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2020, Number 1

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Rev Cubana Neurol Neurocir 2020; 10 (1)

Epileptogenic zone surgery located in an eloquent area of the frontal lobe in an adolescent with epilepsy

Santos SA, Morales CLM, Dearriba RMU, Portela HL, Rio VV, Batista García-Ramo K

Language: Spanish
References: 22
Page: 1-15
PDF size: 493.62 Kb.


ABSTRACT

Objective: To describe the results of pre-surgical, trans-surgical and post-surgical assessment of an adolescent with drug-resistant epilepsy and an estimated epileptogenic zone in an eloquent area of the left frontal lobe.
Clinical case: Male patient, 18 years old, who had drug-resistant left frontal epilepsy since the age of three. Before surgery, the patient suffered 30 and 40 daily disconnection episodes, atonic and, occasionally, daily bilateral clonic tonic. The pre-surgical evaluation identified the left frontal, non-lesional ictal onset zone using 3-tesla magnetic resonance imaging. An interictal / ictal single photon emission computed tomography corrected with magnetic resonance imaging was indicated, which identified left frontal hyperperfusion. Surgery was performed using somatosensory-evoked potentials to identify the central sulcus, direct cortical stimulation to map the primary motor area, and intraoperative electrocorticography to delimit the resection area. Combined disconnective technique (anterior callosotomy) and resective technique of the left superior and middle left gyrus was used, modifying the electrical pattern in the electrocorticography after surgery. The pathological result was type IA focal cortical dysplasia. In the post-surgical follow-up, the patient only has 2-3 weekly crises.
Conclusions: Surgery is feasible in a non-lesional extra-temporal epilepsy with an epileptogenic zone that includes eloquent frontal lobe areas in our country with minimal invasiveness and good results.


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