Eight-Year Experience With 3-T Intraoperative MRI Integration in Focal Pediatric Epilepsy Surgery: Impact on Extent of Resection, Residual Volumes, and Seizure Outcomes

Eid, Hadeel; Crevier‐Sorbo, Gabriel; Moreau, Jeremy T; Saint‐Martin, Christine; Elzawawi, Mohamed; Mousa, Waleed A; Dudley, Roy; Wilson, Nagwa

doi:10.2214/ajr.19.22336

Cited by 12 publications

(38 citation statements)

References 32 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…10 Most patients continue AEDs for the first six to 24 months after surgery, after which some reduce or withdraw treatment. 25 Many continue AEDs, albeit with improved seizure control, and in a report of epilepsy surgery for paediatric cerebral malformations, 75% were still taking anticonvulsants after five years 26 , similar to our institution. Long-term studies do support a higher likelihood of stopping AEDs following epilepsy surgery.…”

Section: Discussionsupporting

confidence: 69%

“…All four still achieved greater than 50% reduction in seizure control, and three achieved Engel Class 1A outcome ultimately. In lesionectomies and temporal lobectomies, complications resulting in permanent contralateral weakness or major visual field deficits are reported to be rare; 25 no unanticipated deficits were seen in our series.…”

Section: Discussionmentioning

confidence: 41%

“…Additionally, this study revealed that, while iMRI may prolong mean operative time by 1.2 hours, it was not associated with additional complications. 25 In our study, seven out of 23 (30%) focal epilepsy patients had iMRI incorporated into their fi rst surgeries. Five of these seven (71%) are now seizure free (Engel Class 1A).…”

Section: Discussionmentioning

confidence: 83%

“…Post-operative complications at our centre were rare and comparable to what has previously been reported, with 4.5-5.1% having serious medical or neurological complications. 25 There were no post-operative mortalities. The four patients (12%) with unanticipated post-operative complications, such as wound dehiscence, tension pneumocephalocele or surgical related haematomas, received timely management.…”

Section: Discussionmentioning

confidence: 91%

“…iMRI use has been associated with smaller residual lesions and is protective against poor Engel outcome score. 22,25 In Sacino et al's 2016 study of 29 paediatric patients who underwent resection of FCD or heterotopia localized to eloquent cortex regions, nine of 11 patients (82%) in the iMRI resection group were seizure free (Engel Class IA) compared with seven of 18 patients (39%) in control group (p=0.05). 22 Eid et al's study also revealed that iMRI was protective against poor seizure outcome (p=0.048) among 80 paediatric patients who underwent focal epilepsy surgery from 2003 to 2017.…”

Section: Discussionmentioning

confidence: 99%

See 4 more Smart Citations

Evaluation and outcomes of paediatric epilepsy surgery in Singapore: A single-centre audit

Tan

Ngoh

et al. 2021

NeuroAsia

View full text Add to dashboard Cite

Background: Paediatric epilepsy surgery reduces seizure burden in drug-refractory epilepsy reducing long-term neurocognitive damage. Methods: Single-centre retrospective audit of pre-surgical evaluations and outcomes of the paediatric epilepsy and epilepsy surgery programme over eleven years at KK Women’s and Children’s Hospital, Singapore. Data were collected based on National Institute of Neurological Disorders and Stroke Common Data Elements guidelines. Outcome was categorized using Engel classification scale, and favourable outcome defined as greater than 50% decrease in seizure frequency or drop attacks. Results: Thirty-three children underwent epilepsy surgery, with mean follow-up 3.8±3.1 years. Median age at surgery was 10.9 years. Twenty-four children with focal epilepsy underwent resection of the epileptogenic focus, including lesionectomy (n=8), anterior temporal lobectomy (n=7), extratemporal lobectomy (n=7) and hemispherectomy (n=2). Nine children underwent corpus callosotomy for Lennox Gastaut Syndrome (n=8) and West Syndrome (n=1). Median hospital stay duration was ten days. All twenty-three focal epilepsy patients with minimum three-month follow-up achieved greater than 50% seizure reduction. Fifteen (65%) focal epilepsy patients achieved seizure-freedom (Engel Class IA) after first surgeries. Four patients required second surgeries, with two achieving seizure-freedom. Intraoperative MRI (iMRI) is beneficial. All nine corpus callosotomy patients (100%) achieved greater than 50% decrease in drop attacks. Number of antiepileptic drugs was weaned for 21/32 (66%) patients. Post-operative complications were low and some patients had anticipated neurological deficits. Outcomes were comparable to current literature. Conclusions: In well-selected candidates with tailored evaluation, paediatric epilepsy surgery is a safe therapeutic option with favourable outcomes and can be performed across the entire paediatric age range.

show abstract

Section: Discussionsupporting

confidence: 69%

Section: Discussionmentioning

confidence: 41%

Section: Discussionmentioning

confidence: 83%

Section: Discussionmentioning

confidence: 91%

Section: Discussionmentioning

confidence: 99%

See 3 more Smart Citations

Evaluation and outcomes of paediatric epilepsy surgery in Singapore: A single-centre audit

Tan

Ngoh

et al. 2021

NeuroAsia

View full text Add to dashboard Cite

show abstract

Laser interstitial thermal therapy in the management of bottom‐of‐sulcus dysplasia‐related epilepsy

Yang,

Zhang,

Wang

et al. 2024

Ann Clin Transl Neurol

View full text Add to dashboard Cite

ObjectiveThis study assessed the efficacy and safety of magnetic resonance‐guided laser interstitial thermal therapy (MRgLITT) versus open surgery (OS) for the treatment of patients with bottom‐of‐sulcus dysplasia (BOSD)‐related epilepsy.MethodsTwenty‐two patients underwent MRgLITT, while 39 underwent OS. Postoperative seizure‐free rates were analyzed using Kaplan–Meier curves. The removal ratio, which represents the extent of damage, was calculated based on preoperative lesion volume and postoperative removal volume. Other outcomes, including adverse events, operative time, and hospital stay, were also compared.ResultsKaplan–Meier curves indicated the seizure‐free rates were comparable between the MRgLITT group (90.9%, 26.5 [23.0, 35.1] months) and OS group (89.7%, 25.2 [16.2, 34.6] months) at the final follow‐up (p = 0.901, log‐rank test). The removal ratio of MRgLITT (1.3 [1.1, 1.7]) was significantly lower (p = 0.007) than that of OS (5.8 [3.6, 8.5]). A comparison of postoperative neurological deficits, infection rates, and fever rates revealed no significant differences between MRgLITT and OS groups. The operative time (hours) of MRgLITT (3.0, [2.1, 4.9]) was significantly shorter (p = 0.007) than that of OS (3.5 [3.0, 4.5]). The hospital stay (days) after MRgLITT (6 [5.0, 7.5]) was significantly shorter (p < 0.001) than that of OS (11.0 [9.0, 13.5]).InterpretationMRgLITT has advantages over OS, including comparable seizure control and adverse event profiles, along with reduced removal ratios, shorter operative time, and shorter hospital stays.

show abstract

Evaluating the use of intraoperative magnetic resonance imaging in paediatric brain tumour resection surgeries: a literature review

Wu,

Clift,

Hilliard

et al. 2023

J of Medical Radiation Sci

View full text Add to dashboard Cite

Brain tumours are the most common solid neoplasm in children, posing a significant challenge in oncology due to the limited range of treatment. Intraoperative magnetic resonance imaging (iMRI) has recently emerged to aid surgical intervention in neurosurgery resection with the potential to delineate tumour boundaries. This narrative literature review aimed to provide an updated evaluation of the clinical implementation of iMRI in paediatric neurosurgical resection, with an emphasis on the extent of brain tumour resection, patient outcomes and its drawbacks. Databases including MEDLINE, PubMed, Scopus and Web of Science were used to investigate this topic with key terms: paediatric, brain tumour, and iMRI. Exclusion criteria included literature comprised of adult populations and the use of iMRI in neurosurgery in the absence of brain tumours. The limited body of research evaluating the clinical implementation of iMRI in paediatric cohorts has been predominantly positive. Current evidence demonstrates the potential for iMRI use to increase rates of gross total resection (GTR), assess the extent of resection, and improve patient outcomes, such as progression‐free survival. Limitations regarding the use of iMRI include prolonged operation times and complications associated with head immobilisation devices. iMRI has the potential to aid in the achievement of maximal brain tumour resection in paediatric patients. Future prospective randomised controlled trials are necessary to determine the clinical significance and benefits of using iMRI during neurosurgical resection for clinical management of brain neoplasms in children.

show abstract

Eight-Year Experience With 3-T Intraoperative MRI Integration in Focal Pediatric Epilepsy Surgery: Impact on Extent of Resection, Residual Volumes, and Seizure Outcomes

Cited by 12 publications

References 32 publications

Evaluation and outcomes of paediatric epilepsy surgery in Singapore: A single-centre audit

Evaluation and outcomes of paediatric epilepsy surgery in Singapore: A single-centre audit

Laser interstitial thermal therapy in the management of bottom‐of‐sulcus dysplasia‐related epilepsy

Evaluating the use of intraoperative magnetic resonance imaging in paediatric brain tumour resection surgeries: a literature review

Contact Info

Product

Resources

About