Abstracts

RATIONALE: Cortectomies can cure refractory epilepsy in selected patients. However, cortical resections may inevitably be associated with arterial brain infarction. The goal of this study was to characterize patterns of brain infarction associated with specific types of cortectomies.
METHODS: Preoperative and postoperative MRIs were analyzed in fifty consecutive patients undergoing cortectomy. Based on the classical microvascularization studies of Lazorthes, cortectomies were divided into five categories and the patern of ensuing brain infarction was studied. Each patient was assessed for associated neurological deficit.
RESULTS: Simple gyrectomies (type 1) were associated with subtle linear or no subcortical infarctions. Multiple gyrectomies (type 2) were associated with pyramidal-shaped infarctions that reached the ventricle. Insulectomies (type 3) and operculectomies (type 4) were associated with infarctions that could reach the corona radiata and the corticospinal tract. Orbitofrontal resections (type 5) could be associated with lenticulostriate infarctions. Most adverse clinical consequences occured with type 3, 4 or 5 resections. Fortunately, postoperative neurological deficits were either transient or mild in most patients studied.
CONCLUSIONS: Each type of cortectomy is associated with a specific and predictable pattern of brain infarction, the consequence of which must be considered before surgery. The present classification permits an estimation of the risk of postoperative neurological morbidity in candidates for cortectomy.