Neurosurgical management of intractable rolandic epilepsy in children: role of resection in eloquent cortex

Object. The author undertook this study to review their experience with cortical resections in the rolandic region in children with intractable epilepsy. Methods The authors retrospectively reviewed the medical records obtained in 22 children with intractable epilepsy arising from the rolandic region. All patients underwent preoperative electroencephalography (EEG), MR Imaging. prolonged video-EEG recordings. functional MR imaging, magnetoencephalography, and in some instances PET/SPECT studies In 21 patients invasive subdural grid and depth electrode monitoring was performed Resection of the epileptogenic zones in the rolandic. region was undertaken in all cases Seizure outcome was graded according to the Engel classification Functional outcome was determined using validated outcome scores. Results There were 10 girls and 12 boys. whose mean age at seizure onset was 3 2 years The mean age at surgery was 10 years. Seizure duration prior to surgery was a mean of 7 4 years Nine patients had preoperative hemiparesis Neuropsychological testing revealed impairment in some domains in 19 patients in whoa 1 evaluation was possible. Magnetic resonance imaging abnormalities were identified in 19 patients Magnetoencephalography was performed in all patients and showed perirolandic spike clusters on the affected side. in 20 patients The mean duration of invasive monitoring wits 4 2 clays The mean number of seizures during the period of invasive monitoring was 17 All patients underwent resection that involved primary motor and/or sensory cortex The most common pathological entity encountered was cortical dysplasia. in 13 children Immediately postoperatively. 20 patient, had differing degrees of hemiparesis. from mild to severe The hemiparesis improved in all affected patients by 3-6 months postoperatively, With at mean follow-up of 4 1 years (minimum 2 years). seizure outcome in 14 children (64%) was Engel Class 1 and seizure outcome in 4 (18%) was Engel Class II In this series. seizure outcome following perirolandic resection was intimately related to the child's age at the time of surgery By univariate logistic regression analysts, age at surgery was a statistically significant factor predicting seizure outcome (p < 0 024). Conclusions. Resection of rolandic cortex for intractable epilepsy is possible with expected morbidity Accurate mapping of regions of functional cortex and epileptogenic zones may lead to Improved seizure outcome in children with intractable rolandic epilepsy It is important to counsel patients and families preoperatively to prepare than for possible worsened functional outcome involving motor. sensory and/or language pathways. (DOI. 10.3171/2009.3.PEDS08459)