Surgical management of epilepsy associated with developmental anomalies of the brain

Disorders as the central nervous system forms during the pre-, peri-, or postnatal periods may cause developmental anomalies of the brain. Such maldevelopment, ranging from slight to severe disturbances, appears to be the mechanism for causing childhood seizure disorders. However, the surgical treatment of these lesions responsible for intractable partial seizures remains undefined.

Twenty-two patients (8 males, 14 females) with chronic seizure disorders associated with structural lesions of the brain related to developmental anomalies were surgically treated (1983 to 1990). Imaging studies, intraoperative findings, and histology showed 12 lesions in the temporal lobe, 1 in the frontal lobe, and 9 of multilobular involvement. All patients had preoperative prolonged electroencephalography with sphenoidal electrodes. Sixteen patients had intraoperative electrocorticography. All underwent craniotomy and total excision of the epileptogenic zone unless the speech or motor cortex was involved.

Results of postoperative seizure control during the follow-up period (mean 5.5 years) were excellent (seizure-free) in 12 patients (including four with complete and eight with incomplete excision of the structural lesion), good in seven, fair in two, and poor in one.

Seizure control is possible for patients with total excision of the epileptogenic zone, even including those with incomplete excision of a structural lesion caused by developmental brain anomalies.