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KMID : 0877219980020010031
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Journal of Korean Epilepsy Society
1998 Volume.2 No. 1 p.31 ~ p.36
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Surgical Treatment of Epilepsy Originating from Central Sulcus Region
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Lee Sang-Koo
Hong Seung-Chyul
Hong Seung-Bong
Seo Dae-Won
Kim Jong-Hyun
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Abstract
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Purpose: Surgical treatment of intractable seizures originating from central sulcus region as primary motor/sensory area is challenging. Precise localization of epileptogenic zone and adjacent functional areas is essential for successful surgical treatment. We have achieved good seizure control without any further neurological´, deficit after seizure focus resection in this area.
Methods: Eight patients of intractable seizures involving central sulcus region (primary motor and/or sensory cortex) were operated upon during the last 22 months. The semiology and the scalp EEG suggested seizures from one side of central sulcus region. MRI, SPECT, and FDG-PET were used as imaging tools for epileptogenic areas. All patients underwent chronic EEG monitoring and functional mapping after subdural electrode insertion prior to the resective procedure.
Results: MRI was abnormal in 3 cases one schizencephaly and two small cortical dysplasias. PET showing discrete focal hypometabolism was very useful for localization of epileptogenic region in 3 cases. Resection was designed depending upon the results from the EEG and functional mapping using the subdural electrodes. Extensive resection was performed in two cases ; one schizencephaly and one with multi-staged resection. Very restricted resections were done in other six cases to avoid damage to the eloquent area. Multiple subpial transection (MST) was performed in two cases, in the primary motor areas involved in the fine hand movements. All but one patient have become seizure-free so far, for the mean follow up of 22.9 months. There was no further neurological deficit except for very little and transient discomfort in the involved face, hand or leg areas.
Conclusion : We conclude that resective procedures for the central sulcus region epilepsy can be performed safely only by very meticulous preoperative evaluation and precise localization using chronic subdural electrode EEG monitoring and functional mapping.
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KEYWORD
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Central sulcus, Epilepsy surgery, Functional mapping, Subdural electrode insertion, Multiple subpial transection
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