Posterior quadrant disconnection for refractory epilepsy: A case series

Area of Science:

• Neurosurgery
• Epileptology
• Pediatric Neurology

Background:

• Epilepsy originating in the posterior head region often presents as medically refractory.
• Surgical interventions are considered for patients with drug-resistant epilepsy.
• Posterior quadrant disconnection is a potential surgical option for specific epilepsy syndromes.

Purpose of the Study:

• To evaluate the surgical outcomes and safety of posterior quadrant disconnection.
• To assess the efficacy of this procedure in patients with refractory epilepsy.
• To analyze the functional impact and morbidity associated with the surgery.

Main Methods:

• A retrospective analysis of seven consecutive patients undergoing posterior quadrant disconnection.
• Patients were evaluated at a level IV epilepsy center over three years.
• Comprehensive pre-surgical assessments included detailed history, neurological examination, video electroencephalography (EEG), neuropsychological testing, magnetic resonance imaging (MRI), diffusion tensor imaging (DTI), positron emission tomography (PET), functional MRI (fMRI), Wada test, and invasive monitoring.

Main Results:

• Seven patients (4 male, 3 female) with a mean age of 8.5 years were included.
• Four patients had left-sided and three had right-sided epilepsy pathologies.
• All patients achieved good seizure outcomes, with no reported functional disabilities or significant morbidity.

Conclusions:

• Posterior quadrant disconnection is an effective and safe surgical procedure for medically refractory epilepsy originating in the posterior quadrant.
• The surgery is well-tolerated across various age groups, particularly in children.
• Careful patient selection is crucial for achieving favorable outcomes without functional impairment.