Extended resection for seizure control of pure motor strip focal cortical dysplasia during awake craniotomy: Illustrative case

Authors

Bayron A. Sandoval-Bonilla, Department of Neurosurgery, Epilepsy Surgery Program, Hospital de Especialidades, CMN Siglo XXI, Instituto Mexicano del Seguro Social, Mexico City, Mexico.
André Palmini, Department of Neurology and Neurosurgery, Epilepsy Surgery Program, Hospital São Lucas da Pontificia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, Brazil.
Eliseu Paglioli, Department of Neurology and Neurosurgery, Epilepsy Surgery Program, Hospital São Lucas da Pontificia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, Brazil.
Alejandro Monroy-Sosa, Advocate Aurora Health
Maria F. De la Cerda-Vargas, Department of Neurosurgery, Hospital de Especialidades No. 71, Instituto Mexicano del Seguro Social, Torreón Coahuila, Mexico.
Job J. Rodríguez-Hernández, Department of Neurosurgery, Epilepsy Surgery Program, Hospital de Especialidades, CMN Siglo XXI, Instituto Mexicano del Seguro Social, Mexico City, Mexico.
Victor R. Chávez-Herrera, Department of Neurosurgery, Epilepsy Surgery Program, Hospital de Especialidades, CMN Siglo XXI, Instituto Mexicano del Seguro Social, Mexico City, Mexico.
Sara P. Perez-Reyes, Department of Neurosurgery, Hospital Regional de Alta Especialidad del Bajío, Instituto Mexicano del Seguro Social, Leon, Guanajuato, Mexico.
Fernando C. Castro-Prado, Department of Neurosurgery, Epilepsy Surgery Program, Hospital de Especialidades, CMN Siglo XXI, Instituto Mexicano del Seguro Social, Mexico City, Mexico.
Samuel Perez-Cardenas, Department of Neurosurgery, University Hospital Monterrey, Nuevo Leon, Mexico; and.
Josafat J. Sánchez-Dueñas, Department of Neurosurgery, Epilepsy Surgery Program, Hospital de Especialidades, CMN Siglo XXI, Instituto Mexicano del Seguro Social, Mexico City, Mexico.
Lucero N. Lagunes-Padilla, Department of Neurosurgery, Hospital Angeles Universidad, Mexico City, Mexico.

Recommended Citation

Sandoval-Bonilla BA, Palmini A, Paglioli E, et al. Extended resection for seizure control of pure motor strip focal cortical dysplasia during awake craniotomy: illustrative case. J Neurosurg Case Lessons. 2022;3(10):CASE21605. Published 2022 Mar 7. doi:10.3171/CASE21605

Affiliations

Advocate Aurora Research Health Institute

Abstract

Background: Focal cortical dysplasias (FCD) represent highly intrinsically epileptogenic lesions that require complete resection for seizure control. Resection of pure motor strip FCD can be challenging. Effective control of postoperative seizures is crucial and extending the boundaries of resection in an eloquent zone remains controversial.

Observations: The authors report a 52-year-old right-handed male with refractory epilepsy. The seizure phenotype was a focal crisis with preserved awareness and a clonic motor onset of right-hemibody. Epilepsy surgery protocol demonstrated a left pure motor strip FCD and a full-awake resective procedure with motor brain mapping was performed. Further resection of surgical boundaries monitoring function along intraoperative motor tasks with no direct electrical stimulation corroborated by intraoperative-neuromonitorization was completed as the final part of the surgery. In the follow-up period of 3-years, the patient has an Engel-IB seizure-control with mild distal lower limb palsy and no gate compromise.

Lessons: This report represents one of the few cases with pure motor strip FCD resection. In a scenario similar to this case, the authors consider that this variation can be useful to improve seizure control and the quality of life of these patients by extending the resection of a more extensive epileptogenic zone minimizing functional damage.

Document Type

Article

PubMed ID

36130534