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.

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.

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.

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.

沟底发育不良 (BOSD) 在放射学上难以识别。本研究的目的是探讨 BOSD 儿童切除手术或 MR 引导的激光间质热疗 (MRgLITT) 后癫痫发作的结果。

接受了切除手术或 MRgLITT 且至少随访 1 年的放射学定义的 BOSD 儿童被纳入。从医疗记录中提取临床、放射学、神经生理学和组织学数据。在适当的情况下，侵入性视频脑电图 (IVEEG) 用于评估发作区或运动/语言映射。还评估了 MRI 可见 BOSD 的组织学，包括覆盖和相邻的皮质。

41 名 BOSD 儿童接受了手术治疗。最初有 20 名患者 (48.8%) 在 MRI 上忽略了该病灶。在 34 名接受 IVEEG 且有可用发作数据的患者中，23 名患者 (67.6%) 的发作区超出了 MRI 可见 BOSD。手术治疗包括病灶切除术（24 名患者）、扩大病灶切除术（12 名患者）、肺叶切除术（1 名患者）和 BOSD 消融（4 名患者）。37 例接受切除术的患者病理学显示局灶性皮质发育不良 IIB 型和 IIA 型分别为 21 例（53.8%）和 16 例（41%）。平均随访 4.3 年后，32 名患者 (78.1%) 实现了无癫痫发作。

BOSD 儿童切除手术或 MRgLITT 后的癫痫发作结果通常是有利的。作者发现神经生理学异常和病理通常超出 MRI 可见的 BOSD。