Cortical Disconnexion as a New Alternative Surgical Treatment for Intractable Frontal or Temporal Epilepsy
Abstract number :
2.150
Submission category :
Year :
2000
Submission ID :
1238
Source :
www.aesnet.org
Presentation date :
12/2/2000 12:00:00 AM
Published date :
Dec 1, 2000, 06:00 AM
Authors :
Stephan Chabardes, Philippe Kahane, Dominique Hoffmann, Lorella Minotti, Ahmed Ashraf, Adnan Koudsie, Alim L Benabid, Dept des neurosciences Clin et biologiques, Grenoble, France.
Temporal lobectomy and selective cortical resections are well established surgical procedures to cure intractable epilepsies. In order to simplify the surgical act, and based on the experience of disconnexion used for hemispherotomy, we developped a new surgical approach consisting in selective disconnexion of the epileptogenic area. 14 patients with intractable partial seizure (aged from 15 to 47 years) were treated by image guided cortical disconnexion. All but 2 were suffering from cryptogenic epilepsy. Stereotaxic intra cerebral EEG recordings were previously performed in 11 cases while the remaining 3 patients were operated without invasive procedure. Temporal lobe disconnexion (n=6) consisted first in disconnecting the posterior part of the superior, mid, inferior and basal temporal gyri, sparing all the cortical vessels and second, using a transylvian sub arachnoidian approach to interrupt the fronto-temporal tract. The posterior part of the hippocampus and para hippocampal gyrus were finally disconnected using a transventricular route. When the epileptogenic area extended to the fronto-basal cortex (n= 2), the disconnexion involved first the pre-central operculum and second, the posterior and anterior part of the inferior frontal sulcus in order to join the frontal pole. The mesial aspect of the frontal disconnexion was achieved using a trans-white matter route. Surgery combined standard temporal lobectomy and fronto-basal disconnexion in 4 patients who had a mesio-temporal lesion. Frontal and occipital disconnexion were performed in the remainings 2 patients. The only complications to deplore consisted in transient contra-lateral facial weakness when fronto-temporal disconnexion were performed and in hemianopsia after occipital disconnexion. Preliminary results showed that 12 of the 14 patients with a post-operative follow-up > 12 months were seizure free after sugery. Surgical cortical tailored disconnexion is feasible, safe and leads to results as good as those obtained with surgical resections. It needs longer follow-up to determine wether the early seizure free outcome is durable without any complications.