Eldin Samer Serag, Iwasaki Masaki, Nishio Yoshiyuki, Jin Kazutaka, Nakasato Nobukazu, Tominaga Teiji
Department of Neurosurgery.
Department of Behavioral Neurology and Cognitive Neuroscience.
Epileptic Disord. 2015 Dec;17(4):479-84. doi: 10.1684/epd.2015.0771.
The primary motor cortex of the oro-facial level can be removed without permanent deficits, because of the bilateral representation of the innate functions. In contrast, resective surgery of the hand motor cortex or higher levels presents more challenges. We treated two adult patients with intractable epilepsy caused by small focal cortical dysplasia in the pre-central gyrus located between the foot and hand primary motor cortices. Focal cortical resection was guided by cortical EEG and intra-operative motor evoked potential, resulting in seizure freedom without neurological deficits in both cases. These cases illustrate that resective surgery can be safely performed in the primary motor cortex even dorsal to the oro-facial level, as long as the critical regions of the hand and foot motor cortices remain intact. Accurate delineation of the anatomical lesion and functional areas using intra-operative neurophysiological monitoring is crucial for successful outcome of the surgery.
由于先天功能的双侧代表，口面部水平的初级运动皮层可以被切除而不会造成永久性缺陷。相比之下，手部运动皮层或更高水平的切除手术则面临更多挑战。我们治疗了两名成年患者，他们因位于足部和手部初级运动皮层之间的中央前回小灶性皮质发育异常而患有难治性癫痫。在皮层脑电图和术中运动诱发电位的引导下进行局灶性皮质切除术，结果两例患者均无癫痫发作且无神经功能缺损。这些病例表明，只要手部和足部运动皮层的关键区域保持完整，即使在口面部水平以上的初级运动皮层进行切除手术也是安全的。术中使用神经生理监测准确描绘解剖病变和功能区域对于手术的成功结果至关重要。
