Central quadrantotomy for intractable childhood epilepsy: operative technique and functional neuroanatomy.

Details

Serval ID
serval:BIB_BC05E9BBFEE3
Type
Article: article from journal or magazin.
Publication sub-type
Case report (case report): feedback on an observation with a short commentary.
Collection
Publications
Institution
Title
Central quadrantotomy for intractable childhood epilepsy: operative technique and functional neuroanatomy.
Journal
Journal of neurosurgery. Pediatrics
Author(s)
Cossu G., Aureli V., Roulet-Perez E., Thomas C., Marston J.S., Pralong E., Messerer M., González-López P., Daniel R.T.
ISSN
1933-0715 (Electronic)
ISSN-L
1933-0707
Publication state
Published
Issued date
01/04/2023
Peer-reviewed
Oui
Volume
31
Number
4
Pages
333-341
Language
english
Notes
Publication types: Case Reports ; Journal Article
Publication Status: epublish
Abstract
Refractory subhemispheric epilepsy has been traditionally treated by resection. The last few decades have seen the emergence of disconnective techniques, for both hemispheric and subhemispheric disease. The aim of this study was to describe the technique for a disconnective surgery for large epileptogenic lesions involving the central (perirolandic cortices), parietal, and occipital lobes. This junctional cortex within the hemisphere (in contrast to anterior and posterior quadrantotomies) presents unique challenges when contemplating a complete disconnection of the region. The surgical technique is achieved through six distinct steps: fronto-central, inferior frontoparietal, lateral temporo-occipital, medial frontal, basal temporo-occipital, and posterior parasagittal callosal disconnections. The functional neuroanatomy of each step is described, along with cadaveric dissections. The authors describe this technique and include a case description of a young girl who presented with childhood-onset intractable epilepsy associated with cognitive stagnation. The postoperative seizure outcome in this patient remains excellent at 2 years' follow-up, with gains in cognition and behavior. Excellent seizure outcomes can be achieved if the network encompassing the entire epileptogenic cortex is disconnected while ensuring preservation of fiber systems that link functionally eloquent uninvolved cortices adjacent to the central quadrant.
Keywords
Female, Humans, Child, Drug Resistant Epilepsy/diagnostic imaging, Drug Resistant Epilepsy/surgery, Epilepsy/diagnostic imaging, Epilepsy/surgery, Epilepsy/pathology, Neuroanatomy, Cerebral Cortex/diagnostic imaging, Cerebral Cortex/surgery, Seizures, Treatment Outcome, Magnetic Resonance Imaging, Electroencephalography, central quadrantotomy, disconnective surgery, refractory epilepsy, subhemispheric epilepsy, surgical technique, telencephalic flexure, white matter
Pubmed
Web of science
Create date
03/03/2023 17:51
Last modification date
08/10/2023 7:00
Usage data