Surgical Result of the Supplementary Sensorimotor Area Seizure

OBJECTIVE: The authors report the operative methods and postoperative outcomes of 14 cases with intractable supplementary sensorimotor area(SSMA) seizures. METHODS: From September 1996 to July 2001, 14 intractable cases treated by operation were reviewed and analysed with the help of each clinical characteristics, magnetic resonance images, histopathologic findings, noninvasive and invasive electroencephalographies(EEG), subdural grid and strip insertion and intracranial electrocorticographies and brain mapping results, retrospectively. The follow-up duration was from 2 months to 70 months(average, 26 months). RESULTS: There were eight males and six females and the age ranged from 2 to 47 years(average, 26.2). In the MRI findings, six lesional and eight nonlesional cases, and there were six localized and eight lateralized cases in the semiology and noninvasive EEG studies. In the histopathologic findings, cortical dysplasia was eight cases, gliosis three cases, leukomalacia one case and normal finding was two cases. In the seizure outcome, Engel's class I was 71.4%, class II was 21.4% and class III was 7.2%. The postoperative neurologic deficits were 12 in 14 cases and nine in 12 cases were dramatically improved within two or three weeks postoperatively and the remained three cases, the lesion was involved in the eloquent area but, all of them were improved via the rehabilitation programs. CONCLUSION: In the intractable SSMA seizure, the surgical treatment is an excellent method of treatment and early transient postoperative neurologic deficits were dramatically improved within several weeks.

A Case of Recurrent Dysembryoplastic Neuroepithelial Tumor in the Temporal Lobe / 대한간질학회지

A boy since 6 years of his age who have had complex partial seizure was referred to our Department in March 1998. The left anterior temporal lobectomy with the resection of the head and body of hippocampus and gross total tumor removal was also performed in April 1998. He has been seizure free and stable about 3 years postoperatively. In January 2001, he revisited us due to headache, nausea, and vomiting from one week before. MRI revealed recurrence of the tumor, and a partial removal of the tumor was performed. Nine months from the second operation, the tumor recurred again and the thrid operation was followed. The pathologic findings were dysembryoplastic neuroepithelial tumor (DNT) in all three cases and no evidences of anaplastic changes were found in two recurrent cases. In general, DNT is known to be a disease that rarely transforms into the malignant, postoperative adjuvant radio-or chemotherapy is unnecessary even after partial resection of the tumor. However, in our case, there were two episodes of recurrence after the total resection. Here, we report the first case of recurrent DNT even after the total resection within three years in our knowledge.