Surgical strategy of perirolandic epilepsy

Yu Jiabin; Xie Haitao; Xie Xuemin; Wu Youliang; Han Fu; Sui Lisen

doi:10.11850/j.issn.1009-122X.2017.05.004

Abstract：Objective To explore the surgical strategy of epilepsy involving in perirolandic area (EIPA). Methods Clinical data of 21 EIPA patients treated by surgery were analyzed retrospectively. All the patients were assigned to receive routine evaluative tests and neurological function score before surgery. Stereoelectroencephalography (SEEG), awake anesthesia, neuronavigation, intraoperative EEG monitoring, direct cortical electrical stimulation were used to locate the epileptogenic focus and functional area according the individual situation. Then the epileptogenic focus was resected according to location results. Results There were 18 patients with epilepsy secondary to tumors. Total resection of tumor and epileptogenic focus were achieved in 12 patients, total resection of the tumor and electrocoagulation of epileptogenic focus were achieved in 3, simple total resection of the tumor was in 1, subtotal resection of the tumor and electrocoagulation of epileptogenic focus were in 2. The focal cortical dysplasia was found in 3 patients and the epileptogenic focus was located by SEEG and resected. The transient dysneuria was seen in 6 patients and permanent dysneuria in 2 ones 3 months after surgery. All the patients were followed up for 6 to 44 months. Engel class Ⅰ was acieved in 15 patients, class Ⅱ in 3, class Ⅲ in 2 and class Ⅳ in 1. Conclusions Multiple technologies combined with surgery in EIPA can increase the resection rate of epileptogenic focus, decrease the disability rate and achieve good outcome.