====== Subpial corticectomy ======

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**Subpial [[corticectomy]]** is a specialized [[neurosurgical procedure]] aimed at treating [[drug-resistant epilepsy]] by selectively removing portions of the [[cerebral cortex]]. This technique is particularly used when the epileptogenic focus is well-defined and localized to specific cortical areas, and when preserving the surrounding brain tissue and functions is critical.

===== Indications =====

1. **Drug-resistant epilepsy:** Patients with epilepsy that does not respond to medical therapy.
2. **Focal cortical lesions:** Such as cortical dysplasia, gliosis, or small tumors associated with seizure activity.
3. **Eloquent cortex involvement:** When the epileptogenic zone is near or within functionally important areas (e.g., motor, sensory, or language regions).

### **Surgical Technique**
1. **Preoperative Localization:**
   - Advanced imaging techniques such as MRI, PET, or SPECT are used for structural and metabolic mapping.
   - Invasive monitoring with electrodes (e.g., SEEG or subdural grids) may be employed to pinpoint the epileptogenic focus.
   - Functional mapping identifies critical regions to avoid during surgery.

===== Procedure =====

   - **Subpial dissection:** The cortex is accessed through a small craniotomy, and the epileptogenic tissue is carefully dissected while preserving the pia mater and underlying white matter.
   - **Selective resection:** Only the targeted cortical areas are removed, minimizing damage to adjacent healthy tissue.
   - **Electrocorticography (ECoG):** Performed intraoperatively to confirm the removal of the epileptogenic focus and avoid disruption of nearby functional zones.

3. **Minimally invasive techniques:** May be employed depending on the location and size of the epileptogenic area, often using advanced neuronavigation systems.

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### **Benefits**
- **Targeted treatment:** Focused removal of epileptogenic areas reduces seizure frequency and severity.
- **Function preservation:** By avoiding deep structures and minimizing collateral damage, the risk of postoperative deficits is reduced.
- **Improved quality of life:** Many patients experience significant improvements in seizure control.

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### **Risks and Complications**
- **Neurological deficits:** Potential for motor, sensory, or cognitive impairment if functional areas are inadvertently affected.
- **Infection or bleeding:** General surgical risks.
- **Incomplete resection:** May result in persistent seizures.

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### **Outcomes**
- Subpial corticectomy has been shown to effectively reduce or eliminate seizures in selected patients, particularly when the epileptogenic focus is clearly localized.
- Postoperative rehabilitation and ongoing management are essential to address any residual symptoms and to optimize neurological recovery.

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This technique is often a part of a multidisciplinary epilepsy surgery program, involving neurologists, neurophysiologists, and neurosurgeons working together to deliver patient-specific care.

===== Simulation =====

[[Subpial corticectomy simulation]].