Resection of the epileptogenic area in critical cortex with the aid of a subdural electrode grid

Stereotact Funct Neurosurg. 1990:54-55:34-45. doi: 10.1159/000100187.

Abstract

Electrode grids were implanted subdurally in 28 patients with epilepsy. In 16 of the 28 patients, an epileptogenic area was located in the speech-dominant left temporal lobe. Recordings made with the grid revealed that the epileptogenic areas in the patients varied widely in extent: the area was confined within the first 10 mm of the temporal lobe in some patients or it was scattered throughout the entire anterior to posterior 80-mm extend in others. Resection of the epileptogenic area was adjusted accordingly in each case. In 6 of 16 patients who were left-hemisphere-dominant for language, up to 55-80 mm from the tip of the temporal lobe was removed, a measure that exceeds the conventional limit of 50 mm from the tip of the dominant hemisphere. In the remaining 12 of the 28 patients, epileptogenic areas were located in a combination of several lobes. In 7 of these 12 patients, the epileptogenic area encompassed the rolandic area; it was removed without deficit in 4 patients and with expected deficit in 3. Of the latter 3 patients, 1 patient underwent hemispherectomy, and a large portion of the epileptogenic rolandic cortex in the frontal and parietal lobes was removed from the other 2. There were 2 cases of grid-related infection, which cleared with antibiotic treatment; there were no lasting complications of grid implantation in any patient. There was no mortality. Electroencephalographic recording and functional mapping using subdural electrode grids allow a tailored, maximal resection of epileptogenic tissue with minimal injury to critical cortex.

MeSH terms

  • Brain Diseases / physiopathology
  • Brain Diseases / surgery
  • Brain Mapping / instrumentation*
  • Brain Neoplasms / physiopathology
  • Brain Neoplasms / surgery
  • Cerebral Cortex / physiopathology
  • Cerebral Cortex / surgery*
  • Computer Graphics
  • Cysts / physiopathology
  • Cysts / surgery
  • Dominance, Cerebral / physiology*
  • Electrodes, Implanted
  • Electroencephalography / instrumentation*
  • Epilepsy / physiopathology
  • Epilepsy / surgery*
  • Hippocampus / physiopathology
  • Hippocampus / surgery
  • Humans
  • Psychosurgery
  • Signal Processing, Computer-Assisted / instrumentation
  • Speech / physiology*
  • Stereotaxic Techniques / instrumentation*
  • Temporal Lobe / physiopathology
  • Temporal Lobe / surgery