Surgical treatment strategies of periventricular nodular heterotopia for children with epilepsy combined with or without other pathologic types
Objective To investigate the surgical strategies and outcome of periventricular nodular heterotopia(PNH)for children with epilepsy combined with or without other pathologic types.Methods The clinical data of 9 PNH patients who received surgical treatment from October 2017 to September 2023 in the Department of Functional Neurosurgery,Beijing Children's Hospital,Capital Medical University were retrospectively analyzed.Neuroimaging data showed that 5 of the 9 patients also had focal cortical dysplasia(FCD)and 1 had megalencephaly and schizencephaly.All patients underwent non-invasive examination during pre-operation evaluation.After identifying the epileptogenic lesion,surgical treatment was directly performed.Stereo-electroencephalography(SEEG)was performed in those patients whose epileptogenic zone was unable to localize,at the same time,radiofrequency thermocoagulation(RFTC)was performed.And the following surgical treatment was determined according to the SEEG and RFTC results.Patients were followed up by outpatient visits or telephone interview.The Engel grading system was used to evaluate the results of seizure control.Results All 9 patients underwent surgical treatment,4 of whom underwent surgical resection,including 2 FCD patients underwent lesion resection directly.One patient with obvious genetic abnormalities and epileptic encephalopathy underwent vagus nerve stimulation.One child with megalencephaly and schizencephaly underwent hemispherotomy.The remaining 5 children underwent SEEG electrode implantation.Among them,2 patients only underwent RFTC for PNH,and 3 children with FCD underwent RFTC of PNH followed by epileptogenic zonectomy.Five children with FCD were all confirmed to be FCD type Ⅱ by pathology after surgery.There were no surgery-related complications in any of the children.All 9 children received clinical follow-up,and the follow-up time M(Q1,Q3)was 20(14,29)months.The last follow-up showed that 7 children had a good outcome,all were Engel grade Ⅰ.There were 2 cases with poor outcome,including 1 case of Engel grade Ⅱ(the child underwent RFTC only for PNH)and 1 case of Engel grade Ⅲ(the child underwent hemispherotomy).Conclusions When PNH is combined with or without other pathological types of epilepsy,individualized treatment should be carried out according to the pathological type.Especially when combined with FCD,excision of FCD can obtain a good outcome.
Drug resistant epilepsyNeurosurgical proceduresTreatment outcomeStereo-electroencephalographyRadiofrequency thermocoagulationNodular heterotopias
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