Ahead of Print: Cingulate Gyrus Epilepsy Surgery
Background: Epilepsy surgery involving the cingulate gyrus has been mostly presented as case reports, and larger series with long-term follow up are not published yet.
Objective: To report our experience with focal epilepsy arising from the cingulate gyrus and surrounding structures and its surgical treatment.
Methods: 22 patients (mean age 36, range 12-63) with a mean seizure history of 23 years (range 2-52) were retrospectively analyzed. We report pre-surgical diagnostics, surgical strategy, and post-operative follow up concerning functional morbidity and seizures (mean follow-up 86 months, range 25-174).
Results: Nineteen patients showed potential epileptogenic lesions on preoperative MRI. All patients had non-invasive pre-surgical work-up; 15 (68%) underwent invasive Video-EEG-Monitoring. In 12 patients we performed extended lesionectomy according to MRI; an extension with regard to EEG-results was done in 6 patients. In 4 patients the resection was incomplete due to involvement of eloquent areas according to functional mapping results. Eight pure cingulate resections (36%, three in the posterior cingulate gyrus) and 14 extended supra-cingular frontal resections were performed. Nine patients suffered from temporary postoperative supplementary motor area (SMA) syndrome after resection in the superior frontal gyrus. Two patients retained a persistent mild hand or leg paresis, respectively. Post-operatively, 62% of patients were seizure-free (ILAE 1) and 76% had a satisfactory seizure outcome (ILAE 1-3).
Conclusion: Epilepsy surgery for lesions involving the cingulate gyrus represents a small fraction of all epilepsy surgery cases, with good seizure outcome and low rates of post-operative permanent deficits. In case of extended supra-cingular resection, SMA-syndrome should be considered.
From: Epilepsy Surgery of the Cingulate Gyrus and the Fronto-mesial Cortex by von Lehe et al