Malformación del desarrollo cortical: Nuestra experiencia acerca de 150 casos

objective: to evaluate the surgical results in a group of patients with epilepsy associated with cortical development malformations (cdm). method: a retrospective study in 150 patients of a series of 570 patients (26.3%) who have undergone surgery for intractable epilepsy with a diagnosis of cdm, since 1988. clinical features, scalp eeg, video eeg, ct scan, mri and neuropsychological evaluation were assessed. population: males: 86 patients, females: 64; mean age, children: 6.7 years (range: 0,5-18.9) and adults: 31.3 years (range: 19-59); mean evolution of epilepsy, children: 4.9 years (range: 1mo-17 yr.), adults: 13.8 years (range: 2mo-50 yr.). clinical manifestations: cps, absences, tonic crises, automatisms and versive crises, cps, transitory anopsia, drop attacks and startle epilepsy, scotoma, masticatory automatisms, clonic crises, photopsia, eye deviation and head attacks. imaging: ct scan was normal in 5, and mri was performed since 1996. twenty of 150 (13.3%) required chronic intracranial electrodes implantation. surgical procedures: resectives: lesionectomies 63 (wide lesionectomy, 17 and + mst, 5), standard anterior temporal lobectomies (satl) 37, anteromesial resections (spencer) 9, corticectomies 11(+mst, 1),amigdalo-hippocampectomies 3, anatomic hemispherectomy 1, lobectomy 1 and polectomies 4; disconnecting procedures: functional hemispherectomies (fh) 10, hemispherotomy 4, hemi-hemispherectomy 1, multiple subpial transection (mst) 1 and 2 callosotomies. other procedures: vagus nerve stimulator (vns) 1, as the first procedure, and radiosurgery 1. intra-op ecog was performed in 54 patients, ssep were in 4 and cortical stimulation in 2. pathological findings: fcd 86 (includes 23 dual pathology, 2 "triple pathology", 5 "associated pathologies", 4 tms + abnormal temporal mesial structures and 3 acquired fcd), dnts 33, tuberous sclerosis 12, hemimegalencephaly 10 and 5 hamartomas. results according to the engel classification: class i: 113 (75.3%), class ii