Abstracts

Rationale: To assess the efficacy and safety of resective epilepsy surgery in unselected patients with both lesional and nonlesional perirolandic epilepsy. Methods: We identified 15 consecutive patients who underwent perirolandic cortical resection (without multiple subpial transections) for intractable epilepsy between 1995 and 2009. This number represents 5.2% of all resective epilepsy surgeries at Brno Epilepsy Center. Detailed analysis was performed in 13 patients with minimal postoperative follow-up 2 years (average 7 years, std. 4.1). The average age at the time of surgery was 27 years (range 13-50 years). Preoperative MRI disclosed restricted lesion in the perirolandic cortex in nine patients, in four subjects repeated thorough neuroimaging investigation failed to identify any structural pathology. Most patients underwent preoperative chronic invasive video-EEG (70%). Advanced neuroimaging (incl. fMRI, SISCOM, MRSI, VBM, etc.) was gradually introduced into preoperative set-up and completed whenever possible. Results: At last follow-up 9 patients were seizure-free - Engel class I (70%), 2 patients were in class II (15%), and 2 patients in class IV (15%). Postoperative neurological deficits were present in 4 patients (30%). In all these cases intensive rehabilitation resulted in a significant improvement, still mild functional deficit remains in 2 patients (15%). Conclusions: Resective epilepsy surgery is an effective and relatively safe therapeutical strategy in properly selected patients with intractable perirolandic epilepsy. This can be concluded for both lesional and nonlesional cases. Intensive multimodal preoperative investigation (incl. invasive EEG, cortical mapping, fMRI, SISCOM, VBM, etc.) and peroperative stereotactic navigation promise to further decrease a significant risk for residual functional deficit.