Surgical treatment of patient with a focal cortical dysplasia located in the dominant temporal lobe: case report

Sitnikov A. R., Grigoryan Yu. A., Stepanyan M. A.

The Federal Centre of Neurosurgery, Moscow, Russia

Rationale: Focal cortical dysplasia (FCD) is a common reason of epilepsy in which the surgical outcomes depend on an anomaly location. We present the clinical case of successful surgical treatment of patient with epilepsy due to FCD located in the dominant temporal lobe.

Results: The 18 year old, right-handed male patient was admitted with complex partial medically intractable seizures (3 – 4 seizures weekly). His neurological status wasn’t remarkable. Neuro-psychological assessment showed the left hemisphere dominancy. During the video EEG the typical epileptic activity was registered in the left temporal lobe. MRI scan showed the moderate cortical thickening, presumably FCD, in the posterior compartment of middle temporal gyrus correlated with EEG data. Also the cyst in left occipital lobe was found. The cortical surface electrodes were implanted over the left temporal lobe for a neurophysiologic monitoring. The monitoring and registration of neuronal activity during the seizures continued 3 days. The pathological activity was registered in the middle and superior temporal gyri close to sensory speech centre. Afterwards the focal cortical resection in the middle temporal gyrus was performed without postoperative deterioration of speech and memory functions. The histological examination of surgical specimen identified as FCD. The postoperative outcome was I class on the Engel’s scale. During the postoperative follow-up the simple partial seizures reoccurred two times.

Conclusion: FCD in the dominant hemisphere with intractable seizures can be carefully treated surgically using the preoperative invasive electrophysiological monitoring without following deterioration of cortical functions.

Опубликовано The "5th Kuopio Epilepsy Symposium" in Kuopio, March 28-29, 2008