A Surgical Case of Complete Resection of the Focal Cortical and Subcortical Dysplasia in the Motor Cortex

Focal cortical dysplasias (FCDs) are highly epileptogenic and frequently associated with medically refractory focal epilepsy. FCDs are frequently located in the frontal lobe, making its complete resection highly challenging when in proximity to the motor cortex. We report a case of a 25-year-old wom...

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Bibliographic Details
Published in:World neurosurgery 2019-12, Vol.132, p.93-98
Main Authors: Farhat, Sahar, Darwish, Houssein, Nasreddine, Wassim, Salame, Joseph, Beydoun, Ahmad
Format: Article
Language:English
Subjects:
Adult
Brain Mapping
Complete resection
Diffusion Tensor Imaging
Drug Resistant Epilepsy - etiology
Drug Resistant Epilepsy - surgery
Epilepsy - complications
Epilepsy - surgery
Female
Focal cortical dysplasia
Functional MRI
Functional Neuroimaging
Humans
Magnetic Resonance Imaging
Malformations of Cortical Development, Group I - complications
Malformations of Cortical Development, Group I - surgery
Mapping
Motor cortex
Motor Cortex - surgery
Neurosurgical Procedures - methods
White Matter - surgery
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Summary:Focal cortical dysplasias (FCDs) are highly epileptogenic and frequently associated with medically refractory focal epilepsy. FCDs are frequently located in the frontal lobe, making its complete resection highly challenging when in proximity to the motor cortex. We report a case of a 25-year-old woman with medically refractory epilepsy secondary to a focal cortical dysplasia in the motor cortex and extending deeply into the subcortical white matter. A detailed presurgical evaluation and invasive electroencephalographic monitoring performed at our epilepsy monitoring unit, along with the use of motor mapping, functional magnetic resonance imaging, diffusion tensor imaging, and the Stealth navigation system resulted in the complete resection of the lesion without a permanent postoperative motor deficit. The patient remained seizure-free at a 63-month follow-up while being maintained on a single antiepileptic drug. A detailed presurgical evaluation, accurate mapping of the functional and dysplastic cortex, and a well-planned tailored and complete surgical resection of the cortical dysplasia can result in a favorable outcome with relatively little risk of postoperative neurologic deficit.
ISSN:1878-8750
1878-8769
DOI:10.1016/j.wneu.2019.08.181