Editors' Note: One-Stage, Limited-Resection Epilepsy Surgery for Bottom-of-Sulcus Dysplasia

Abstract

In “One-Stage, Limited-Resection Epilepsy Surgery for Bottom-of-Sulcus Dysplasia,” Macdonald-Laurs et al. described the performance of corticectomy guided by MRI and electrocorticography (ECoG) in 38 patients with bottom-of-sulcus dysplasia (BOSD). They found that at a median of 6 years postop, 87% of patients were seizure free and noted that their outcomes are similar to those reported in a small series of patients with BOSD who underwent stereotactic thermocoagulation (STC) and laser interstitial thermal therapy (LITT). Hu et al. reported that based on their recent LITT trial, in which they found that 6 of 7 (86%) patients with BOSD were seizure-free 6 months postop, they recommend minimally invasive procedures for BOSD. Harvey et al. agreed with the use of STC or LITT for BOSD in locations that are not easily accessible via a small craniotomy. However, these procedures preclude the use of ECoG to determine epileptogenicity, histopathologic confirmation, and genetic testing of the tissues. In addition, STC and LITT pose risk to surrounding normal cortex and are not widely available. The authors all agree that there is a need for additional long-term outcome data using different treatment strategies in larger cohorts of patients with BOSD. In “One-Stage, Limited-Resection Epilepsy Surgery for Bottom-of-Sulcus Dysplasia,” Macdonald-Laurs et al. described the performance of corticectomy guided by MRI and electrocorticography (ECoG) in 38 patients with bottom-of-sulcus dysplasia (BOSD). They found that at a median of 6 years postop, 87% of patients were seizure free and noted that their outcomes are similar to those reported in a small series of patients with BOSD who underwent stereotactic thermocoagulation (STC) and laser interstitial thermal therapy (LITT). Hu et al. reported that based on their recent LITT trial, in which they found that 6 of 7 (86%) patients with BOSD were seizure-free 6 months postop, they recommend minimally invasive procedures for BOSD. Harvey et al. agreed with the use of STC or LITT for BOSD in locations that are not easily accessible via a small craniotomy. However, these procedures preclude the use of ECoG to determine epileptogenicity, histopathologic confirmation, and genetic testing of the tissues. In addition, STC and LITT pose risk to surrounding normal cortex and are not widely available. The authors all agree that there is a need for additional long-term outcome data using different treatment strategies in larger cohorts of patients with BOSD.