Abstracts

Rationale: Malformations of cortical development (MCD) in children present frequently with seizure onset in early infancy, and often exhibit poor developmental outcome and poor responses to medications. Early surgery is still challenging due to a higher operative risk comparing to that in older children. We describe seizure control following early resective surgery for infantile intractable epilepsy due to MCD. Methods: Retrospective analysis of 22 patients (ages 2 -10 months, median 5.0 months) who underwent resective surgery from 2003 to 2010 with a minimum follow up period of 1 year.Results: Seventeen patients (77%) exhibited preoperatively epileptic encephalopathy. Mean preoperative developmental quotient (DQ) was 47.9. Mean age at surgery was 5.0 months. Fourteen patients had diffuse unilateral hemispheric MCD or hemimegalencephaly, 7 patients had focal cortical dysplasia, and 1 had cortical tubar. Sixteen patients (73%) underwent resective surgery using disconnective technique. Surgical procedures comprised 14 vertical parasagittal hemispherotomies, 6 focal resections and 2 frontal disconnections. Fifteen patients (68%) were Engel Class I and 7 continued to have seizures and were classified as Engel Class II(1 case), III (2 cases) or IV (4 cases) . There were no mortalities. Postoperative complications included subsequent shunt procedure in 1 patient, transient hyponatremia in 1patient, chronic subdural hematoma in 1 patient and meningitis in 1 patient.Conclusions: Early resective surgery using disconnective technique for infantile intractable epilepsy due to MCD results in good seizure control and decrease of perioperative morbidity.