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Resective surgery for medically intractable epilepsy associated with schizencephaly
1Washington University Epilepsy Program, Department of Neurology and Neurological Surgery, St. Louis, Missouri.
Journal of Neurosurgery
|May 1, 1994
Summary
Schizencephaly, a brain malformation, can cause intractable epilepsy. Seizures may originate from cleft regions or temporal lobes, requiring comprehensive electroencephalographic (EEG) monitoring.
Area of Science:
- Neurology
- Neuroscience
- Developmental Neuroscience
Background:
- Schizencephaly is a rare congenital brain malformation characterized by a cleft in the cerebral hemispheres.
- Patients often present with neurological deficits, including intractable epilepsy.
Observation:
- Four adult patients with closed schizencephaly and medically intractable epilepsy underwent detailed neurological and electrophysiological evaluations.
- Magnetic resonance imaging (MRI) and computerized tomography (CT) were used for imaging.
- Scalp electroencephalography (EEG) and, in two cases, electrocorticography (ECoG) identified seizure origins.
Findings:
- Seizure origins were localized to the schizencephalic cleft regions in two patients.
- In the other two patients, seizures originated from the ipsilateral temporal lobe.
- Surgical interventions included temporal lobectomy and resection of pachygyria surrounding the cleft.
Implications:
- The abnormal cortical mantle lining schizencephalic clefts is potentially epileptogenic.
- Temporal allocortex can also serve as a seizure focus in these patients.
- Comprehensive EEG monitoring of the entire ipsilateral hemisphere and cleft region is crucial for accurate diagnosis and management.