Abstracts

RATIONALE: Frontal lobe resections have been carried out for the treatment of refractory epilepsy since the end of the XIX century. The size of frontal resections needed to render patients seizure-free is usually larger than that need in temporal lobe epilepsy. SMA resections have been related to a higher rate of surgical morbidity. This paper reports our results obtained in patients with refractory epilepsy submitted to SMA resections. METHODS: Sixteen patients with SMA-type seizures submitted to SMA resections were studied. In 4, a selective removal of the SMA was carried out (Group I) while in 12 there was an additional cortical removal (Group II). All Group I patients had left side resections; 11 group II patients were operated on the right and 1 on the left side. Mean age at surgery was 24 years (4-42); mean seizure frequency was 2x/day (1x/week-10x/day) and the mean follow-up time was 20 months (3-48). RESULTS: Pathological examination disclosed cortical dysplasia (n=1), gliosis (n=2) and oligodendroglioma (n=1) in group I patients. Group II patients' pathology included gliosis (n=2), neurocysticercosis (n=1), cortical dysplasia (n=6), DNET (n=1), ganglioglioma (n=1) and oligodendroglioma (n=1). Three group I and 11 group II patients have been seizure-free since surgery. One patient from each group is in Engel's class II (one with cortical dysplasia and one with gliosis). There was no neurological morbidity lasting more than 10 days. CONCLUSIONS: Frontal lobe resections might be limited to the SMA or include additional cortex. Good surgical results can be obtained in patients with SMA-type seizures. Despite its location just near to the motor strip, long lasting hemiparesis is very unfrequently seen postoperatively and most of the patients leave the hospital with no noticeable neurologic abnormalities.