title: Resection of focal cortical dysplasia located in the upper pre-central gyrus.
abstract: The primary motor cortex of the oro-facial level can be removed without permanent deficits, because of the bilateral representation of the innate functions. In contrast, resective surgery of the hand motor cortex or higher levels presents more challenges. We treated two adult patients with intractable epilepsy caused by small focal cortical dysplasia in the pre-central gyrus located between the foot and hand primary motor cortices. Focal cortical resection was guided by cortical EEG and intra-operative motor evoked potential, resulting in seizure freedom without neurological deficits in both cases. These cases illustrate that resective surgery can be safely performed in the primary motor cortex even dorsal to the oro-facial level, as long as the critical regions of the hand and foot motor cortices remain intact. Accurate delineation of the anatomical lesion and functional areas using intra-operative neurophysiological monitoring is crucial for successful outcome of the surgery.
authors.affiliation: Department of Neurosurgery.
authors.forename: Samer Serag
authors.initials: SS
authors.lastname: Eldin
authors.affiliation: Department of Neurosurgery.
authors.forename: Masaki
authors.initials: M
authors.lastname: Iwasaki
authors.affiliation: Department of Behavioral Neurology and Cognitive Neuroscience.
authors.forename: Yoshiyuki
authors.initials: Y
authors.lastname: Nishio
authors.affiliation: Department of Epileptology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan.
authors.forename: Kazutaka
authors.initials: K
authors.lastname: Jin
authors.affiliation: Department of Epileptology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan.
authors.forename: Nobukazu
authors.initials: N
authors.lastname: Nakasato
authors.affiliation: Department of Neurosurgery.
authors.forename: Teiji
authors.initials: T
authors.lastname: Tominaga
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D006801:Humans; D054220:Malformations of Cortical Development / Q000150:complications / Q000601:surgery*; D009044:Motor Cortex / Q000601:surgery*; D012640:Seizures / Q000209:etiology / Q000601:surgery*; D016896:Treatment Outcome
keywords: epilepsy surgery; focal cortical dysplasia; multimodal imaging; primary motor cortex; seizure outcome