The application of brain mapping in the surgical management of hemisphere lesion induced epilepsy

Objective To explore the application of brain mapping in the surgical management of hemisphere lesion induced epilepsy.Methods A retrospective analysis of 30 patients with hemisphere lesion induced epilepsy were enrolled,including 21 males and 9 females,whose average age was 12.9 ± 8.7 years (range from 4 months to 30 years) with the average disease duration of 7.8 years (range from 1 month ～ 29 years).The seizures were unable to be controlled by using up to four antiepileptic drugs.Preoperatively we conducted scalp video-EEG (sVEEG) and MRI examination to confirm the epileptogenichemisphere,and the function of epileptogenic hemisphere was evaluated by the handedness assessment,hand fine motor,fMRI,DTI and Wada test.Hemispherectomy was performed for patients with a nonfunctioning hemisphere.For the patients with hemisphere remained partially functional,we performed combined surgery preserved eloquent brain region,identified by intraoperative electrical stimulations.Results 20 cases (20/30) underwent hemispherectomy,and 10 cases (10/30) underwent combined surgery with reserving eloquent brain regions.Postoperative follow-up analysis showed 14 cases (14/30) achieved improvement in language function,and 9 cases(9/30) achieved improvement in motor function of contralateral lower extremity and 10 cases (10/30) achieved improvement in gross motor function of contralateral upper extremity.None of them became worse after surgery.Meanwhile,there were 7 cases (7/30) who achieved improvement in contralateral hand fine motor,while 3 case (3/30)who underwent hemispherectomy became worse after surgery.Twenty-six cases were followed up more than six months,and the control rate of epilepsy was assessed.Among them,24 cases (24/30) were satisfied with results,1 case (1/30) was significantly improved and 1 case (1/30) was beneficial; All of 18 cases who underwent hemispherectomy were satisfied,while among the other 8 cases underwent combined surgery,6 cases were satisfied,1 case was significantly improved and 1 case was beneficial.Conclusions For patients with hemisphere lesion induced epilepsy,the surgical procedure was closely related to the postoperative seizure control rate and the incidence rate of neurological dysfunction.And brain mapping was crucial for surgerystrategy management. Key words: Epilepsy;  Eloquent brain region;  Surgery