Artikel
Voxel-based morphometry in epilepsy surgery for patients with focal cortical dysplasia using neuronavigation and intraoperative MRI
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Autoren
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Björn Sommer
- University Hospital Erlangen, Department of Neurosurgery, Erlangen, Deutschland
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Stefan Rampp
- Universitätsklinikum Erlangen, Neurochirurgie, Erlangen, Deutschland
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Hajo M. Hamer
- Universitätsklinikum Erlangen, Klinik für Neurologie, Epilepsiezentrum, Erlangen, Deutschland
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Ingmar Blümcke
- Department of Neuropathology, University Hospital Erlangen, Erlangen, Deutschland
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Michael Buchfelder
- Universitätsklinikum Erlangen, Klinik für Neurochirurgie, Erlangen, Deutschland
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Karl Rössler
- Department of Neurosurgery Erlangen, Erlangen, Deutschland
| Veröffentlicht: | 9. Juni 2017 |
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Gliederung
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Objective: Voxel-based morphometry (VBM) is an important post-processing MRI technique to identify occult malformations in epilepsy patients. We investigated our surgical results in patients operated on for focal cortical dysplasia (FCD) who suffered from refractory epilepsy with the aid of VBM, neuronavigation and intraoperative 1.5T-MRI (iopMRI).
Methods: In this retrospective study, 14 patients (9 female, 4 male, median age 32.0 ± 13.1 yrs) were operated on a FCD in our department using VBM data. The VBM lesion was superimposed into neuronavigation and surgery was performed with intraoperative 1.5T-MRI resection control. Median duration of epilepsy was 20.0 ± 12.5 years. Additional functional MR imaging (motor, memory and speech areas) and diffusion tensor imaging (DTI) for tracking neuronal fibers (language and pyramidal tracts) was acquired in 11 patients. Every patient underwent invasive phase-2 monitoring before respective surgery.
Results: Complete resection of the FCDs was achieved in all of these patients. Intraoperative MRI revealed remnant pathological tissue according to our resection plan in 3/14 patients (21%), which led to further tissue removal intraoperatively. Of 14 patients (7 lesional, 7 non-lesional), VBM identified the FCD in 12 cases and missed the exact localization in 2 non-lesional patients. In 6/12 patients, the VBM lesion was resected completely according to the latest postoperative 3T MRI. Five of these six patients were seizure-free (Engel 1A), whereas only one patient of the remaining 6 patients with subtotal resection of the VBM lesion had excellent seizure control. Overall, 8/14 patients (57%) had Engel class 1A outcome. After surgery, one patient had a permanent and one patient a transient neurological deficit (7% each).
Conclusion: Especially in cases with ill-defined or non-lesional FCDs, voxel-based morphometry, neuronavigation and intraoperative MRI proved to be helpful in the resection of the epileptogenic zone. The rate of complete resections was increased, which transformed into a higher rate of seizure-free patients.
