title: Epilepsy surgery of the cingulate gyrus and the frontomesial cortex.
abstract: BACKGROUND
  Epilepsy surgery involving the cingulate gyrus has been mostly presented as case reports, and larger series with long-term follow-up are not published yet.
  
  
  OBJECTIVE
  To report our experience with focal epilepsy arising from the cingulate gyrus and surrounding structures and its surgical treatment.
  
  
  METHODS
  Twenty-two patients (mean age, 36; range, 12-63) with a mean seizure history of 23 years (range, 2-52) were retrospectively analyzed. We report presurgical diagnostics, surgical strategy, and postoperative follow-up concerning functional morbidity and seizures (mean follow-up, 86 months; range, 25-174).
  
  
  RESULTS
  Nineteen patients showed potential epileptogenic lesions on preoperative magnetic resonance imaging (MRI). All patients had noninvasive presurgical workup; 15 (68%) underwent invasive Video-electroencephalogram (EEG)-Monitoring. In 12 patients we performed extended lesionectomy according to MRI; an extension with regard to EEG results was done in 6 patients. In 4 patients, the resection was incomplete because of the involvement of eloquent areas according to functional mapping results. Eight pure cingulate resections (36%, 3 in the posterior cingulate gyrus) and 14 extended supracingular frontal resections were performed. Nine patients experienced temporary postoperative supplementary motor area syndrome after resection in the superior frontal gyrus. Two patients retained a persistent mild hand or leg paresis, respectively. Postoperatively, 62% of patients were seizure-free (International League Against Epilepsy [ILAE] 1), and 76% had a satisfactory seizure outcome (ILAE 1-3).
  
  
  CONCLUSIONS
  Epilepsy surgery for lesions involving the cingulate gyrus represents a small fraction of all epilepsy surgery cases, with good seizure outcome and low rates of postoperative permanent deficits. In case of extended supracingular resection, supplementary motor area syndrome should be considered.
authors.affiliation: Department of Neurosurgery, University Hospital Bonn, Bonn, Germany. Marec.von_Lehe@ukb.unibonn.de
authors.forename: Marec
authors.initials: M
authors.lastname: von Lehe
authors.forename: Jan
authors.initials: J
authors.lastname: Wagner
authors.forename: Joerg
authors.initials: J
authors.lastname: Wellmer
authors.forename: Hans
authors.initials: H
authors.lastname: Clusmann
authors.forename: Thomas
authors.initials: T
authors.lastname: Kral
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D038524:Diffusion Magnetic Resonance Imaging; D004569:Electroencephalography; D004827:Epilepsy / Q000150:complications / Q000601:surgery*; D005260:Female; D005625:Frontal Lobe / Q000601:surgery*; D006179:Gyrus Cinguli / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000009:adverse effects / Q000379:methods*; D011183:Postoperative Complications / Q000453:epidemiology* / Q000209:etiology; D012189:Retrospective Studies; D012640:Seizures / Q000209:etiology / Q000601:surgery; D055815:Young Adult