SURGICAL-MANAGEMENT OF EPILEPSY ASSOCIATED WITH DEVELOPMENTAL ANOMALIES OF THE BRAIN

BACKGROUND Disorders as the central nervous system forms during the pr e-, peri-, or postnatal periods may cause developmental anomalies of t he brain. Such maldevelopment, ranging from slight to severe disturban ces, appears to be the mechanism for causing childhood seizure disorde rs. However, the surgical treatment of these lesions responsible for i ntractable partial seizures remains undefined. METHOD Twenty-two patie nts (8 males, 14 females) with chronic seizure disorders associated wi th structural lesions of the brain related to developmental anomalies were surgically treated (1983 to 1990). Imaging studies, intraoperativ e findings, and histology showed 12 lesions in the temporal lobe, 1 in the frontal lobe, and 9 of multilobular involvement. All patients had preoperative prolonged electroencephalography with sphenoidal electro des. Sixteen patients had intraoperative electrocorticography. All und erwent craniotomy and total excision of the epileptogenic zone unless the speech or motor cortex was involved. RESULTS Results of postoperat ive seizure control during the follow-up period (mean 5.5 years) were excellent (seizure-free) in 12 patients (including four with complete and eight with incomplete excision of the structural lesion), good in seven, fair in two, and poor in one. CONCLUSION Seizure control is pos sible for patients with total excision of the epileptogenic zone, even including those with incomplete excision of a structural lesion cause d by developmental brain anomalies.