Coexistence of Neoplasia and Cortical Dysplasia Associated with Intractable Epilepsy: A Clinical Study of Seven Surgical Patients and Surgical Strategies

ABSTRACT

A tumor and cortical dysplasia may be the concomitant cause of the causes of intractable epilepsy, but a few studies have examined so far. From among 249 patients who underwent surgery for intractable epilepsy at Dongsan Epilepsy Center, those in whom neoplasia and cortical dysplasia coexisted were selected for this study, and were reviewed the clinical, electrophysiological, neuroimaging and pathological findings. In 17 of 25 lesionrelated epilepsy patients, tumors including dysembryoplastic neuroepithelial tumor(DNT)(n=6), ganglioglioma(n=5), gangliocytoma(n=1), low grade astrocytoma(n=2), oligodendroglioma(n=2), hypothalamic hamartoma(n=1) were verified. Of these 17 cases involving tumors, concomitant cortical dysplasia was observed in 7(DNT; 6, ganglioglioma; 1). All these patients underwent sophisticated presurgical evaluation and intraoperative acute recording(EcoG) for the identification of adjacent or remote epileptogenic areas as well as functional brain mapping by electrical stimulation or SSEP to verify the eloquent areas. In intractable epilepsy, the coexistence of cortical dysplasia and neoplasia is not common, though careful intraoperative evaluation of the tumor and surrounding tissue using electrocorticogram (EcoG) may lead to its pathological identification and excellent surgical results for these rare lesions.