Monday July 3, 2006
12:00-13:30
Hall 5B
Platform Session
Epilepsy Surgery I

Abstract

Abstract 1 G. Dorfmüller, 1 C. Bulteau, 1 M. Fohlen, 1 C. Jalin, and 1 O. Delalande ( 1 Fondation A. de Rothschild, Paris, France ) Purpose: To present our experience with frameless stereotactically placed depth electrodes in presurgical evaluation of children with drug-resistant partial seizures. Method: A total of 738 multilead electrodes were placed with the aid of a Robot-guided MRI-based stereotactic system (Schaerer-Mayfield Neuromate) in 83 children (2.8 to 18 years, mean 9.4). Each monitoring included 6 to 14 electrodes (mean 9) for a period of 2 to 17 days (mean 7). Results: Twelve children underwent monitoring of a single lobe, 43 of 2, 26 of 3, and 2 children of 4 lobes; 6 had a bilateral recording. MRI was negative in 8 patients (10%). Further studies (PET, SPECT, fMRI, WADA testing, foramen ovale recording) were performed prior to the stereoelectroencephalography (S-EEG) in several cases. We performed electrode stimulations in order to map motor and/or language cortex, and in order to induce seizures. Beside 3 electrode breaks during removal, there were no other surgery-related complications. Having identified the epileptogenic zone, we proposed tailored resection in 69 cases, 1 child had a hemispherotomy instead. In 13 children (16%), SEEG results precluded resective surgery. To date, 57 children underwent surgery; histopathology revealed cortical developmental malformation in 29, glioneural tumour in 13, hippocampal sclerosis in 7 (+ neocortical dysplasia in 5), ischemic alteration in 3, and was negative in 5 cases. Conclusion: Depth recording remains essential in evaluating the indication and extension of focal resection, particularly in children. Our frameless technique is safe and well tolerated, with no related morbidity in this large series.