Venkatesan Sanjeevi, Scalia Gianluca, Kumar V R Roopesh, Rajendran Adhithyan, Jeyaraj Malcom, Umana Giuseppe Emmanuele, Chaurasia Bipin
Departments of Neurosurgery.
Neurosurgery Unit, Department of Head and Neck Surgery, Garibaldi Hospital.
Ann Med Surg (Lond). 2024 Jun 19;86(8):4879-4883. doi: 10.1097/MS9.0000000000002282. eCollection 2024 Aug.
Focal cortical dysplasia (FCD) is a significant cause of drug-resistant epilepsy, often necessitating surgical intervention. Type IIb FCD poses challenges due to its strong association with drug-resistant seizures. Effective management involves advanced imaging, intraoperative neurophysiological monitoring, and precise surgical techniques. This case study illustrates these strategies in an 11-year-old female with drug-resistant epilepsy attributed to Type IIb FCD.
The patient, an 11-year-old female, had drug-resistant seizures despite various anticonvulsant treatments. Preoperative 3 Tesla (3T) MRI revealed an ill-defined lesion in the right frontal operculum. The surgical team used neuro-navigation for intraoperative guidance and electrocorticography for lesionectomy. Pathology confirmed Type IIb FCD with rare concentric calcifications.
Drug-resistant seizures in FCD often require surgery when medications fail. This case highlights the importance of comprehensive preoperative evaluations and advanced imaging, such as 3T MRI, to accurately identify lesions. Intraoperative neurophysiological monitoring, including electrocorticography, ensures precise resection of the epileptogenic zone. The unusual finding of concentric calcifications in Type IIb FCD is noteworthy, suggesting the need for further research to understand their impact on the disease.
Microsurgical lesionectomy is crucial for managing drug-resistant seizures in Type IIb FCD. Combining advanced imaging with intraoperative monitoring improves surgical precision and outcomes. The rare pathological finding of calcifications highlights the diversity of FCD manifestations, warranting further study. These techniques can significantly enhance seizure control and quality of life in patients with drug-resistant epilepsy.
局灶性皮质发育不良（FCD）是耐药性癫痫的重要病因，常需手术干预。IIb型FCD因其与耐药性癫痫发作密切相关而带来挑战。有效的治疗管理包括先进的影像学检查、术中神经生理监测以及精确的手术技术。本病例研究展示了针对一名因IIb型FCD导致耐药性癫痫的11岁女性患者所采用的这些策略。
该患者为一名11岁女性，尽管接受了各种抗惊厥治疗，仍有耐药性癫痫发作。术前3特斯拉（3T）磁共振成像（MRI）显示右侧额下回有一个边界不清的病变。手术团队在术中使用神经导航进行引导，并采用皮质脑电图进行病灶切除术。病理证实为IIb型FCD，伴有罕见的同心钙化。
当药物治疗失败时，FCD中的耐药性癫痫发作通常需要手术治疗。本病例突出了全面术前评估和先进影像学检查（如3T MRI）对于准确识别病变的重要性。术中神经生理监测，包括皮质脑电图，可确保精确切除癫痫病灶。IIb型FCD中同心钙化这一不寻常的发现值得关注，提示需要进一步研究以了解其对疾病的影响。
显微手术病灶切除术对于治疗IIb型FCD的耐药性癫痫发作至关重要。将先进的影像学检查与术中监测相结合可提高手术精度和治疗效果。钙化这一罕见的病理发现凸显了FCD表现的多样性，值得进一步研究。这些技术可显著提高耐药性癫痫患者的癫痫控制率和生活质量。
