title: [Surgical resection of focal cortical dysplasias in the central region].
abstract: OBJECTIVE
  Taylor-type focal cortical dysplasias (TTFCD) represent a particular pathological entity responsible for severe drug-resistant epilepsy of extratemporal location. Epilepsy can be surgically cured if complete removal of the lesion can be performed. However, identification on imaging may be difficult and negative standard MRIs are not rare. The frequent location of TTFCD in the central region restrains the possibilities of complete resection. We report a series of patients operated on for intractable epilepsy associated with TTFCD in the central area.
  
  
  METHODS
  Between 2000 and 2006, of 34 consecutive patients with TTFCD, 17 had a lesion located in the central area. MRI was considered normal in eight, although in five a subtle gyral abnormality was disclosed on further analysis. A (18)FDG PET scan performed in 16 cases demonstrated focal hypometabolism in 15 that correlated with abnormalities on MRI when visible. SEEG performed in 13 cases revealed typical abnormalities for TTFCD in 10 cases. At resection, cortical and subcortical stimulations of the dysplastic cortex did not elicit a motor response.
  
  
  RESULTS
  Postoperative motor or sensory deficit was observed in 13 patients--severe in four--which subsequently resolved completely in seven. Six patients had a minor permanent, motor or sensory deficit. Four patients were reoperated for seizure recurrence and residual dysplastic tissue was found at reoperation in three cases. Average postoperative follow-up was 3.7 years. Sixteen patients (94%) were in Engel Class I (65% in Class IA).
  
  
  CONCLUSIONS
  This study suggests that surgical resection of central region TTFCD may be associated with favorable seizure outcome and no or minor functional permanent disability. In cases of seizure relapse, reoperation can be performed without further permanent deficit and lead to seizure-free outcome. Future techniques for intraoperative detection of these lesions could optimize their complete resection in functional areas.
authors.affiliation: Service de neurochirurgie, centre hospitalier Sainte-Anne, université Paris-Descartes, 1, rue Cabanis, 75674 Paris cedex 14, France.
authors.forename: D
authors.initials: D
authors.lastname: Marnet
authors.forename: B
authors.initials: B
authors.lastname: Devaux
authors.forename: F
authors.initials: F
authors.lastname: Chassoux
authors.forename: E
authors.initials: E
authors.lastname: Landré
authors.forename: M
authors.initials: M
authors.lastname: Mann
authors.forename: B
authors.initials: B
authors.lastname: Turak
authors.forename: S
authors.initials: S
authors.lastname: Rodrigo
authors.forename: P
authors.initials: P
authors.lastname: Varlet
authors.forename: C
authors.initials: C
authors.lastname: Daumas-Duport
mesh_terms: D000293:Adolescent; D000328:Adult; D002540:Cerebral Cortex / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery*; D002648:Child; D004351:Drug Resistance; D004569:Electroencephalography; D004827:Epilepsy / Q000175:diagnosis / Q000473:pathology* / Q000601:surgery*; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D019635:Neurosurgical Procedures; D049268:Positron-Emission Tomography; D011183:Postoperative Complications / Q000453:epidemiology / Q000523:psychology; D019275:Radiopharmaceuticals; D016896:Treatment Outcome
chemical_list: D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18