Comprehensive Epilepsy Program, Department of Neurology, American University of Beirut Medical Center, Beirut, Lebanon.
Department of Neurosurgery, American University of Beirut Medical Center, Beirut, Lebanon.
World Neurosurg. 2019 Dec;132:93-98. doi: 10.1016/j.wneu.2019.08.181. Epub 2019 Sep 3.
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.
局灶性皮质发育不良（FCD）是高度致痫性的，常与药物难治性局灶性癫痫相关。FCD 常位于额叶，当靠近运动皮质时，完全切除非常具有挑战性。
我们报告了一例 25 岁女性病例，其因运动皮质的局灶性皮质发育不良且深部延伸至皮质下白质而继发药物难治性癫痫。我们的癫痫监测单元进行了详细的术前评估和有创性脑电图监测，并结合运动定位、功能磁共振成像、弥散张量成像和 Stealth 导航系统，实现了病变的完全切除，而无永久性术后运动缺陷。患者在 63 个月的随访中保持无癫痫发作，同时仅使用一种抗癫痫药物。
详细的术前评估、功能和发育不良皮质的准确映射，以及皮质发育不良的精心规划和彻底手术切除，可以获得良好的结果，且术后神经功能缺陷的风险相对较小。
