Objective: This study evaluates surgical outcomes in patients with balloon cell containing, focal cortical dysplasia (FCD type IIB) in the peri-rolandic region. We also address the question of, postoperative seizure worsening after an incomplete resection in this patient population.
Methods: We retrospectively reviewed the clinical data on patients with pathologically proven FCD, who underwent epilepsy surgery over a 12-year period. Seizure outcomes were compared between, patients with rolandic FCD and non-rolandic frontal FCD.
Results: Seventeen patients with rolandic and 22 patients with non-rolandic FCD were identified. Twelve patients were found to have type IIB lesions (8 rolandic). Seizure freedom at last follow up was, achieved in 59% of the rolandic subset of patients (including 75% seizure freedom in the rolandic type, IIB cases, as opposed to 44% of rolandic non-type IIB and 75% of type IIB outside the rolandic, region). New postoperative neurological deficits occurred in 59% of the rolandic subgroup and were, independent of pathology. Three patients (3/8) with incompletely resected rolandic type IIB lesions, developed status epilepticus postoperatively; all 3 patients became seizure free following a second, more extensive surgical resection.
Conclusions: Patients with rolandic FCD can achieve a good surgical outcome after a complete, resection. However, an incomplete surgical resection in this patient population may lead to acute, postoperative seizure worsening.