title: Surgical management of cortical dysplasia in infancy and early childhood.
abstract: OBJECTIVE
  To describe operative procedures, seizure control and complications of surgery for cortical dysplasia (CD) causing intractable epilepsy in infancy and early childhood.
  
  
  METHODS
  Fifty-six consecutive children (less than 6years old) underwent resective epilepsy surgery for CD from December 2000 to August 2011. Age at surgery ranged from 2 to 69months (mean 23months) and the follow-up was from 1 to 11years (mean 4years 4months).
  
  
  RESULTS
  Half of the children underwent surgery during infancy at an age less than 10months, and the majority (80%) of these infants needed extensive surgical procedures, such as hemispherotomy and multi-lobar disconnection. Seizure free (ILAE class 1) outcome was obtained in 66% of the cases (class 1a; 55%): 85% with focal resection (n=13), 50% with lobar resection (n=18), 71% with multilobar disconnection (n=7) and 67% with hemispherotomy (n=18). Peri-ventricular and insular structures were resected in 23% of focal and 61% of lobar resections. Repeated surgery was performed in 9 children and 5 (56%) became seizure free. Histological subtypes included hemimegalencephaly (16 patients), polymicrogyria (5 patients), and FCD type I (6 patients), type IIA (19 patients), type IIB (10 patients). Polymicrogyria had the worst seizure outcome compared to other pathologies. Surgical complications included 1 post-operative hydrocephalus, 1 chronic subdural hematoma, 2 intracranial cysts, and 1 case of meningitis. No mortality or severe morbidities occurred.
  
  
  CONCLUSIONS
  Early surgical intervention in children with CD and intractable seizures in infancy and early childhood can yield favorable seizure outcome without mortality or severe morbidities although younger children often need extensive surgical procedures.
authors.affiliation: Department of Neurosurgery, Epilepsy Center, National Center of Neurology and Psychiatry, Tokyo, Japan. otsukit@ncnp.go.jp
authors.forename: Taisuke
authors.initials: T
authors.lastname: Otsuki
authors.forename: Ryoko
authors.initials: R
authors.lastname: Honda
authors.forename: Akio
authors.initials: A
authors.lastname: Takahashi
authors.forename: Takanobu
authors.initials: T
authors.lastname: Kaido
authors.forename: Yu
authors.initials: Y
authors.lastname: Kaneko
authors.forename: Tetsuji
authors.initials: T
authors.lastname: Nakai
authors.forename: Yuko
authors.initials: Y
authors.lastname: Saito
authors.forename: Masayuki
authors.initials: M
authors.lastname: Itoh
authors.forename: Eiji
authors.initials: E
authors.lastname: Nakagawa
authors.forename: Kenji
authors.initials: K
authors.lastname: Sugai
authors.forename: Masayuki
authors.initials: M
authors.lastname: Sasaki
mesh_terms: D002540:Cerebral Cortex / Q000473:pathology / Q000601:surgery*; D002675:Child, Preschool; D004569:Electroencephalography / Q000379:methods; D004827:Epilepsy / Q000209:etiology / Q000503:physiopathology / Q000601:surgery; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D054220:Malformations of Cortical Development / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D011183:Postoperative Complications / Q000517:prevention & control; D012086:Reoperation / Q000009:adverse effects / Q000379:methods; D016896:Treatment Outcome
keywords: Epilepsy surgery; Focal cortical dysplasia; Hemimegalencephaly; Hemispherotomy; Infant; Multilobar disconnection; Polymicrogyria; Seizure outcome