title: Emerging surgical strategies of intractable frontal lobe epilepsy with cortical dysplasia in terms of extent of resection.
abstract: OBJECTIVE
  Cortical dysplasia (CD) is one of the common causes of epilepsy surgery. However, surgical outcome still remains poor, especially with frontal lobe epilepsy (FLE), despite the advancement of neuroimaging techniques and expansion of surgical indications. The aim of this study was to focus on surgical strategies in terms of extent of resection to improve surgical outcome in the cases of FLE with CD.
  
  
  METHODS
  A total of 11 patients of FLE were selected among 67 patients who were proven pathologically as CD, out of a total of 726 epilepsy surgery series since 1992. This study categorized surgical groups into three according to the extent of resection : 1) focal corticectomy, 2) regional corticectomy, and 3) partial functional lobectomy, based on the preoperative evaluation, in particular, ictal scalp EEG onset and/or intracranial recordings, and the lesions in high-resolution MRI. Surgical outcome was assessed following Engel's classification system.
  
  
  RESULTS
  Focal corticectomy was performed in 5 patients and regional corticectomy in another set of 5 patients. Only 1 patient underwent partial functional lobectomy. Types I and II CD were detected with the same frequency (45.45% each) and postoperative outcome was fully satisfactory (91%).
  
  
  CONCLUSIONS
  The strategy of epilepsy surgery is to focus on the different characteristics of each individual, considering the extent of real resection, which is based on the focal ictal onset consistent with neuroimaging, especially in the practical point of view of neurosurgery.
authors.affiliation: Department of Neurosurgery, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea.
authors.forename: Jung-Hoon
authors.initials: JH
authors.lastname: Shin
authors.affiliation: Department of Neurosurgery, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea.
authors.forename: Na-Young
authors.initials: NY
authors.lastname: Jung
authors.affiliation: Department of Pathology, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea.
authors.forename: Sang-Pyo
authors.initials: SP
authors.lastname: Kim
authors.affiliation: Department of Neurosurgery, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea.
authors.forename: Eun-Ik
authors.initials: EI
authors.lastname: Son
keywords: Cortical dysplasia; Epilepsy surgery; Frontal lobe epilepsy