Epilepsy surgery of the cingulate gyrus and the frontomesial cortex.

Abstract:

BACKGROUND:Epilepsy surgery involving the cingulate gyrus has been mostly presented as case reports, and larger series with long-term follow-up are not published yet. OBJECTIVE:To report our experience with focal epilepsy arising from the cingulate gyrus and surrounding structures and its surgical treatment. METHODS:Twenty-two patients (mean age, 36; range, 12-63) with a mean seizure history of 23 years (range, 2-52) were retrospectively analyzed. We report presurgical diagnostics, surgical strategy, and postoperative follow-up concerning functional morbidity and seizures (mean follow-up, 86 months; range, 25-174). RESULTS:Nineteen patients showed potential epileptogenic lesions on preoperative magnetic resonance imaging (MRI). All patients had noninvasive presurgical workup; 15 (68%) underwent invasive Video-electroencephalogram (EEG)-Monitoring. In 12 patients we performed extended lesionectomy according to MRI; an extension with regard to EEG results was done in 6 patients. In 4 patients, the resection was incomplete because of the involvement of eloquent areas according to functional mapping results. Eight pure cingulate resections (36%, 3 in the posterior cingulate gyrus) and 14 extended supracingular frontal resections were performed. Nine patients experienced temporary postoperative supplementary motor area syndrome after resection in the superior frontal gyrus. Two patients retained a persistent mild hand or leg paresis, respectively. Postoperatively, 62% of patients were seizure-free (International League Against Epilepsy [ILAE] 1), and 76% had a satisfactory seizure outcome (ILAE 1-3). CONCLUSION:Epilepsy surgery for lesions involving the cingulate gyrus represents a small fraction of all epilepsy surgery cases, with good seizure outcome and low rates of postoperative permanent deficits. In case of extended supracingular resection, supplementary motor area syndrome should be considered.

journal_name

Neurosurgery

journal_title

Neurosurgery

authors

von Lehe M,Wagner J,Wellmer J,Clusmann H,Kral T

doi

10.1227/NEU.0b013e318237aaa3

subject

Has Abstract

pub_date

2012-04-01 00:00:00

pages

900-10; discussion 910

issue

4

eissn

0148-396X

issn

1524-4040

journal_volume

70

pub_type

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