TRANSIENT POSTOPERATIVE NEUROLOGIC DEFICIT AFTER SUPPLEMENTARY MOTOR AREA RESECTION
Abstract number :
3.226
Submission category :
Year :
2002
Submission ID :
3457
Source :
www.aesnet.org
Presentation date :
12/7/2002 12:00:00 AM
Published date :
Dec 1, 2002, 06:00 AM
Authors :
Barbara C. Jobst, David W. Roberts, Vijay M. Thadani, Peter D. Williamson. Section of Neurology, Dartmouth-Hitchcock Medical Center, Lebanon, NH; Department of Neurosurgery, Dartmouth-Hitchcock-Medical Center, Lebanon, NH
RATIONALE: Supplementary motor area (SMA) resection is a commonly performed surgical procedure in epilepsy surgery. A postoperative transient neurologic deficit has been reported in 0%-100% of patients.
METHODS: Retrospective review of postoperative neurologic deficit in 10 patients after SMA resection for epilepsy surgery. All patients underwent intracranial EEG monitoring with coverage of the SMA. Resections were tailored to EEG onset.
RESULTS: All patients had a postoperative deficit. 8 patients (80%) had a functional motor deficit of the contralateral extremities. In all of those patients this predominantly involved the lower extremity. Seven patients (70%) patients had a speech and language deficit. The postoperative deficit lasted between two and 65 days (mean 13.3 days). The longest deficits were seen in a 20 year old (21 days) and a 59 year old patient (65 days) both with cortical dysplasia. Three other patients with cortical dysplasia had shorter deficits. The pathology of the remaining patients showed normal tissue (3), gliosis (1) and previous hemorrhage (1). All postoperative deficits resolved completely and patients did not have detectable functional motor or speech deficits on neurologic exam in follow up. All patients underwent intracranial functional motor mapping and the primary motor cortex was preserved in all patients. 8 patients (80%) were seizure free, one Engel Class II and one Engel Class IV due to a complication of a dural leak.
CONCLUSIONS: After SMA resection for epilepsy surgery a postoperative motor and speech deficit can be expected. Patient should be well aware of this complication before undergoing epilepsy surgery. Deficits are transient. Factors that determine extent and length of deficit are not clear.
[Supported by: Hitchcock Foundation]