Abstracts

RATIONALE: Large frontal and parietal resections may be needed for the treatment of refractory epilepsy. There has always been a great concern related to the potential neurologic and neuropsychological morbidity of such procedures. This paper describes the main acute postoperative syndromes observed in patients submitted to large frontal or parietal resections. METHODS: Sixteen patients submitted to frontal (5 left, 11 right)(Group I) and 9 to parietal (5 left, 4 right)(Group II) cortical resections were studied. All were submitted to surgery under general anesthesia and intra- or preoperative motor strip mapping. A postoperative MRI documented the extention of the resection in all patients. RESULTS: Seven Group I patients disclosed postoperative signs or symptoms suggestive of a frontal lobe syndrome: 7 had apathy (mean duration= 7 days,range 2-10; 3 with left and 4 with right side resections), 7 had urinary incontinence (mean duration= 9 days, range 1-10; 4 with left and 3 with right side resections), 1 had transient hemiparesis (7 days; right side resection) and 2 had hemineglect (5 and 7 days respectively, both with non-dominant resections). Four Group II patients disclosed an acute parietal postoperative syndrome: 2 patients had face recognition deficits (1 transient=14 days and 1 permanent), 1 had permanent grade IV hemiparesis (V=normal) and contralateral paresthesias were seen in 2 (5 days' duration in both). CONCLUSIONS: Acute postoperative syndromes may occur in up to 50% of the patients submitted to extensive frontal or parietal resections. They are usually transient, lasting less then 10 days. The postoperative period is usually well tolerated by the patients. Large parietal resections seemed to be associated with a higher rate of acute neurologic and neuropsychologic morbidity when compared to as extensive frontal lobe resections.