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One-Stage, Limited-Resection Epilepsy Surgery for Bottom-of-Sulcus Dysplasia.

Emma Macdonald-Laurs¹, Wirginia J Maixner¹, Catherine A Bailey¹

¹From the Departments of Neurology (E.M.-L., C.A.B., S.M.B., R.J.L., J.L.F., A.S.H.), Neurosurgery (W.J.M., J.Y.-M.Y., A.E.L.W., A.W.), Medical Imaging (S.A.M., M.J.K., P.F.), Anatomical Pathology (D.M., C.D.), Psychology (J.A.W.), and Anaesthesia (A.D.), The Royal Children's Hospital; Murdoch Children's Research Institute (E.M.-L., W.J.M., S.M.B., S.A.M., J.Y.-M.Y., A.E.L.W., C.D., A.D., K.P., R.J.L., A.W., A.S.H.); University of Melbourne (E.M.-L., W.J.M, S.M.B., S.A.M., J.Y.-M.Y., A.E.L.W., M.J.K., C.D., A.D., R.J.L., A.S.H.); and Florey Institute of Neuroscience and Mental Health (A.E.L.W., G.D.J., A.S.H.), Parkville, Victoria, Australia.

|May 5, 2021

Summary

A minimally invasive surgery called corticectomy effectively controls seizures in patients with bottom-of-sulcus dysplasia (BOSD). This procedure, guided by MRI and electrocorticography (ECoG), offers a safe and successful treatment option for drug-resistant epilepsy.

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Area of Science:

Neurosurgery
Epileptology
Neuroradiology

Background:

Drug-resistant focal epilepsy often presents with subtle cortical malformations.
Bottom-of-sulcus dysplasia (BOSD) is an MRI-detectable malformation associated with intractable seizures.
Effective surgical targets for BOSD remain a focus of epilepsy research.

Purpose of the Study:

To evaluate the efficacy and safety of a 1-stage, limited corticectomy for MRI-positive BOSD.
To determine if limited resection controls seizures in patients with BOSD.
To assess the need for additional monitoring during surgery for BOSD.

Main Methods:

Retrospective review of patients with drug-resistant focal epilepsy and MRI-positive BOSD.
Surgical resection guided by MRI and electrocorticography (ECoG).
Analysis of clinical, neuroimaging, ECoG, operative, and histopathology data.

Main Results:

Eighty-seven percent of patients achieved seizure freedom at a median follow-up of 6.3 years.
Thirty-one patients were seizure-free and off antiseizure medication.
Limited corticectomy to the dysplastic sulcus was effective in most cases.

Conclusions:

1-stage, limited corticectomy guided by MRI and ECoG is a safe and effective treatment for BOSD.
Intracranial EEG monitoring and functional mapping may not be necessary for BOSD resection.
This approach offers a promising surgical strategy for seizure control in BOSD patients.