Awake surgery with mapping-based resection to treat focal epilepsy in eloquent brain areas.
Acta Neurochir. 2024-10-29; 166(1):
DOI: 10.1007/s00701-024-06326-1
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Guibourd de Luzinais M(1), Engelhardt J(2)(3), Ollivier M(4), Planchon C(2)(3),
Gallice T(2), Michel V(5), de Montaudouin M(5), Aupy J(5), Penchet G(2).
Author information:
(1)Department of Neurosurgery, Bordeaux University Hospital Center, Bordeaux,
Cedex, France. .
(2)Department of Neurosurgery, Bordeaux University Hospital Center, Bordeaux,
Cedex, France.
(3)Mathematics Institute of Bordeaux, University of Bordeaux, Bordeaux, France.
(4)Department of Diagnostic and Therapeutic Neuroradiology, Bordeaux University
Hospital Center, Bordeaux, France.
(5)Department of Neurology, Section of Epileptology, Bordeaux University
Hospital Center, Bordeaux, France.
OBJECTIVES: Resective surgery is a potential therapeutic option for select
patients with intractable focal epilepsy. However, the presence of ictal onset
zones within or surrounding highly functional brain areas presents a surgical
challenge, leading to poor seizure and functional outcomes. This report
describes our experiences with awake mapping-tailored resection of epileptogenic
areas involving eloquent cortices and evaluates their feasibility, tolerance,
limitations, and significance.
METHODS: The study included patients who underwent surgery for drug-resistant
focal epilepsy at our center under awake conditions. The surgical approach aimed
to achieve maximum resection of preoperatively defined epileptogenic zones,
considering the boundaries defined by surrounding functional areas. We collected
data on preoperative evaluations, intraoperative tests and seizures,
postoperative status epilepticus, and neurological functional outcomes.
RESULTS: We included 22 patients, 10 of whom had non-lesional epilepsy.
Language, motor function, and sensory function were at risk in 19, 9, and 4
patients, respectively. Resection was performed as planned in 14 (63.6%)
patients, while modifications were necessary in 8 (36.4%) patients due to
functional constraints. The mean follow-up duration was 29.8 months. Sixteen
(72.7%) patients achieved Engel class Ia outcomes, indicating seizure freedom,
while none of the patients experienced clinically significant permanent
postoperative neurological deficits.
SIGNIFICANCE: Resective surgery with intraoperative brain mapping under awake
conditions was a valid treatment option for achieving a cure in cases of
drug-resistant focal epilepsy, even in situations in which the condition is
considered inoperable due to the risk of significant postoperative neurological
deficits.
© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Austria,
part of Springer Nature.