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67th Annual Meeting of the German Society of Neurosurgery (DGNC)
Joint Meeting with the Korean Neurosurgical Society (KNS)

German Society of Neurosurgery (DGNC)

12 - 15 June 2016, Frankfurt am Main

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Epilepsy surgery in patients with focal cortical dysplasia using neuronavigational guidance and intraoperative high-field MRI

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  • Björn Sommer - Neurochirurgische Klinik, Universitätsklinikum Erlangen, Germany
  • Hajo M. Hamer - Epilepsiezentrum, Neurologische Klinik, Universitätsklinikum Erlangen, Germany
  • Ingmar Blümcke - Neuropathologisches Institut, Universitätsklinikum Erlangen, Germany
  • Michael Buchfelder - Neurochirurgische Klinik, Universitätsklinikum Erlangen, Germany
  • Karl Roessler - Neurochirurgische Klinik, Universitätsklinikum Erlangen, Germany

Deutsche Gesellschaft für Neurochirurgie. 67. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), 1. Joint Meeting mit der Koreanischen Gesellschaft für Neurochirurgie (KNS). Frankfurt am Main, 12.-15.06.2016. Düsseldorf: German Medical Science GMS Publishing House; 2016. DocDI.06.02

doi: 10.3205/16dgnc127, urn:nbn:de:0183-16dgnc1276

Published: June 8, 2016

© 2016 Sommer et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

Text

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%.