Surgical outcomes for superior frontal sulcus focal cortical dysplasia-related epilepsy.

BACKGROUND AND

OBJECTIVES

Focal Cortical Dysplasia (FCD) is the most common cause of drug-resistant epilepsy in children. FCDs occur throughout the cortex but with preferential hotspots in the frontal and temporal lobes, particularly within and adjacent to the superior frontal sulcus (SFS). Preliminary evidence suggests a potential pathologically-informed gradient across the SFS. This study investigated the hypothesis that SFS-FCDs align to an anterior-posterior gradient with anterior lesions more likely to be FCD Type IIA, and posterior lesions more likely FCD Type IIB. We also investigated clinic-pathologic predictors of surgical outcomes for these lesions.

METHODS

Records were reviewed from 35 pediatric patients with SFS-FCD-related epilepsy treated at Children's National Hospital between January 2009 to January 2025. All patients had MRI-confirmed FCD. Lesion masks were co-registered with SFS mask to determine anterior-posterior gradient and compared to pathological information. Clinicopathologic factors were analyzed for associations with surgical outcomes.

RESULTS

There was no confirmed FCD pathological association with the SFS anterior-posterior gradient. 54% (19/35) were treated with resection with Engel I outcome in 74% (14/19), and Engel I+II (good outcome) in 95% (18/19). Neither FCD subtype nor presence of focal to bilateral tonic-clonic seizures (FBTCS) were associated with seizure-free outcome.

DISCUSSION: These data do not confirm a pathological gradient within the SFS. FCD pathological subtype and FBTCS are not associated with surgical outcomes in the SFS. High rates of seizure-free outcomes can be achieved with resective surgical strategies for superior frontal sulcus FCD-related epilepsy.