Focal Cortical Dysplasia: A Review of Pathological Features, Genetics, and Surgical Outcome

Vincent Y. Wang, M.D. Ph.D.; Edward F. Chang, M.D.; Nicholas M. Barbaro, M.D.

Disclosures

Neurosurg Focus. 2006;20(1) 

In This Article

Conclusions

Surgery for FCD can benefit many patients, especially if complete resection of abnormal regions is possible. The preoperative workup should include high-resolution MR imaging, videotelemetry, and EEG. It is important to recognize that MR imaging findings may be normal in some cases and that regions of histological FCD may extend beyond the abnormal areas identified on MR images. Intraoperative monitoring frequently includes electrocorticography, cortical stimulation for motor mapping, and, sometimes, somatosensory evoked potentials if the lesion is near the central sulcus. In recent years, frameless navigation systems have been useful in resection. The best outcomes result when resection of areas with radiological and electrophysiological abnormalities can be achieved. When the results from published descriptions of surgical series were combined, approximately 60% of patients with FCD experienced good seizure control after resection of the lesion ( Table 1 ). As normal radiological studies do not preclude a diagnosis of cortical dysplasia, only careful and complete histopathological examination of tissue removed from patients with pharmacoresistant epilepsy will help to determine the percentage of cases where FCD exists. Neuroimaging techniques will continue to improve over time and will likely be more useful for identifying the extent of lesions in the future. Co-registration of data from high-resolution MR imaging, EEG, magnetoencephalography, positron emission tomography, and functional MR imaging will allow maximal resection of the abnormal regions with less morbidity.

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