Surgical outcome following resection of rolandic focal cortical dysplasia.
OBJECTIVE
This study evaluates surgical outcomes in patients with balloon cell containing, focal cortical dysplasia (FCD type IIB) in the peri-rolandic region. We also address the question of, postoperative seizure worsening after an incomplete resection in this patient population.


METHODS
We retrospectively reviewed the clinical data on patients with pathologically proven FCD, who underwent epilepsy surgery over a 12-year period. Seizure outcomes were compared between, patients with rolandic FCD and non-rolandic frontal FCD.


RESULTS
Seventeen patients with rolandic and 22 patients with non-rolandic FCD were identified. Twelve patients were found to have type IIB lesions (8 rolandic). Seizure freedom at last follow up was, achieved in 59% of the rolandic subset of patients (including 75% seizure freedom in the rolandic type, IIB cases, as opposed to 44% of rolandic non-type IIB and 75% of type IIB outside the rolandic, region). New postoperative neurological deficits occurred in 59% of the rolandic subgroup and were, independent of pathology. Three patients (3/8) with incompletely resected rolandic type IIB lesions, developed status epilepticus postoperatively; all 3 patients became seizure free following a second, more extensive surgical resection.


CONCLUSIONS
Patients with rolandic FCD can achieve a good surgical outcome after a complete, resection. However, an incomplete surgical resection in this patient population may lead to acute, postoperative seizure worsening.
Cleveland Clinic Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, OH 44195, USA. sarkisr@ccf.org
Rani A
RA
Sarkis
Lara E
LE
Jehi
William E
WE
Bingaman
Imad M
IM
Najm
D000293:Adolescent; D000328:Adult; D002540:Cerebral Cortex / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D004569:Electroencephalography; D017034:Epilepsy, Frontal Lobe / Q000601:surgery*; D019305:Epilepsy, Rolandic / Q000601:surgery*; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D054220:Malformations of Cortical Development / Q000601:surgery*; D008875:Middle Aged; D015999:Multivariate Analysis; D018579:Patient Selection; D012189:Retrospective Studies; D016896:Treatment Outcome