Zhao Baotian, Zhang Chao, Wang Xiu, Wang Yao, Liu Chang, Mo Jiajie, Zheng Zhong, Zhang Kai, Shao Xiao-Qiu, Hu Wenhan, Zhang Jianguo
Departments of1Neurosurgery and.
4Department of Neurosurgery, Beijing Fengtai Hospital, Beijing, People's Republic of China.
J Neurosurg. 2020 Aug 7;135(1):266-272. doi: 10.3171/2020.5.JNS20751. Print 2021 Jul 1.
Focal cortical dysplasia type II (FCD II) is a common histopathological substrate of epilepsy surgery. Here, the authors propose a sulcus-centered resection strategy for this malformation, provide technical details, and assess the efficacy and safety of this technique. The main purpose of the sulcus-centered resection is to remove the folded gray matter surrounding a dysplastic sulcus, particularly that at the bottom of the sulcus. The authors also retrospectively reviewed the records of 88 consecutive patients with FCD II treated with resective surgery between January 2015 and December 2018. The demographics, clinical characteristics, electrophysiological recordings, neuroimaging studies, histopathological findings, surgical outcomes, and complications were collected. After the exclusion of diffusely distributed and gyrus-based lesions, 71 patients (30 females, 41 males) who had undergone sulcus-centered resection were included in this study. The mean (± standard deviation) age of the cohort was 17.78 ± 10.54 years (38 pediatric patients, 33 adults). Thirty-five lesions (49%) were demonstrated on MRI; 42 patients (59%) underwent stereo-EEG monitoring before resective surgery; and 37 (52%) and 34 (48%) lesions were histopathologically proven to be FCD IIa and IIb, respectively. At a mean follow-up of 3.34 ± 1.17 years, 64 patients (90%) remained seizure free, and 7 (10%) had permanent neurological deficits including motor weakness, sensory deficits, and visual field deficits. The study findings showed that in carefully selected FCD II cases, sulcus-centered resection is an effective and safe surgical strategy.
II型局灶性皮质发育不良（FCD II）是癫痫手术常见的组织病理学基础。在此，作者提出针对这种畸形的以脑沟为中心的切除策略，提供技术细节，并评估该技术的有效性和安全性。以脑沟为中心切除的主要目的是切除发育异常脑沟周围折叠的灰质，尤其是脑沟底部的灰质。作者还回顾性分析了2015年1月至2018年12月期间连续88例接受切除性手术治疗的FCD II患者的记录。收集了患者的人口统计学资料、临床特征、电生理记录、神经影像学研究、组织病理学发现、手术结果及并发症。排除弥漫性分布和基于脑回的病变后，本研究纳入71例（30例女性，41例男性）接受以脑沟为中心切除的患者。该队列的平均（±标准差）年龄为17.78±10.54岁（38例儿童患者，33例成人）。35个病灶（49%）在MRI上显示；42例患者（59%）在切除性手术前接受了立体脑电图监测；37个（52%）和34个（48%）病灶经组织病理学证实分别为FCD IIa和IIb型。平均随访3.34±1.17年，64例患者（90%）无癫痫发作，7例（10%）有永久性神经功能缺损，包括肌无力、感觉缺损和视野缺损。研究结果表明，在精心挑选的FCD II病例中，以脑沟为中心的切除是一种有效且安全的手术策略。
