Author(s) : Lara E Jehi, Hans Ö Lüders, Richard Naugle, Paul Ruggieri, Harold Morris , Nancy Foldvary, Elaine Wyllie, Prakash Kotagal, Bill Bingaman, Dudley Dinner, Richard Prayson, Beate Diehl, Andreas Alexopoulos, Jocelyn Bautista, Robyn Busch, Epilepsy Center, Cleveland Clinic Foundation, Epilepsy Center, University Hospitals, Cleveland, Department of Neurology, University of Vermont College of Medicine, Burlington, VA, Department of Pathology, Cleveland Clinic Foundation, Ohio, USA.
Summary :[March 2008 - Cleveland Case Report]. There is a well-described association between the occurrence of developmental tumors and the presence of cortical dysplasia in the neighboring brain tissue. The main surgical approaches in the treatment of medically refractory epilepsy related to such developmental tumors include a lesionectomy versus a tailored cortical resection, often guided by an invasive evaluation. This case report describes the surgical management of a 26-year-old female with olfactory auras evolving into automotor seizures and convulsions, occurring in the context of a right temporo-parietal developmental lesion. It illustrates the pros and cons of various surgical approaches, and discusses some pathophysiological aspects of developmental tumors, dysplasia and epilepsy. [Published with video sequences]
Figure 1 Selected T1 (A, C), FLAIR (B)
and gadolinium enhanced (D) MRI brain showing cystic,
non-enhancing, heterogeneous lesion at the junction of the right
superior and middle temporal gyri.
Figure 2 Automotor seizure recorded on scalp EEG
showing a right temporal ictal onset.
Figure 3 Pathological sections from lesionectomy
showing sections of nodularity and marked cellular atypia
(A), cells with perinuclear clearing (B) and
surrounding cortex with mild cellular disorganization (C),
features consistent with a developmental tumor.
Figure 5 Cartoon showing lateral temporoparietal and
basal temporal subdural grid coverage. Area of previous
lesionectomy is highlighted in red.
Figure 6 Interictal spiking seen predominantly in
the right anterior temporal distribution (SA 24, and SC9, shown in
red, 80% of spiking, followed by SA 13, green 15%, then SA24, shown
in blue).
Figure 7 EEG seizure with onset manifesting as
paroxysmal fast activity (solid arrows) in the right lateral
temporal region (SA17, shown in dark green), with spread within
13 s to the anterior and basal temporal regions (electrodes
shown in lighter green).
Figure 8 Postoperative MRI showing extension of
lesionectomy and associated anterior right anterior temporal
resection.
Figure 9 Pathological slides analyzed showing
predominantly gliosis but no evidence of residual tumor.
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