gms | German Medical Science

68th Annual Meeting of the German Society of Neurosurgery (DGNC)
7th Joint Meeting with the British Neurosurgical Society (SBNS)

German Society of Neurosurgery (DGNC)

14 - 17 May 2017, Magdeburg

Article

Send article

Focal cortical dysplasia as a challenge for the epilepsy surgeon: could multimodal neuronavigation help?

Meeting Abstract

Search Medline for

  • Björn Sommer - University Hospital Erlangen, Department of Neurosurgery, Erlangen, Deutschland
  • Hajo M. Hamer - Universitätsklinikum Erlangen, Klinik für Neurologie, Epilepsiezentrum, Erlangen, Deutschland
  • Ingmar Blümcke - Department of Neuropathology, University Hospital Erlangen, Erlangen, Deutschland
  • Michael Buchfelder - Universitätsklinikum Erlangen, Klinik für Neurochirurgie, Erlangen, Deutschland
  • Karl Rössler - Department of Neurosurgery Erlangen, Erlangen, Deutschland

Deutsche Gesellschaft für Neurochirurgie. Society of British Neurological Surgeons. 68. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), 7. Joint Meeting mit der Society of British Neurological Surgeons (SBNS). Magdeburg, 14.-17.05.2017. Düsseldorf: German Medical Science GMS Publishing House; 2017. DocDI.19.05

doi: 10.3205/17dgnc289, urn:nbn:de:0183-17dgnc2892

Published: June 9, 2017

© 2017 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) one of the major causes of drug-resistant epilepsy. As long-term seizure control after surgery still remains disappointing, we evaluated our patient cohort using functional neuronavigation and intraoperative 1.5T-MRI (iopMRI).

Methods: In this retrospective study, 66 patients (33 female, 33 male, mean age 36.4 ± 12.7 yrs) with FCD and drug-resistant epilepsy underwent surgery in our Department between 2/2003 and 10/2016. Mean duration of epilepsy was 20.7 ± 12.9 years. Surgery was performed with the aid of neuronavigation and intraoperative 1.5T-iopMRI. 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 25 patients. We integrated three-dimensional intraoperative visualization of phase-2 electrodes in 15 patients.

Results: Of 66 patients undergoing surgery, complete resection was achieved in 91% (60/66). Remnant tissue according to the resection plan was detected with iopMRI in 13 patients (20%). After intraoperative update of neuronavigation, eight of these 13 patients undergoing re-resection were seizure free. Overall, complete seizure control (Engel Class IA) was 64% (42/66, mean FU 52.5 ± 33.1 months). Five patients had a permanent (6%, 4/66) and two patient a transient postoperative neurological deficit (5%, 3/66).

Conclusion: Epilepsy surgery in patients with FCDs can be enhanced with the aid of multimodal neuronavigation, leading to promising long-term seizure control. As a direct consequence of intraoperative MR imaging, the rate of complete resections of pathological tissue as well as the number of potentially seizure-free patients can be increased.