Surgical outcomes in children with bottom-of-sulcus dysplasia and drug-resistant epilepsy: A retrospective cohort study

Puneet Jain*, Ayako Ochi, Carter McInnis, Hiroshi Otsubo, O. Carter Snead, George M. Ibrahim, Elizabeth Donner, Elysa Widjaja

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

6 Scopus citations


OBJECTIVE Bottom-of-sulcus dysplasia (BOSD) is challenging to identify radiologically. The aim of this study was to explore seizure outcomes after resective surgery or MR-guided laser interstitial thermal therapy (MRgLITT) in children with BOSD. METHODS Children with radiologically defined BOSD who underwent resective surgery or MRgLITT, with at least 1 year of follow-up were included. Clinical, radiological, neurophysiological, and histological data were extracted from medical records. Invasive video EEG (IVEEG) was used to evaluate the ictal onset zone or motor/language mapping, wherever appropriate. Histology of MRI-visible BOSD, including the overlying and adjacent cortex, was also evaluated. RESULTS Forty-one children with BOSD underwent surgical treatment. The lesion was initially overlooked on MRI in 20 patients (48.8%). Of 34 patients who underwent IVEEG and who had available ictal data, the ictal onset zone extended beyond the MRI-visible BOSD in 23 patients (67.6%). Surgical treatment included lesionectomy (24 patients), extended lesionectomy (12 patients), lobectomy (1 patient), and ablation of BOSD (4 patients). The pathology in 37 patients who underwent resection showed focal cortical dysplasia type IIB and type IIA in 21 (53.8%) and 16 patients (41%), respectively. Seizure freedom was achieved in 32 patients (78.1%) after a mean follow-up of 4.3 years. CONCLUSIONS Seizure outcomes after resective surgery or MRgLITT in children with BOSD were generally favorable. The authors found that the neurophysiological abnormality and pathology often extended beyond the MRI-visible BOSD.

Original languageEnglish (US)
Pages (from-to)295-305
Number of pages11
JournalJournal of Neurosurgery: Pediatrics
Issue number3
StatePublished - Sep 2021


  • Bottom-of-sulcus dysplasia
  • Epilepsy surgery
  • Focal cortical dysplasia
  • Invasive-EEG monitoring
  • Laser interstitial thermal therapy
  • Motor mapping
  • Stereo-EEG

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery
  • Pediatrics, Perinatology, and Child Health


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