Frontal Lobe Decortication (Frontal Lobectomy with Ventricular Preservation) in Epilepsy-Part 1: Anatomic Landmarks and Surgical Technique.

Autor: Wen HT; Division of Neurosurgery, Hospital das Clínicas, College of Medicine, University of São Paulo, Brazil. Electronic address: wenht@uol.com.br., Da Róz LM; Division of Neurosurgery, Hospital das Clínicas, College of Medicine, University of São Paulo, Brazil., Rhoton AL Jr; Department of Neurological Surgery, University of Florida, Gainesville, Florida, USA., Castro LH; Department of Neurology, Hospital das Clínicas, College of Medicine, University of São Paulo, Brazil., Teixeira MJ; Division of Neurosurgery, Hospital das Clínicas, College of Medicine, University of São Paulo, Brazil.
Jazyk: angličtina
Zdroj: World neurosurgery [World Neurosurg] 2017 Feb; Vol. 98, pp. 347-364. Date of Electronic Publication: 2016 Oct 27.
DOI: 10.1016/j.wneu.2016.10.090
Abstrakt: Background: An extensive frontal resection is a frequently performed neurosurgical procedure, especially for treating brain tumor and refractory epilepsy. However, there is a paucity of reports available regarding its surgical anatomy and technique.
Objectives: We sought to present the anatomic landmarks and surgical technique of the frontal lobe decortication (FLD) in epilepsy. The goals were to maximize the gray matter removal, spare primary and supplementary motor areas, and preserve the frontal horn.
Material and Methods: The anatomic study was based on dissections performed in 15 formalin-fixed adult cadaveric heads. The clinical experience with 15 patients is summarized.
Result: FLD consists of 5 steps: 1) coagulation and section of arterial branches of lateral surface; 2) paramedian subpial resection 3 cm ahead of the precentral sulcus to reach the genu of corpus callosum; 3) resection of gray matter of lateral surface, preserving the frontal horn; 4) removal of gray matter of basal surface preserving olfactory tract; 5) removal of gray matter of the medial surface under the rostrum of corpus callosum. The frontal horn was preserved in all 15 patients; 12 patients (80%) had no complications; 2 patients presented temporary hemiparesis; and 1 Rasmussen syndrome patient developed postoperative fever. The best seizure control was in cases with focal magnetic resonance imaging abnormalities limited to the frontal lobe.
Conclusion: FLD is an anatomy-based surgical technique for extensive frontal lobe resection. It presents reliable anatomic landmarks, selective gray matter removal, preservation of frontal horn, and low complication rate in our series. It can be an alternative option to the classical frontal lobectomy.
(Copyright © 2016 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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