Transmantle sign in focal cortical dysplasia: A unique radiological entity with excellent prognosis for seizure control ; Clinical article

Doris D. Wang, Abby E. Deans, A. James Barkovich, Tarik Tihan, Nicholas Barbaro, Paul A. Garcia, Edward F. Chang

Research output: Contribution to journalArticle

23 Citations (Scopus)

Abstract

Object. Focal cortical dysplasia (FCD) represents a spectrum of developmental cortical abnormalities and is one of the most common causes of intractable epilepsy in children and young adults. Outcomes after surgery for FCD are highly variable, and prognosticators of seizure freedom are unclear. In a subset of FCDs, a transmantle sign is observed on imaging that focally spans the entire cerebral mantle from the ventricle to the cortical surface. The aim of this study was to characterize seizure control outcomes and prognostic significance of the transmantle sign in FCD epilepsy. Methods. Fourteen patients with the transmantle sign underwent epilepsy surgery for medically refractory epilepsy. Thirteen patients underwent resective surgery and 1 underwent multiple subpial transections with vagus nerve stimulator placement. Patient demographics, MRI, electroencephalography, intraoperative electrocorticography (ECoG), and pathology were reviewed. The results of this series were compared with those of 114 previously reported patients with FCD without the transmantle sign. Results. All patients were found to have childhood seizure onset and concordant MRI and ECoG findings. The primary MRI findings associated with transmantle sign included gray-white junction blurring, appearance of cortical thickening, T2 or FLAIR abnormality, and bottom-of-the-sulcus dysplasia. The transmantle sign was usually a focal finding, typically confined to 1 or several gyri with well-circumscribed epileptic tissue. Correlation of the transmantle sign with FCD histopathological subtypes was highly variable. Patients who underwent complete resection of MRI and ECoG abnormalities (12 of 13 patients) became seizure free. When compared with 114 FCD patients without the transmantle sign, patients with the transmantle sign showed significantly improved seizure-free outcomes after complete resections (p = 0.04). Conclusions. The presence of the transmantle sign in patients with medically refractory partial epilepsy is associated with highly favorable seizure control outcomes after surgical treatment.

Original languageEnglish (US)
Pages (from-to)337-344
Number of pages8
JournalJournal of Neurosurgery
Volume118
Issue number2
DOIs
StatePublished - Feb 2013
Externally publishedYes

Fingerprint

Malformations of Cortical Development
Seizures
Epilepsy
Vagus Nerve Injuries
Cerebral Ventricles
Partial Epilepsy
Young Adult
Electroencephalography
Demography
Pathology

Keywords

  • Cortical development surgery
  • Cortical malformation
  • Epilepsy
  • Focal cortical dysplasia
  • Transmantle sign

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery

Cite this

Transmantle sign in focal cortical dysplasia : A unique radiological entity with excellent prognosis for seizure control ; Clinical article. / Wang, Doris D.; Deans, Abby E.; James Barkovich, A.; Tihan, Tarik; Barbaro, Nicholas; Garcia, Paul A.; Chang, Edward F.

In: Journal of Neurosurgery, Vol. 118, No. 2, 02.2013, p. 337-344.

Research output: Contribution to journalArticle

Wang, Doris D. ; Deans, Abby E. ; James Barkovich, A. ; Tihan, Tarik ; Barbaro, Nicholas ; Garcia, Paul A. ; Chang, Edward F. / Transmantle sign in focal cortical dysplasia : A unique radiological entity with excellent prognosis for seizure control ; Clinical article. In: Journal of Neurosurgery. 2013 ; Vol. 118, No. 2. pp. 337-344.
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abstract = "Object. Focal cortical dysplasia (FCD) represents a spectrum of developmental cortical abnormalities and is one of the most common causes of intractable epilepsy in children and young adults. Outcomes after surgery for FCD are highly variable, and prognosticators of seizure freedom are unclear. In a subset of FCDs, a transmantle sign is observed on imaging that focally spans the entire cerebral mantle from the ventricle to the cortical surface. The aim of this study was to characterize seizure control outcomes and prognostic significance of the transmantle sign in FCD epilepsy. Methods. Fourteen patients with the transmantle sign underwent epilepsy surgery for medically refractory epilepsy. Thirteen patients underwent resective surgery and 1 underwent multiple subpial transections with vagus nerve stimulator placement. Patient demographics, MRI, electroencephalography, intraoperative electrocorticography (ECoG), and pathology were reviewed. The results of this series were compared with those of 114 previously reported patients with FCD without the transmantle sign. Results. All patients were found to have childhood seizure onset and concordant MRI and ECoG findings. The primary MRI findings associated with transmantle sign included gray-white junction blurring, appearance of cortical thickening, T2 or FLAIR abnormality, and bottom-of-the-sulcus dysplasia. The transmantle sign was usually a focal finding, typically confined to 1 or several gyri with well-circumscribed epileptic tissue. Correlation of the transmantle sign with FCD histopathological subtypes was highly variable. Patients who underwent complete resection of MRI and ECoG abnormalities (12 of 13 patients) became seizure free. When compared with 114 FCD patients without the transmantle sign, patients with the transmantle sign showed significantly improved seizure-free outcomes after complete resections (p = 0.04). Conclusions. The presence of the transmantle sign in patients with medically refractory partial epilepsy is associated with highly favorable seizure control outcomes after surgical treatment.",
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AU - Barbaro, Nicholas

AU - Garcia, Paul A.

AU - Chang, Edward F.

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AB - Object. Focal cortical dysplasia (FCD) represents a spectrum of developmental cortical abnormalities and is one of the most common causes of intractable epilepsy in children and young adults. Outcomes after surgery for FCD are highly variable, and prognosticators of seizure freedom are unclear. In a subset of FCDs, a transmantle sign is observed on imaging that focally spans the entire cerebral mantle from the ventricle to the cortical surface. The aim of this study was to characterize seizure control outcomes and prognostic significance of the transmantle sign in FCD epilepsy. Methods. Fourteen patients with the transmantle sign underwent epilepsy surgery for medically refractory epilepsy. Thirteen patients underwent resective surgery and 1 underwent multiple subpial transections with vagus nerve stimulator placement. Patient demographics, MRI, electroencephalography, intraoperative electrocorticography (ECoG), and pathology were reviewed. The results of this series were compared with those of 114 previously reported patients with FCD without the transmantle sign. Results. All patients were found to have childhood seizure onset and concordant MRI and ECoG findings. The primary MRI findings associated with transmantle sign included gray-white junction blurring, appearance of cortical thickening, T2 or FLAIR abnormality, and bottom-of-the-sulcus dysplasia. The transmantle sign was usually a focal finding, typically confined to 1 or several gyri with well-circumscribed epileptic tissue. Correlation of the transmantle sign with FCD histopathological subtypes was highly variable. Patients who underwent complete resection of MRI and ECoG abnormalities (12 of 13 patients) became seizure free. When compared with 114 FCD patients without the transmantle sign, patients with the transmantle sign showed significantly improved seizure-free outcomes after complete resections (p = 0.04). Conclusions. The presence of the transmantle sign in patients with medically refractory partial epilepsy is associated with highly favorable seizure control outcomes after surgical treatment.

KW - Cortical development surgery

KW - Cortical malformation

KW - Epilepsy

KW - Focal cortical dysplasia

KW - Transmantle sign

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