• Massimo Cossu, Piergiorgio d'Orio, Carmen Barba, Sofia Asioli, Francesco Cardinale, Sara Casciato, Massimo Caulo, Gabriella Colicchio, Alessandro Consales, Alfredo D'Aniello, Alessandro De Benedictis, Luca De Palma, Giuseppe Didato, Giancarlo Di Gennaro, Roberta Di Giacomo, Vincenzo Esposito, Renzo Guerrini, Michele Nichelatti, Martina Revay, Michele Rizzi, Giampaolo Vatti, Flavio Villani, Nelia Zamponi, Laura Tassi, and Carlo Efisio Marras.
• "C. Munari" Epilepsy Surgery Center, Niguarda Hospital, Milan, Italy.
• Neurosurgery. 2021 Jan 13; 88 (2): 384-393.

BackgroundHippocampal sclerosis (HS) may be associated with focal cortical dysplasia IIIa (FCD IIIa) in patients undergoing surgery for temporal lobe epilepsy (TLE).ObjectiveTo investigate whether the anatomo-electro-clinical profile and surgical outcome in patients with HS-related TLE are affected by coexisting FCD IIIa.MethodsA total of 220 patients, operated in 5 centers, with at least 24 mo follow-up (FU), were retrospectively studied. Preliminary univariate and subsequent multivariate analyses were performed to investigate possible associations between several potential presurgical, surgical, and postsurgical predictors and different variables (Engel's class I and Engel's class Ia, co-occurrence of FCD IIIa).ResultsAt last available postoperative control (FU: range 24-95 mo, median 47 mo), 182 (82.7%) patients were classified as Engel's class I and 142 (64.5%) as Engel's class Ia. At multivariate analysis, extension of neocortical resection and postoperative electroencephalogram were significantly associated with Engel's class I, whereas length of FU had a significant impact on class Ia in the whole cohort and in isolated HS (iHS) patients, but not in the FCD IIIa group. No differences emerged in the anatomo-electro-clinical profile and surgical results between patients with FCD IIIa and with iHS.ConclusionCoexistence of FCD IIIa did not confer a distinct anatomo-electro-clinical profile to patients with HS-related epilepsy. Postoperative seizure outcome was similar in FCD IIIa and iHS cases. These findings indicate limited clinical relevance of FCD IIIa in HS-related epilepsy and might be useful for refining future FCD classifications. Further studies are needed to clarify the correlation of class Ia outcome with the duration of FU.Copyright © 2020 by the Congress of Neurological Surgeons.

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