Surgical outcomes and motor function in pediatric peri-Rolandic epilepsy: A single center's experience with 152 cases

Peri-Rolandic epilepsy in pediatric patients presents unique surgical challenges due to the involvement of eloquent cortical regions, where resective surgery carries risks of permanent neurological deficits. This study investigates lesion distribution, surgical outcomes, and the relationship between lesion location and postoperative motor function in children undergoing surgery for drug-resistant epilepsy in the peri-Rolandic area.

This retrospective study included 152 pediatric patients who underwent craniotomy for peri-Rolandic epilepsy between September 2014 and January 2023. Patients met the criteria of drug-resistant epilepsy, peri-Rolandic surgical resection, and a minimum follow-up of 6 months. Preoperative evaluations included video electroencephalography (VEEG), magnetic resonance imaging, and positron emission tomography, with invasive monitoring in select cases. Motor function and seizure outcomes were assessed using Engel classification and multivariate logistic regression to examine correlations between lesion location, motor deficits, and seizure prognosis.

Lesions were most commonly found in the central operculum, affecting 66% of patients. Postoperative seizure freedom (Engel class I) was achieved in 80% of cases. Among patients with preoperative motor deficits (28%), 39.5% fully recovered after surgery, whereas 27.9% experienced permanent severe impairments. Resecting lesions in the precentral gyrus, paracentral lobule, and premotor cortex was significantly associated with long-term motor dysfunction. There was no significant association between the location of the lesion and postoperative seizure control.

Surgery for peri-Rolandic epilepsy in children is effective in achieving seizure control, although it carries risks of motor dysfunction. Lesion location should be carefully considered to optimize surgical outcomes, balancing seizure control with the preservation of motor function.