Lesionectomy as management for super-refractory status epilepticus due to focal cortical dysplasia: illustrative case

Super-refractory status epilepticus (SRSE) is characterized by seizure activity that continues 24 hours or more despite the initiation of anesthetic therapy; it is a condition where epileptic activity may persist uninterrupted despite adequate anesthetic management, recur during ongoing anesthetics, or relapse after anesthesia withdrawal, requiring its readministration. In selected cases, surgical procedures such as lesionectomy may serve as a valuable treatment alternative.

A 25-year-old female with a known diagnosis of focal epilepsy secondary to a focal cortical dysplasia (FCD) was admitted to the emergency department; despite treatment with multiple antiseizure medications, seizure activity persisted, and she developed an SRSE. MRI showed right FCD at the level of the superior frontal sulcus, with cortical thickening, an abnormal gray-white matter interface, and a transmantle sign. Because of the SRSE, she underwent a lesionectomy guided by intraoperative electrocorticography. Histopathology confirmed FCD type IIb. Postoperatively, the patient's SRSE resolved, and she remains seizure free.

This case highlights that lesionectomy, combined with intraoperative electrocorticography, should be considered a viable strategy for managing SRSE secondary to FCD. https://thejns.org/doi/10.3171/CASE25306.