Neurosurgical management of intractable rolandic epilepsy in children: role of resection in eloquent cortex

作者：Mony Benifla, Francesco Sala, John A. Jane, Hiroshi Otsubo, Ayako Ochi, James M. Drake, Shelly K. Weiss, Elizabeth Donner, Ayataka Fujimoto, Stephanie Holowka, Elysa Widjaja, O. Carter Snead, Mary Lou Smith, Mandeep S. Tamber, James T. Rutka · 发表于：Journal of Neurosurgery Pediatrics · 年份：2009 · DOI：10.3171/2009.3.peds08459 · 被引用次数：97 · 研究领域：Epilepsy research and treatment、EEG and Brain-Computer Interfaces、Neonatal and fetal brain pathology

OBJECT: The authors undertook this study to review their experience with cortical resections in the rolandic region in children with intractable epilepsy. METHODS: The authors retrospectively reviewed the medical records obtained in 22 children with intractable epilepsy arising from the rolandic region. All patients underwent preoperative electroencephalography (EEG), MR imaging, prolonged video-EEG recordings, functional MR imaging, magnetoencephalography, and in some instances PET/SPECT studies. In 21 patients invasive subdural grid and depth electrode monitoring was performed. Resection of the epileptogenic zones in the rolandic region was undertaken in all cases. Seizure outcome was graded according to the Engel classification. Functional outcome was determined using validated outcome scores. RESULTS: There were 10 girls and 12 boys, whose mean age at seizure onset was 3.2 years. The mean age at surgery was 10 years. Seizure duration prior to surgery was a mean of 7.4 years. Nine patients had preoperative hemiparesis. Neuropsychological testing revealed impairment in some domains in 19 patients in whom evaluation was possible. Magnetic resonance imaging abnormalities were identified in 19 patients. Magnetoencephalography was performed in all patients and showed perirolandic spike clusters on the affected side in 20 patients. The mean duration of invasive monitoring was 4.2 days. The mean number of seizures during the period of invasive monitoring was 17. All patients unde...