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

S. Uematsu, R. Lesser, R. Fisher, G. Krauss, J. Hart, E. P. Vining, J. Freeman, B. Gordon

Research output: Contribution to journalArticle

28 Scopus citations

Abstract

Electrode grids were implanted sub durally 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.

Original languageEnglish (US)
Pages (from-to)34-45
Number of pages12
JournalStereotactic and Functional Neurosurgery
Volume54
Issue number1-8
DOIs
StatePublished - Jan 1 1990

Keywords

  • Epilepsy
  • Epilepsy surgery
  • Motor cortex
  • Speech
  • Speech-dominant temporal lobe
  • Subdural grid
  • Temporal lobe

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

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