Modified posterior quadrant disconnection in surgical treatment of drug-resistant epilepsy in a patient with left temporal and occipital lobe malformation

Pedyash N.V.

Pirogov National Medical Surgical Center

SPIN RSCI: 4659-3419
Scopus AuthorID: 57189622550
ORCID: 0000-0002-2713-5904

Khamidov F.M.

Pirogov National Medical Surgical Center

ORCID: 0000-0002-4575-151X

Utyashev N.P.

Pirogov National Medical Surgical Center

RSCI AuthorID: 57786938400
ORCID: 0000-0002-0770-2983

Zuev A.A.

Pirogov Russian National Research Medical University

SPIN RSCI: 9377-4574
Scopus AuthorID: 26424155600
ORCID: 0000-0003-2974-1462

Modified posterior quadrant disconnection in surgical treatment of drug-resistant epilepsy in a patient with left temporal and occipital lobe malformation

Authors:

Pedyash N.V., Khamidov F.M., Utyashev N.P., Zuev A.A.

More about the authors

Journal: Burdenko's Journal of Neurosurgery. 2022;86(6): 76‑83

DOI: 10.17116/neiro20228606176

Downloaded: 73

To cite this article:

Pedyash NV, Khamidov FM, Utyashev NP, Zuev AA. Modified posterior quadrant disconnection in surgical treatment of drug-resistant epilepsy in a patient with left temporal and occipital lobe malformation. Burdenko's Journal of Neurosurgery. 2022;86(6):76‑83. (In Russ., In Engl.)
https://doi.org/10.17116/neiro20228606176

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Adults with large multilobar lesions of temporal, parietal and occipital lobes of the dominant hemisphere suffering from drug-resistant epilepsy were considered inoperable for a long time.

OBJECTIVE

To demonstrate favorable postoperative outcome in a patient with massive periventricular heterotopia of the left temporal and occipital lobes complicated by drug-resistant epilepsy.

MATERIAL AND METHODS

We analyzed localization of the brain malformation (massive periventricular heterotopia) and its relationship with surrounding structures in a 38-year-old patient considering preoperative MRI, functional MRI and MR tractography data. Quality of modified posterior quadrant disconnection was assessed within a day and 6 months after surgery in accordance with MRI data. Transcranial stimulation, direct cortical and subcortical monopolar stimulation were used for intraoperative monitoring of corticospinal tract. We also assessed neurological status and linguistic testing data before surgery, 4 days and 6 months after surgery.

RESULTS

Modified posterior disconnection of temporal, parietal and occipital lobes was performed. Intraoperative neurophysiological cortical mapping (asleep-awake-sedation protocol) verified localization of Wernicke’s area. There was an expected right-sided homonymous hemianopsia in postoperative period without speech disorders. Postoperative outcome Engel grade 1A under anticonvulsant therapy was obtained.

CONCLUSION

The authors report successful surgical treatment of massive malformation of the left temporal, parietal and occipital lobes and literature review devoted to this issue.

Keywords:

surgical treatment of drug-resistant epilepsy

massive periventricular heterotopia

intraoperative neurophysiological speech mapping

posterior quadrant disconnection

Authors:

Pedyash N.V.

Pirogov National Medical Surgical Center

SPIN RSCI: 4659-3419
Scopus AuthorID: 57189622550
ORCID: 0000-0002-2713-5904

Khamidov F.M.

Pirogov National Medical Surgical Center

ORCID: 0000-0002-4575-151X

Utyashev N.P.

Pirogov National Medical Surgical Center

RSCI AuthorID: 57786938400
ORCID: 0000-0002-0770-2983

Zuev A.A.

Pirogov Russian National Research Medical University

SPIN RSCI: 9377-4574
Scopus AuthorID: 26424155600
ORCID: 0000-0003-2974-1462

Received:

09.02.2022

Accepted:

11.10.2022

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