World neurosurgery 2018 03 29() pii S1878-8750(18)30627-2
We report the surgical management of a lesional drug-resistant epilepsy caused by a meningioangiomatosis associated with a type IIIc focal cortical dysplasia located in the left supplementary motor area in a young male patient.
A first anatomical-based partial surgical resection was performed at 11 years old under general anaesthesia without intraoperative mapping, which allowed for postoperative seizure control (Engel IA) for six years. The patient then presented with intractable right sensatory and aphasic focal onset seizures despite two appropriate antiepileptic drugs. A second functional-based surgical resection was performed using intraoperative cortico-subcortical functional mapping with direct electrical stimulation under awake conditions. A complete surgical resection was performed and a left partial supplementary motor area syndrome was observed. At six postoperative months, the patient is seizure free (Engel IA) with an ongoing decrease in antiepileptic drug therapy.
Intraoperative functional brain mapping can be applied to preserve the brain function and networks around a meningioangiomatosis to facilitate the resection of potentially epileptogenic perilesional dysplastic cortex and to tailor the extent of resection to functional boundaries.