Artikel
Epilepsy surgery in patients with focal cortical dysplasia using neuronavigational guidance and intraoperative high-field MRI
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Veröffentlicht: | 8. Juni 2016 |
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Gliederung
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Objective: Focal cortical dysplasia (FCD) is very frequently associated with epilepsy. However, seizure control after surgery still remains unsatisfactory in most of the cases. We investigated our patient cohort operated on drug-resistant epilepsy caused by FCDs with complementary use of intraoperative high-field MRI (iopMRI) and neuronavigation.
Method: In this retrospective study, 43 patients (21 female, 22 male, mean age 32.2 ± 16.1 yrs) with FCD and drug-resistant epilepsy underwent surgery in our Department between 2003 and 2014. Mean duration of epilepsy was 19.8 ± 14.6 years. Surgery was performed with the aid of neuronavigation and intraoperative 1.5T-iopMRI. In 25 patients, additional functional MR imaging (motor, memory and speech areas) as well as diffusion tensor imaging (DTI) for tracking neuronal fibers (language and pyramidal tracts) was used. We integrated three-dimensional intraoperative visualization of phase-2 electrodes in 10 patients.
Results: Of 43 patients undergoing surgery, complete resection was achieved in 91% (39/43). In 10 patients (23%), iopMRI identified residual tissue according to the navigational plan, which led to an extended resection and intraoperative update of neuronavigational data. Six of these patients had excellent seizure outcome. Overall, complete seizure control (Engel Class IA) was achieved in 28/43 patients (65%, mean FU 48.7 ± 30.2 months). Surgical complications occurred in 5% (2/43) of all patients. One patient suffered from a permanent and two patients from transient postoperative neurological deficits (7%, 3/43).
Conclusions: Our surgical strategy using multimodal neuronavigation as a complementary feature in patients with FCDs and drug-resistant epilepsy led to long-term seizure control rates that are remarkable. As complete resection of the pathological tissue directly correlates with epilepsy outcome, iopMRI increased the rate of potentially seizure-free patients by 14%.