Treatment of Foci Resection and Bipolar Electro- Coagulation on Functional Cortex in Tuberous Sclerosis Complex Involving Eloquent CortexAuthor(s): Zhai Feng, Zhou Jian, Gao Qing, Wang Mengyang, Qi Xueling, Chen Shuai, Luan Guoming
The tuberous sclerosis complex (TSC) patients with refractory epilepsy involving eloquent are poor candidates for conventional resection surgery. We have previously proved that the approach of bipolar electro-coagulation on functional cortex (BCFC), which is similar to multiple subpial transections (MST) in the treatment of unifocal epilepsy involving eloquent areas, is effective, safe and easy to operate. This report describes our some long-term followup for combined foci resection and BCFC in TSC patients with refractory epilepsy involving eloquent cortex.
Ten patients aged from 10 to 35 years were admitted with refractory epilepsy. Cranial computed tomography (CT) and magnetic resonance imaging (MRI) showed classic features of TSC, and met the diagnostic criteria of TSC. The ten patients, who underwent combination therapy of foci resection and BCFC for epilepsy management between May 2004 and May 2014, were retrospectively reviewed with regard to seizure outcome, MRI, neuropsychology and postoperative complications.
The outcome of Engel class I was achieved in 5 patients, Engel class II in 3 patients and Engel class III in 2 patients, respectively. The results of MRI of the 10 patients showed no significant changes in the morphology of the coagulated area, and the 8 of them were effectively improved on postoperative intelligence and memory scores by WISC - RC scale and WMS scale evaluation. One patient developed mild hemiparesis after electro-coagulation and was fully recovered within 1 month. No permanent neurological deficit was found for all the patients during a standard clinical examination.
The combination therapy of foci resection and BCFC is an effective and safe surgical approach for the treatment of TSC associated epilepsy involving eloquent cortex.