Focal Cortical Dysplasia Surgery [Neurosurgery Wiki]

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====== Focal Cortical Dysplasia Surgery ======

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[[Surgery]] is considered in selected cases to achieve seizure control.

===== 🔍 Indications =====
  * Medically refractory epilepsy (failure of ≥2 anti-seizure medications)
  * Well-localized epileptogenic zone
  * MRI-visible lesion (especially FCD Type II)
  * Concordant findings between MRI, EEG, and functional imaging
  * Lesion not involving eloquent cortex or amenable to functional mapping

===== 🧠 Preoperative Evaluation =====
  * [[MRI|High-resolution 3T MRI (epilepsy protocol)]]
  * [[EEG|Video-EEG monitoring]] to define seizure onset zone
  * Functional imaging:
    * [[PET]] (interictal hypometabolism)
    * [[SPECT]] (ictal/interictal perfusion mismatch)
  * Neuropsychological assessment
  * [[MEG]] or [[SEEG]] in MRI-negative or complex cases

===== 🔧 Surgical Techniques =====
  * **[[Lesionectomy]]**: Removal of visible lesion
  * **[[Extended resection]]**: Includes epileptogenic cortex surrounding the lesion
  * **[[Lobectomy]] / [[multilobar resection]]**: If larger epileptogenic network
  * **[[LITT]] (Laser interstitial thermal therapy)**: Minimally invasive alternative for deep or eloquent areas
  * **[[Palliative]] options**: [[Vagus nerve stimulation]], [[corpus callosotomy]] if non-resectable

===== 📊 Outcomes =====
  * Seizure freedom (Engel Class I):
    * 70–80% in well-selected patients
    * Higher success in FCD Type IIb and MRI-positive cases
  * Predictors of good outcome:
    * Complete resection
    * Histology: FCD IIb
    * Concordant EEG/MRI
  * Possible complications:
    * Neurological deficits (depending on location)
    * Transient or permanent cognitive impairment

===== 🧬 Histopathological Classification (ILAE) =====
  * **Type I**: Isolated cortical dyslamination
  * **Type IIa**: Dysmorphic neurons without balloon cells
  * **Type IIb**: Dysmorphic neurons with balloon cells (best surgical outcomes)
  * **Type III**: FCD associated with another lesion (e.g., tumor, hippocampal sclerosis)

===== 📚 Postoperative Follow-up =====
  * Post-op MRI to assess completeness of resection
  * EEG monitoring
  * Gradual withdrawal of antiepileptic drugs after ≥1–2 years seizure freedom
  * Neuropsychological reassessment




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===== Resection for focal cortical dysplasia treatment =====

[[Resection for focal cortical dysplasia treatment]].