Abstracts

Rationale: Resective surgery for epileptogenic lesion adjacent to the pyramidal tract like the bottom of precentral sulcus or the upper limit of posterior insula can cause postoperative motor deficit. The ischemia of deep white matter is regarded as one of the cause of this. To avoid such complication, we applied a surgical technique in the resective surgery. We validate the efficacy of this method and report surgical outcomes in this presentation.Methods: 7 patients were assigned in this study who were underwent respective surgery for MRI visible lesion adjacent to the pyramidal tract from 2014-2015. Median age at surgery was 3 years (4 months- 43 years). Clinical presentation, seizure outcome and complication (motor deficit) were examined.Results: MRI lesion located at superior frontal sulcus-gyrus in 2, inferior frontal gyrus, operculum, or insula in 5. Intracranial electrodes implant was performed in 5. We preserved subtle lesion where was presumed as blood supply area of the pyramidal tract in all cases. All but 2 (71.4%) were seizure free at the last follow-up (mean follow-up duration: 6.3 months, 1-14 months). 3 patient developed transient motor weakness for 2 weeks, and no patient developed permanent motor impairment. Pathological diagnoses of resected specimen were focal cortical dysplasia (FCD) type2a in 3, type2b in 2, DNT in 1, and cortical tuber in 1.Conclusions: Resective surgery using with our method for lesion adjacent to pyramidal tract could provide the preservation of motor function, and short-term seizure outcome is good. This technique is probably helpful for functional preservation and seizure outcome compatibility, but long-term observation of seizure outcome will be needed.