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71. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
9. Joint Meeting mit der Japanischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

21.06. - 24.06.2020

Reoperation in failed epilepsy surgery using MEG, neuronavigation and intraoperative MR imaging

Anwendung von MEG, Neuronavigation und intraoperativer Bildgebung für Reoperationen von nicht anfallsfreien Patienten nach primärer OP

Meeting Abstract

  • Julia Shawarba - Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Deutschland
  • Burkhard Kasper - Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Deutschland
  • Stefan Rampp - Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Deutschland
  • Roland Coras - Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Deutschland
  • Ingmar Blümcke - Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Deutschland
  • Michael Buchfelder - Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Deutschland
  • presenting/speaker Karl Rössler - Medizinische Universität Innsbruck, Neurochirurgische Klinik, Wien, Austria

Deutsche Gesellschaft für Neurochirurgie. 71. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), 9. Joint Meeting mit der Japanischen Gesellschaft für Neurochirurgie. sine loco [digital], 21.-24.06.2020. Düsseldorf: German Medical Science GMS Publishing House; 2020. DocP222

doi: 10.3205/20dgnc508, urn:nbn:de:0183-20dgnc5089

Published: June 26, 2020

© 2020 Shawarba et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at



Objective: Reoperations in patients with failed epilepsy surgery are still challenging although a reasonably good seizure outcome seems possible. Advanced imaging and intraoperative MR tomography may contribute to a better postoperative seizure outcome in this patient group.

Methods: We investigated 27 patients (13 female/14 male/mean age at first surgery 29.4 yrs) with a mean seizure history of 14 years mean (from 1-35 yrs). The mean time between first surgery and reoperation after failure was 3.8 years (from 0-13 yrs). Additionally, to the standard preoperative investigations, 35 magnetoencephalography (MEG) investigations were performed and 17 patients had intraoperative neuronavigation and MR imaging during reoperation.

Results: Histologically, reoperated patients included 7 with unspecific gliosis (25.9%), 6 with gangliogliomas (22.2%), 6 with focal cortical dysplasia (22.2%), 4 with hippocampal sclerosis and 4 other pathologies. The postoperative seizure outcome in the investigated patients after a second surgery was 67% Engel Grade I (18/27 patients, follow up time 4.9 yrs). Altogether, 78% of patients had a better seizure outcome than after the first surgery, 19% had an equal outcome and 3% a worse outcome. Integration of preoperative MEG and intraoperative MR imaging correlated positively with enhanced seizure outcome.

Conclusion: Our investigation demonstrated that patients with failed epilepsy surgery may have a favorable seizure outcome after a second surgery due to advanced preoperative imaging and intraoperative MR technology.