gms | German Medical Science

66. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
Friendship Meeting mit der Italienischen Gesellschaft für Neurochirurgie (SINch)

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

7. - 10. Juni 2015, Karlsruhe

Invasive monitoring with depth electrodes and electrophysiologically navigated resection of the epileptogenic focus in patients with pharmacoresistant seizures: technical feasibility and clinical outcome

Meeting Abstract

  • Jun Thorsteinsdottir - Neurochirurgische Klinik und Poliklinik, Klinikum der Ludwig-Maximilians-Universität München
  • Christian Vollmar - Neurologische Klinik und Poliklinik, Klinikum der Ludwig-Maximilians-Universität München
  • Soheyl Noachtar - Neurologische Klinik und Poliklinik, Klinikum der Ludwig-Maximilians-Universität München
  • Jörg-Christian Tonn - Neurochirurgische Klinik und Poliklinik, Klinikum der Ludwig-Maximilians-Universität München
  • Friedrich-Wilhelm Kreth - Neurochirurgische Klinik und Poliklinik, Klinikum der Ludwig-Maximilians-Universität München
  • Aurelia Peraud - Neurochirurgische Klinik und Poliklinik, Klinikum der Ludwig-Maximilians-Universität München

Deutsche Gesellschaft für Neurochirurgie. 66. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC). Karlsruhe, 07.-10.06.2015. Düsseldorf: German Medical Science GMS Publishing House; 2015. DocMI.05.04

doi: 10.3205/15dgnc278, urn:nbn:de:0183-15dgnc2780

Veröffentlicht: 2. Juni 2015

© 2015 Thorsteinsdottir et al.
Dieser Artikel ist ein Open-Access-Artikel und steht unter den Lizenzbedingungen der Creative Commons Attribution 4.0 License (Namensnennung). Lizenz-Angaben siehe http://creativecommons.org/licenses/by/4.0/.


Gliederung

Text

Objective: In patients with pharmacoresistant seizures, presurgical workup can identify epilepsy surgery options when non-invasive imaging has failed. Early postoperative recurrences for epilepsy are often associated with suboptimal identification/resection of the epileptogenic focus. In the current pilot study a new approach was tested: the seizure onset zone was determined using invasive monitoring with stereotactically implanted depth electrodes; electrophysiologically navigated resection was done thereafter. We here report on the risks and the effectiveness of this approach.

Method: After preoperative evaluation using noninvasive techniques (scalp EEG monitoring, ictal SPECT and interictal PET scanning) and review in the multidisciplinary epilepsy conference, decision of depth electrode implantation was made. All patients gave informed consent. Depth electrodes were stereotactically implanted. The exact seizure onset zone was determined by video-EEG-recordings and linked to the respective electrode positions in the post-implantation CT-scan (slice thickness: 1.25mm). After image fusion with the preoperative MRI and integration of these data into the navigation system, 3D reconstruction of the focus was possible and electrophysiologically guided resection was initiated.

Results: 45 patients were included (mean age: 34.5y, range: 3.4-59.7y). The mean frequency of focal and/or general seizures was 88.9 times per month. For invasive monitoring 3-12 electrodes were implanted per patient without any morbidity. The location of the focus was frontal (37.8%), temporal (37.8%), parietal (4.4%), occipital (4.4%) and multilobar (15.6%). Histological examination revealed focal cortical dysplasia (22.2%), gliosis (35.6%), grey-white-differentiation disorder (13.3%), tumor (8.9%), hippocampal sclerosis (11.1%), hamartoma (2.2 %). Histology was unknown in 3 cases (6.7%). Median follow-up was 12.9 months.

Engel Class IA outcome was achieved in 28 (62.2%) patients, Engel Class IB outcome in 9 patients (20%), and Engel Class IC outcome in 5 patients (11.1%). In 3 patients the outcome was unknown (6.7%). Transient perioperative morbidity was 1%. No permanent deficits were seen.

Conclusions: Stereotactic implantation of depth electrodes is safe. It enables precise identification of the epileptic focus thereby allowing electrophysiologically navigated focus resection with excellent clinical outcome.