Context and objectives
Epilepsy surgery in eloquent areas remains a challenge when the MRI is negative. In this context multiple subpial transections technique represents an alternative to the cortical resection. The aim of our study was to identify clinical and pathological features and the postoperative outcome of patients with nonlesionalepilepsy and treated using radiating transections.
Methods:
This study is a series of 25 patients with MRI negative epilepsy treated by the radiating multiple subpial transections technique at CliniquesUniversitaires Saint-Luc/Brussels. Specific study parameters were: seizures type, use of invasive EEGs, number of transections, histopathological findings, seizures trends and postoperative neurological deficits.
Results:
Our patients benefited an average of 37 transections (extremes 4-89) alone or associated with other procedures. Generalized seizures were observed in 64% of patients and 60% required invasive EEGs. In 48% of cases, the histopathological examination performed on intraoperative specimens was non-contributory. Minor permanent neurological deficit was noted in 2 patients. Seizures evaluation showed a favorable outcome in 72% of cases with total suppression in 9 patients (36%).
Conclusion:
Our Patients with non-lesional epilepsy in eloquent areas are characterized by a high incidence of generalized seizures, extensive use of invasive EEGs, and nearly half non-contributory histopathological analyzes. Radiating transections perfomed alone or in association with other procedures provide their seizures suppression in at least one third of cases with low morbidity.