Revista argentina de neurocirugía
On-line version ISSN 1850-1532
POMATA, Hugo B et al. Malformación del desarrollo cortical: Nuestra experiencia acerca de 150 casos. Rev. argent. neurocir. [online]. 2010, vol.24, suppl.1, pp. S93-S103. ISSN 1850-1532.
Objective: To evaluate the surgical results in a group of patients with epilepsy associated with cortical development malformations (CDM). Method: A retrospective study in 150 patients of a series of 570 patients (26.3%) who have undergone surgery for intractable epilepsy with a diagnosis of CDM, since 1988. Clinical features, scalp EEG, video EEG, CT scan, MRI and neuropsychological evaluation were assessed. Population: males: 86 patients, females: 64; mean age, children: 6.7 years (range: 0,5-18.9) and adults: 31.3 years (range: 19-59); mean evolution of epilepsy, children: 4.9 years (range: 1mo-17 yr.), adults: 13.8 years (range: 2mo-50 yr.). Clinical manifestations: CPS, absences, tonic crises, automatisms and versive crises, CPS, transitory anopsia, drop attacks and Startle epilepsy, scotoma, masticatory automatisms, clonic crises, photopsia, eye deviation and head attacks. Imaging: CT scan was normal in 5, and MRI was performed since 1996. Twenty of 150 (13.3%) required chronic intracranial electrodes implantation. Surgical procedures: resectives: lesionectomies 63 (wide lesionectomy, 17 and + MST, 5), standard anterior temporal lobectomies (SATL) 37, anteromesial resections (Spencer) 9, corticectomies 11(+MST, 1),amigdalo-hippocampectomies 3, anatomic hemispherectomy 1, lobectomy 1 and polectomies 4; disconnecting procedures: functional hemispherectomies (FH) 10, hemispherotomy 4, hemi-hemispherectomy 1, multiple subpial transection (MST) 1 and 2 callosotomies. Other procedures: vagus nerve stimulator (VNS) 1, as the first procedure, and radiosurgery 1. Intra-op ECoG was performed in 54 patients, SSEP were in 4 and cortical stimulation in 2. Pathological findings: FCD 86 (includes 23 dual pathology, 2 "triple pathology", 5 "associated pathologies", 4 TMS + abnormal temporal mesial structures and 3 acquired FCD), DNTs 33, tuberous sclerosis 12, hemimegalencephaly 10 and 5 hamartomas. Results according to the Engel classification: class I: 113 (75.3%), class II: 17 (11.#%), class III: 6 (4%) and class IV: 3 (2%) patients. Less than 1 year post-op 2. Not classified, 9 patients: 2 callosotomies, 3 NVS (2 performed as second procedure), 1 radiosurgery, 2 patients died post-op due to a coagulation disorders and 1 lost follow-up. Conclusions: CDM represented 26.3% (150/570) of patients who underwent surgery for intractable epilepsy. These patients usually present an early onset and unfavorable evolution of epilepsy. However, response to surgical treatment was good with 130/150 (86.6%) in Engel class I and II. The results suggest that surgery should be considered as an early therapeutic option in this pathology. The intra-op ECoG, SSEP and MRI were useful tools for intra-operative strategy, for to enlarge the resections as well as to complement it with MST. All available surgical procedures were necessary to perform the surgical treatment of the CDM. The FCD of the central area, language areas and the insular region were a particular challenge for the surgical team.