Summary:Focal cortical dysplasia (FCD) is a congenital disorder of neuronal migration that is increasingly recognized as a common cause of seizures in children, occurring in 20–30% of all surgically treated cases of epilepsy in the pediatric population. Advances in neuroimaging have contributed to recognition of FCD. We report 15 children (9 female, 6 male) with FCD and surgically treated intractable epilepsy. In 9 cases, a surgical strategy of anatomic (frameless stereotactic) grid placement and physiologic (electrocorticography) resection was employed. Postoperative MRI scans were obtained, the pathologic specimen was graded according to the Brannstrom system, and seizure outcome was defined using the Engel classification. There were no deaths and no permanent morbidity. After, on average, 4 years since treatment, 10 children are seizure free, 2 are 2A, 2 are 2B and 1 is 3A. Predictors of good outcome are an MRI-defined lesion and increased cortical disorganization (higher Brannstrom grade). Subtotal resection did not preclude a seizure-free outcome.
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ISSN:1016-2291
1423-0305
DOI:10.1159/000085159