Surgical Treatment for Perirolandic Lesional Epilepsy

Summary: Our purpose was to evaluate the safety and efficacy of surgical treatment for perirolandic lesional epilepsy. We analyzed the records of 14 consecutive patients who underwent a stereotactic lesionectomy for intractable partial epilepsy between 1985 and 1994. All patients had a neuroimaging‐identified lesion in the perirolandic cortex. The mean duration of follow‐up was 6 years (range 1–11 years). Thirteen patients (93%) had a significant improvement in seizure tendency. Eleven patients (78%) were rendered seizure‐free. Morbidity occurred in only one patient, who experienced an increased monoparesis after surgery. Stereotactic lesionectomy is an effective surgical strategy in patients with perirolandic lesional epilepsy. The recent development of functional brain imaging using subtraction ictal single‐photon emission computed tomography co‐registered with volumetric magnetic resonance imaging has been shown to be a reliable indicator of epileptic brain tissue that may significantly alter the preoperative evaluation in patients with extratemporal seizures. Summary: Stereotactic lesionectomy in a consecutive series of patients with medically refractory partial seizures related to perirolandic lesional epilepsy proved to be safe and effective. The rationale for the operative procedure was to resect the neuroimaging‐identified abnormality. The only patient who did not experience an excellent outcome, i.e., Class I or 11, was an individual who did not have a pathologically verified foreign‐tissue lesion. The advantages of this operative approach include the use of a surgical strategy that does not require extensive preoperative functional mapping and the ability to excise the pathologic lesion using a small cranial trephine. The main disadvantage of stereotactic neurosurgery for epilepsy is the inability to resect the epileptogenic zone, which may be necessary to render the patient seizure‐free. The procedure is also not “risk‐free,” as demonstrated by the patient who experienced an increased hemiparesis.