OBJECTIVE The authors perform thorough, noninvasive presurgical evaluations for intractable epilepsy at their center and avoid unnecessary intracranial EEG when possible. The purpose of this study was to clarify the appropriateness of their lesion-oriented surgical strategy for localized focal cortical dysplasia (FCD) type II. METHODS Fifty-one patients with pathologically proven localized FCD type II who were followed for at least 1 year after surgery were included. Patients with FCD type II with lobar or multilobar distribution were excluded. The results of presurgical evaluations, including thin-slice 3-T MRI, FDG-PET, and ictal SPECT, as well as surgical procedures and postoperative seizure and functional outcomes, were examined retrospectively. RESULTS MRI was positive in 46 (90%) of 51 patients, and FDG-PET revealed localized hypo- or hypermetabolism in 47 (92%) of 51 patients. Ictal SPECT revealed concordant hyperperfusion in 37 of 42 patients examined. Intracranial EEG was used in only 13 patients (25%), including 5 with negative MRI results and 4 with subtle MRI findings. Of the 15 patients with FCD in the vicinity of eloquent (sensorimotor and language) areas, intracranial EEG was used in 4. Lesionectomy was performed in all 51 patients. Intraoperative electrocorticography (ECoG) was performed in 8 patients, but the findings were not used to tailor the extent of resection. Postoperative seizure outcomes were Engel class I in 47 patients (92%) and Ia in 45 (88%). In the 15 patients with FCD in the vicinity of eloquent areas, 13 (87%) achieved a class I outcome. Predictive factors for favorable seizure outcome were complete resection of the MRI lesion (p = 0.006) and frontal lobe surgery (p = 0.012). Postoperative neurological deficits were noted in only 4 (27%) of 15 patients with FCD in the vicinity of eloquent areas. All 5 MRI-negative patients achieved an Engel class I outcome. CONCLUSIONS In most of the patients with localized FCD type II, MRI and/or FDG-PET detected the localized abnormality. Lesionectomy without intracranial EEG led to seizure freedom in most cases. Even when lesions were in the vicinity of eloquent areas, seizure and functional outcomes were favorable. Intraoperative ECoG may thus be unnecessary. Complete resection of the lesion is essential for favorable seizure outcome in MRI-positive patients. In MRI-negative patients, surgery with intracranial EEG guided by FDG-PET provided seizure-free outcomes.

中文翻译：

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II 型局部局灶性皮质发育不良：MRI 和 FDG-PET 引导下病灶切除术可消除癫痫发作。

目的 作者在其中心对难治性癫痫进行彻底、无创的术前评估，并尽可能避免不必要的颅内脑电图检查。本研究的目的是阐明针对 II 型局部局灶性皮质发育不良 (FCD) 的病变导向手术策略的适当性。方法 纳入 51 例经病理证实的局限性 FCD II 型患者，术后随访至少 1 年。排除具有肺叶或多叶分布的 II 型 FCD 患者。回顾性检查了术前评估的结果，包括薄层 3-T MRI、FDG-PET 和发作期 SPECT，以及手术过程和术后癫痫发作和功能结果。结果 51 名患者中有 46 名 (90%) MRI 呈阳性，FDG-PET 显示 51 名患者中有 47 名 (92%) 存在局部代谢低下或亢进。发作期 SPECT 显示 42 名接受检查的患者中有 37 名出现一致的过度灌注。仅 13 名患者 (25%) 使用了颅内脑电图，其中 5 名 MRI 结果呈阴性，4 名 MRI 发现细微。在 15 例口才（感觉运动和语言）区附近的 FCD 患者中，4 例使用了颅内脑电图。所有 51 例患者均进行了病灶切除术。对 8 名患者进行了术中皮质电图 (ECoG)，但结果并未用于调整切除范围。术后癫痫发作结果为 47 名患者 (92%) 为 Engel I 级，45 名患者 (88%) 为 Ia 级。在口才区附近的 15 名 FCD 患者中，13 名（87%）达到了 I 级结果。良好癫痫结果的预测因素是 MRI 病灶的完全切除 (p = 0.006) 和额叶手术 (p = 0.012)。15 名 FCD 患者中，只有 4 名（27%）在口才区附近发现术后神经功能缺损。所有 5 名 MRI 阴性患者均达到 Engel I 级结果。结论 在大多数局限性 FCD II 型患者中，MRI 和/或 FDG-PET 检测到局部异常。在大多数情况下，不进行颅内脑电图检查的病灶切除术可以使癫痫发作消失。即使病变位于言语区域附近，癫痫发作和功能结果也是有利的。因此术中 ECoG 可能是不必要的。完全切除病变对于 MRI 阳性患者的良好癫痫结果至关重要。在 MRI 阴性患者中，FDG-PET 引导下的颅内脑电图手术可实现无癫痫发作的结果。