Hemispherotomy or Lobectomy? The Role of Presurgical Neuroimaging in a Young Case of a Large Porencephalic Cyst with Intractable Epilepsy

Abstract

A young patient with a large left hemisphere porencephalic cyst underwent neuroimaging investigation (functional magnetic resonance imaging (fMRI), EEG-fMRI, DTI tractography) during presurgical evaluation for intractable epilepsy. The functional workup showed that (a) the healthy hemisphere had undertaken language processing, primary and secondary sensory functions of bilateral upper and lower extremities, and bilateral feet motion, and (b) the porencephalic hemisphere had retained contralateral arm and shoulder motion. EEG-fMRI localized the epileptogenic area occipitally. Tractography anatomically supported the above. Neuroimaging tailored surgery into selective lobectomy, thereby preserving all sensorimotor functionality and strongly supporting its use for presurgical evaluation of patients with large hemispheric lesions.

The role of preoperative diffusion tensor imaging in predicting and improving functional outcome in pediatric patients undergoing epilepsy surgery: a systematic review

“…Of the analyzed studies, seven reported the use of DTI and its relationship to the patient’s motor outcome. 20,41,45,48–51 The studies by Kokkinos and Shinoda were case reports in which DTI was used to assess the relationship of the corticospinal tracts (CST) with the region of interest resulting in a tailored surgical plan to avoid this tract resulting in preservation of motor function in both patients.. 41,45 Yang et al reported on a prospective study analyzing 16 patients and using HARDI diffusion-weighted data which enabled a tailored surgical plan resulting in 100% preservation of post-operative motor function. 20 Finally, the last three studies by Nelles, Jeong and Wang focused on the use of DTI for predicting motor outcome after epilepsy surgery and showed that quantitative values calculated with DTI, such as FA and the robustness of the CST, can accurately predict post-operative motor function with a specificity that ranges between 69.6 and 100% and a sensitivity of 80–85.7% 49–51 ( Figure 5 ).…”

The start and development of epilepsy surgery in Europe: a historical review

“…The other 20 % of the operations were extra-temporal epilepsy cases with focal cortical resections and occasionally multilobar resections. Acute intraoperative ECoG is utilized in most temporal and extra-temporal cases for confirmation of epileptogenicity and modifications of resections in selected cases [26, 59, 60]. Follow-up information is available on a yearly basis for at least 90 % of the operated patients with 80 % of the patients having an Engel class I outcome, 15 % a class II–III, and 5 % a class IV outcome.…”

Porencephaly and intraparenchymal hyperacute infarct due to bilateral anterior cerebral artery embolism in adult: A rare case

“…Microcephaly is generally related. 5,6 The differential diagnosis of porencephaly includes schizencephaly, arachnoid cyst, cystic neoplasm and hydrocephalus. In schizencephaly there are fissures with smooth outline while in porencephaly, the cysts are round with jagged contours and there may be thrombus or detritus.…”