title: Epilepsy surgery in the posterior part of the brain.
abstract: Posterior cortex epilepsy surgery is rarely performed and is associated with a high number of surgical failures, partly because accurate localization of the epileptogenic zone in the posterior part of the brain is extremely difficult. We present the characteristics as well as the surgical outcome and its determinants of a cohort of 208 consecutive patients (adults/children: 125/83) operated on for drug-resistant posterior cortex epilepsy at the "Claudio Munari" Epilepsy Surgery Centre, Milan between May 1996 and May 2013 (mean postsurgical follow-up: 9.6years). In addition, we highlight the differences in anatomoelectroclinical features and outcome between (i) patients who necessitated an invasive preoperative evaluation and those who proceeded directly to surgery and (ii) adults and children. Mean age at epilepsy onset was 6.8years (91.4% with onset before 14years of age). A high seizure frequency was reported by 51% of subjects, interictal and ictal EEG features were localizing in 16% and 28% of cases, and 86% of patients had a positive, judged as more or less informative, MRI. Invasive presurgical evaluation by stereoelectroencephalography was performed in 54% of patients; explorations may schematically be grouped in three main implantation patterns. Globally, 70% of subjects achieved seizure freedom, and further, 10% achieved Engel class II, with the patients operated on in childhood achieving significantly better postsurgical results in terms of seizure freedom and drug discontinuation. Duration of epilepsy represented the most consistent predictor of surgical outcome, with early surgery being correlated with higher chances of surgical success. Therefore, we recommend an early surgical referral in cases of pharmacoresistant posterior cortex seizures. Furthermore, we suggest that surgical failure might be predicted very early, namely within the first 6 postoperative months. We conclude that surgical management of posterior cortex epilepsy may attain excellent results.
authors: "Claudio Munari" Epilepsy Surgery Centre, Niguarda Ca' Granda Hospital, Milan, Italy; Neuroscience Department, University of Milan-Bicocca, Milan, Italy. Electronic address: alexandra_liava@yahoo.it.
authors: Alexandra
authors: A
authors: Liava
authors: "Claudio Munari" Epilepsy Surgery Centre, Niguarda Ca' Granda Hospital, Milan, Italy.
authors: Roberto
authors: R
authors: Mai
authors: "Claudio Munari" Epilepsy Surgery Centre, Niguarda Ca' Granda Hospital, Milan, Italy.
authors: Francesco
authors: F
authors: Cardinale
authors: "Claudio Munari" Epilepsy Surgery Centre, Niguarda Ca' Granda Hospital, Milan, Italy.
authors: Laura
authors: L
authors: Tassi
authors: "Claudio Munari" Epilepsy Surgery Centre, Niguarda Ca' Granda Hospital, Milan, Italy.
authors: Giuseppe
authors: G
authors: Casaceli
authors: "Claudio Munari" Epilepsy Surgery Centre, Niguarda Ca' Granda Hospital, Milan, Italy.
authors: Francesca
authors: F
authors: Gozzo
authors: "Claudio Munari" Epilepsy Surgery Centre, Niguarda Ca' Granda Hospital, Milan, Italy.
authors: Massimo
authors: M
authors: Cossu
authors: "Claudio Munari" Epilepsy Surgery Centre, Niguarda Ca' Granda Hospital, Milan, Italy.
authors: Lino
authors: L
authors: Nobili
authors: "Claudio Munari" Epilepsy Surgery Centre, Niguarda Ca' Granda Hospital, Milan, Italy.
authors: Laura
authors: L
authors: Castana
authors: "Claudio Munari" Epilepsy Surgery Centre, Niguarda Ca' Granda Hospital, Milan, Italy.
authors: Ivana
authors: I
authors: Sartori
authors: "Claudio Munari" Epilepsy Surgery Centre, Niguarda Ca' Granda Hospital, Milan, Italy.
authors: Giorgio
authors: G
authors: Lo Russo
authors: "Claudio Munari" Epilepsy Surgery Centre, Niguarda Ca' Granda Hospital, Milan, Italy.
authors: Stefano
authors: S
authors: Francione
mesh_terms: D000293:Adolescent; D000328:Adult; D002540:Cerebral Cortex / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D004569:Electroencephalography; D004827:Epilepsy / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D006801:Humans; D007223:Infant; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome; D055815:Young Adult
keywords: Epilepsy duration; Epilepsy surgery; Posterior cortex; Stereoelectroencephalography; Surgical outcome