From the Departments of Neurology (E.M.-L., C.A.B., S.M.B., R.J.L., J.L.F., A.S.H.), Neurosurgery (W.J.M., J.Y.-M.Y., A.E.L.W., A.W.), Medical Imaging (S.A.M., M.J.K., P.F.), Anatomical Pathology (D.M., C.D.), Psychology (J.A.W.), and Anaesthesia (A.D.), The Royal Children's Hospital; Murdoch Children's Research Institute (E.M.-L., W.J.M., S.M.B., S.A.M., J.Y.-M.Y., A.E.L.W., C.D., A.D., K.P., R.J.L., A.W., A.S.H.); University of Melbourne (E.M.-L., W.J.M, S.M.B., S.A.M., J.Y.-M.Y., A.E.L.W., M.J.K., C.D., A.D., R.J.L., A.S.H.); and Florey Institute of Neuroscience and Mental Health (A.E.L.W., G.D.J., A.S.H.), Parkville, Victoria, Australia.
Neurology. 2021 Jul 13;97(2):e178-e190. doi: 10.1212/WNL.0000000000012147. Epub 2021 May 4.
To determine whether 1-stage, limited corticectomy controls seizures in patients with MRI-positive, bottom-of-sulcus dysplasia (BOSD).
We reviewed clinical, neuroimaging, electrocorticography (ECoG), operative, and histopathology findings in consecutively operated patients with drug-resistant focal epilepsy and MRI-positive BOSD, all of whom underwent corticectomy guided by MRI and ECoG.
Thirty-eight patients with a median age at surgery of 10.2 (interquartile range [IQR] 6.0-14.1) years were included. BOSDs involved eloquent cortex in 15 patients. Eighty-seven percent of patients had rhythmic spiking on preresection ECoG. Rhythmic spiking was present in 22 of 24 patients studied with combined depth and surface electrodes, being limited to the dysplastic sulcus in 7 and involving the dysplastic sulcus and gyral crown in 15. Sixty-eight percent of resections were limited to the dysplastic sulcus, leaving the gyral crown. Histopathology was focal cortical dysplasia (FCD) type IIb in 29 patients and FCDIIa in 9. Dysmorphic neurons were present in the bottom of the sulcus but not the top or the gyral crown in 17 of 22 patients. Six (16%) patients required reoperation for postoperative seizures and residual dysplasia; reoperation was not correlated with ECoG, neuroimaging, or histologic abnormalities in the gyral crown. At a median 6.3 (IQR 4.8-9.9) years of follow-up, 33 (87%) patients are seizure-free, 31 off antiseizure medication.
BOSD can be safely and effectively resected with MRI and ECoG guidance, corticectomy potentially being limited to the dysplastic sulcus, without need for intracranial EEG monitoring and functional mapping.
This study provides Class IV evidence that 1-stage, limited corticectomy for BOSD is safe and effective for control of seizures.
确定 1 期、局限性皮质切除术是否能控制 MRI 阳性、底部脑回发育不良（BOSD）患者的癫痫发作。
我们回顾了连续接受手术治疗的药物难治性局灶性癫痫和 MRI 阳性 BOSD 患者的临床、神经影像学、皮质脑电图（ECoG）、手术和组织病理学资料，所有患者均接受 MRI 和 ECoG 引导的皮质切除术。
共纳入 38 例患者，手术时的中位年龄为 10.2 岁（四分位距[IQR]为 6.0-14.1）。15 例患者的 BOSD 累及功能区皮质。87%的患者术前 ECoG 存在节律性棘波。24 例接受联合深部和表面电极检查的患者中，22 例存在节律性棘波，其中 7 例局限于发育不良的脑回，15 例涉及发育不良的脑回和脑回冠部。68%的切除范围局限于发育不良的脑回，保留了脑回冠部。29 例组织病理学为 IIb 型局灶性皮质发育不良（FCD），9 例为 IIa 型 FCD。22 例患者中有 17 例发育不良脑回底部存在形态异常神经元，但脑回顶部和脑回冠部没有。6 例（16%）患者因术后癫痫发作和残留发育不良而需要再次手术；再次手术与 ECoG、神经影像学或脑回冠部的组织学异常无关。在中位随访 6.3 年（IQR 4.8-9.9）时，33 例（87%）患者无癫痫发作，31 例患者停用抗癫痫药物。
BOSD 可通过 MRI 和 ECoG 引导安全有效地切除，皮质切除术可潜在地局限于发育不良的脑回，无需颅内 EEG 监测和功能定位。
本研究提供了 IV 级证据，表明 1 期、局限性皮质切除术治疗 BOSD 安全有效，可控制癫痫发作。
