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Background and objective <p>Lesionectomy is a well-established surgical option for intractable epilepsy in children with focal lesions. However, seizure foci located in eloquent regions remain a challenge for this surgical entity. We report our surgical experience for lesionectomy involving the rolandic and perirolandic cortex in children with intractable epilepsy.</p> Methods <p>Medical records for children with intractable epilepsy arising from the rolandic and perirolandic cortex that underwent lesionectomy at our institution were reviewed retrospectively. All patients underwent preoperative electroencephalography (EEG), magnetic resonance imaging (MRI) epilepsy protocol, video-EEG recording, and some included positron emission tomography (PET) studies. Intraoperative electrocorticography (ECoG) was utilized for all patients. The seizure outcome was graded according to the Engel classification. Motor strength was evaluated using the Medical Research Council (MRC) scale.</p> Results <p>Ten patients were included (six boys, four girls). The mean age at seizure onset was 2.8&#xa0;years, the mean age at surgery was 6.3&#xa0;years, and the mean duration of seizures before surgery was 3.5&#xa0;years. The most common pathology was cortical dysplasia. Eight patients (72.7%) experienced new or worsening motor deficits immediately after surgery; however, all showed improvement in their motor deficits during follow-up. Five children (50%) have residual mild motor deficits at the last follow-up. With a mean follow-up of 6&#xa0;months, the seizure outcome was Engel Class I in 8 children (80%), Engel Class II in one child (10%), and Engel Class III in one child (10%).</p> Conclusions <p>The high rate of Engel Class I outcomes demonstrates that achieving seizure freedom is possible, even when the epileptic foci involve the Rolandic or perirolandic region. Immediate postoperative motor weakness is expected; however, the low incidence of permanent severe deficits demonstrates the effectiveness of the surgical strategies employed.</p>

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Lesionectomy involving rolandic and perirolandic cortex for intractable epilepsy in children: surgical strategy and motor outcome

  • 期刊论文

  • 发表日期：

    2025年11月12日

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  • Peh Hueh Low,
  • Mei Sin Lim,
  • Nadiah Ahmad Fuad,
  • Fadzlishah Johanabas,
  • Ahmad Rithauddin Mohamed,
  • Azmi Alias

摘要

Background and objective

Lesionectomy is a well-established surgical option for intractable epilepsy in children with focal lesions. However, seizure foci located in eloquent regions remain a challenge for this surgical entity. We report our surgical experience for lesionectomy involving the rolandic and perirolandic cortex in children with intractable epilepsy.

Methods

Medical records for children with intractable epilepsy arising from the rolandic and perirolandic cortex that underwent lesionectomy at our institution were reviewed retrospectively. All patients underwent preoperative electroencephalography (EEG), magnetic resonance imaging (MRI) epilepsy protocol, video-EEG recording, and some included positron emission tomography (PET) studies. Intraoperative electrocorticography (ECoG) was utilized for all patients. The seizure outcome was graded according to the Engel classification. Motor strength was evaluated using the Medical Research Council (MRC) scale.

Results

Ten patients were included (six boys, four girls). The mean age at seizure onset was 2.8 years, the mean age at surgery was 6.3 years, and the mean duration of seizures before surgery was 3.5 years. The most common pathology was cortical dysplasia. Eight patients (72.7%) experienced new or worsening motor deficits immediately after surgery; however, all showed improvement in their motor deficits during follow-up. Five children (50%) have residual mild motor deficits at the last follow-up. With a mean follow-up of 6 months, the seizure outcome was Engel Class I in 8 children (80%), Engel Class II in one child (10%), and Engel Class III in one child (10%).

Conclusions

The high rate of Engel Class I outcomes demonstrates that achieving seizure freedom is possible, even when the epileptic foci involve the Rolandic or perirolandic region. Immediate postoperative motor weakness is expected; however, the low incidence of permanent severe deficits demonstrates the effectiveness of the surgical strategies employed.