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.

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:

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

1. 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.
2. Selective resection: Only the targeted cortical areas are removed, minimizing damage to adjacent healthy tissue.
3. 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.

Subpial corticectomy simulation.