Article
Ultrasound-assisted surgery for focal cortical dysplasia in patients with therapy-refractory epilepsy – a single center prospective trial
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Authors
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Kevin Akeret
- Universitätspital Zürich, Klinik für Neurochirurgie, Zürich, Schweiz
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David Bellut
- Universitätspital Zürich, Klinik für Neurochirurgie, Zürich, Schweiz
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Hans-Jürgen Huppertz
- Schweizer Epilepsiezentrum, Zürich, Schweiz
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Kristina König
- Schweizer Epilepsiezentrum, Zürich, Schweiz
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Thomas Grunwald
- Schweizer Epilepsiezentrum, Zürich, Schweiz
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Georgia Ramantani
- Kinderspital Zürich, Zürich, Schweiz
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Luca Regli
- Universitätspital Zürich, Klinik für Neurochirurgie, Zürich, Schweiz
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Carlo Serra
- Universitätspital Zürich, Klinik für Neurochirurgie, Zürich, Schweiz
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Niklaus Krayenbühl
- Universitätspital Zürich, Klinik für Neurochirurgie, Zürich, Schweiz
| Published: | June 18, 2018 |
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Outline
Text
Objective: Recent advances in neuroimaging, especially postprocessing MRI analysis, allow to detect malformations of cortical development (MCDs) as the underlying pathology of focal epileptogenesis, of which focal cortical dysplasia (FCDs) is the most frequent subtype. Surgery has shown to be the best therapeutic option for medically refractory cases. Postsurgical seizure outcome primarily depends on the extent and completeness of resection, making intraoperative visualization and delineation of FCDs essential. Our study assesses the value of ultrasound (IOUS) for intraoperative visualization of lesion borders in patients undergoing epilepsy surgery for suspected FCD.
Methods: Patients’ characteristics, neurological examination and imaging data of 17 consecutive patients with therapy-refractory epilepsy undergoing IOUS-assisted microsurgical resection for suspected FCD were prospectively collected between November 2012 and December 2016. The focus of the present study was the analysis of anatomical and morphological features of the FCD – comparing IOUS and preoperative postprocessing MRI. Furthermore, the relation of these features to histological FCD-subtype and effect of IOUS on postoperative residual dysplastic tissue and seizure outcome was evaluated.
Results: Histopathological analysis revealed FCD type I in 3 patients, 12 cases of type II, one with FCD type III and one patient with nonspecific histological findings. In all cases of FCD type II, IOUS allowed clear intraoperative lesion visualization and demarcation. The morphological features depicted showed high correlation with preoperative postprocessing MRI analysis, assisting the surgeon in complete resection. IOUS also allowed to visualize the type III FCD and showed features not typical for FCD in the case, where histology revealed nonspecific findings. Visualization of FCD I proofed to be more difficult and sonographic features were less clear than those seen on postprocessed MR images, correlating with the more discrete histological changes underlying FCD I.
Conclusion: IOUS is a safe, valuable and accurate neurosurgical tool, improving intraoperative visualization of FCD and its adjacent anatomy. IOUS correlates well with preoperative imaging, especially postprocessing MRI. Its clear visualization of lesion borders maximizes the completeness of resection, which in turn correlates with seizure outcome.
