Resection of the epileptogenic area in critical cortex with the aid of a subdural electrode grid

Sumio Uematsu, Ronald Lesser, Robert Fisher, Greg Krauss, John Hart, Eileen P. Vining, John Freeman, Barry Gordon

Research output: Contribution to journalArticle

Abstract

Electrode grids were implanted sub durally in 28 patients with epilepsy. In 16 of the 28 patients, an epileptogenic area was located in the speech-dominant left temporal lobe. Recordings made with the grid revealed that the epileptogenic areas in the patients varied widely in extent: the area was confined within the first 10 mm of the temporal lobe in some patients or it was scattered throughout the entire anterior to posterior 80-mm extend in others. Resection of the epileptogenic area was adjusted accordingly in each case. In 6 of 16 patients who were left-hemisphere-dominant for language, up to 55-80 mm from the tip of the temporal lobe was removed, a measure that exceeds the conventional limit of 50 mm from the tip of the dominant hemisphere. In the remaining 12 of the 28 patients, epileptogenic areas were located in a combination of several lobes. In 7 of these 12 patients, the epileptogenic area encompassed the rolandic area; it was removed without deficit in 4 patients and with expected deficit in 3. Of the latter 3 patients, 1 patient underwent hemispherectomy, and a large portion of the epileptogenic rolandic cortex in the frontal and parietal lobes was removed from the other 2. There were 2 cases of grid-related infection, which cleared with antibiotic treatment: there were no lasting complications of grid implantation in any patient. There was no mortality. Electroencephalographic recording and functional mapping using subdural electrode grids allow a tailored, maximal resection of epileptogenic tissue with minimal injury to critical cortex.

Original languageEnglish (US)
Pages (from-to)34-45
Number of pages12
JournalStereotactic and Functional Neurosurgery
Volume54
Issue number1-8
DOIs
StatePublished - Jan 1 1990

Keywords

  • Epilepsy
  • Epilepsy surgery
  • Motor cortex
  • Speech
  • Speech-dominant temporal lobe
  • Subdural grid
  • Temporal lobe

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

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