Impact of intraoperative MRI on outcomes in epilepsy surgery: preliminary experience of two years

Kurwale, Nilesh; Chandra, Sarat P; Chouksey, Pradeep; Arora, Amit; Garg, Ajay; Sarkar, Chitra; Bal, Chandrashekhar; Tripathi, Manjari

doi:10.3109/02688697.2014.1003034

Cited by 17 publications

(9 citation statements)

References 20 publications

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“…The role of intraoperative imaging, such as intraoperative MRI, is not presently clear. 10 Surprisingly, propofol was used in anesthesia in 59% of the children, although not approved for use in children younger than 3 years of age. 11 As far as can be determined from the clinical outcomes forwarded by the centers, propofol use did not carry an increased risk in this patient population, despite reports in the literature, especially under the age of 2 years.…”

Section: Discussionmentioning

confidence: 99%

Technical aspects of pediatric epilepsy surgery: Report of a multicenter, multinational web‐based survey by the ILAE Task Force on Pediatric Epilepsy Surgery

et al. 2016

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SUMMARYSurgical techniques may vary extensively between centers. We report on a web-based survey aimed at evaluating the current technical approaches in different centers around the world performing epilepsy surgery in children. The intention of the survey was to establish technical standards. A request was made to 88 centers to complete a web-based survey comprising 51 questions. There were 14 questions related to general issues, 13 questions investigating the different technical aspects for children undergoing epilepsy surgery, and 24 questions investigating surgical strategies in pediatric epilepsy surgery. Fifty-two centers covering a wide geographic representation completed the questionnaire. The median number of resective procedures per center per year was 47. Some important technical practices appeared (>80% of the responses) such as the use of prophylactic antibiotics (98%), the use of high-speed drills for bone opening (88%), nonresorbable material for bone flap closure (85%), head fixation (90%), use of the surgical microscope (100%), and of free bone flaps. Other questions, such as the use of drains, electrocorticography (ECoG) and preoperative withdrawal of valproate, led to mixed, inconclusive results. Complications were noted in 3.8% of the patients submitted to cortical resection, 9.9% hemispheric surgery, 5% callosotomy, 1.8% depth electrode implantation, 5.9% subdural grids implantation, 11.9% hypothalamic hamartoma resection, 0.9% vagus nerve stimulation (VNS), and 0.5% deep brain stimulation. There were no major differences across regions or countries in any of the subitems above. The present data offer the first overview of the technical aspects of pediatric epilepsy surgery worldwide. Surprisingly, there seem to be more similarities than differences. That aside many of the evaluated issues should be examined by adequately designed multicenter randomized controlled trials (RCTs). Further knowledge on these technical issues might lead to increased standardization and lower costs in the future, as well as definitive practice guidelines.

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Section: Discussionmentioning

confidence: 99%

Technical aspects of pediatric epilepsy surgery: Report of a multicenter, multinational web‐based survey by the ILAE Task Force on Pediatric Epilepsy Surgery

et al. 2016

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“…Apart from these early studies, however, convincing information from small case series demonstrating the advantages of iMRI for distinct epilepsy surgical procedures is still lacking. 12,13,51,85 To our knowledge, this is the first report on surgical and seizure outcome results in a large consecutive cohort of patients with epilepsy surgically treated using neuronavigation and iMRI. Our results demonstrate that there is a significant benefit of iMRI combined with neuronavigation, not for all operations but particularly for surgical procedures for lesional epilepsy.…”

mentioning

confidence: 89%

“…60,73,74,75 A CM or FCD may have contact with deep structures such as speech or visual tracts. 74,83 Thus, the use of intraoperative structural and diffusion tensor imaging (DTI) and neuronavigation can lead to increased resection volume and prevent postoperative neurological deterioration, 51,60,70,72,85 which is why, in 2002, we began performing surgery on patients with surgically treatable epilepsy in an operating theater equipped with a high-field 1.5-T intraoperative MRI (iMRI) facility. In addition, for lesions near eloquent cortical brain areas or tracts, functional MRI (fMRI) and DTI may help surgeons to visualize eloquent cortex and fiber tracts preoperatively.…”

mentioning

confidence: 99%

Resective surgery for medically refractory epilepsy using intraoperative MRI and functional neuronavigation: the Erlangen experience of 415 patients

Rössler¹,

Hofmann²,

Sommer³

et al. 2016

FOC

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OBJECTIVE Intraoperative overestimation of resection volume in epilepsy surgery is a well-known problem that can lead to an unfavorable seizure outcome. Intraoperative MRI (iMRI) combined with neuronavigation may help surgeons avoid this pitfall and facilitate visualization and targeting of sometimes ill-defined heterogeneous lesions or epileptogenic zones and may increase the number of complete resections and improve seizure outcome. METHODS To investigate this hypothesis, the authors conducted a retrospective clinical study of consecutive surgical procedures performed during a 10-year period for epilepsy in which they used neuronavigation combined with iMRI and functional imaging (functional MRI for speech and motor areas; diffusion tensor imaging for pyramidal, speech, and visual tracts; and magnetoencephalography and electrocorticography for spike detection). Altogether, there were 415 patients (192 female and 223 male, mean age 37.2 years; 41% left-sided lesions and 84.9% temporal epileptogenic zones). The mean preoperative duration of epilepsy was 17.5 years. The most common epilepsy-associated pathologies included hippocampal sclerosis (n = 146 [35.2%]), long-term epilepsy-associated tumor (LEAT) (n = 67 [16.1%]), cavernoma (n = 45 [10.8%]), focal cortical dysplasia (n = 31 [7.5%]), and epilepsy caused by scar tissue (n = 23 [5.5%]). RESULTS In 11.8% (n = 49) of the surgeries, an intraoperative second-look surgery (SLS) after incomplete resection verified by iMRI had to be performed. Of those incomplete resections, LEATs were involved most often (40.8% of intraoperative SLSs, 29.9% of patients with LEAT). In addition, 37.5% (6 of 16) of patients in the diffuse glioma group and 12.9% of the patients with focal cortical dysplasia underwent an SLS. Moreover, iMRI provided additional advantages during implantation of grid, strip, and depth electrodes and enabled intraoperative correction of electrode position in 13.0% (3 of 23) of the cases. Altogether, an excellent seizure outcome (Engel Class I) was found in 72.7% of the patients during a mean follow-up of 36 months (range 3 months to 10.8 years). The greatest likelihood of an Engel Class I outcome was found in patients with cavernoma (83.7%), hippocampal sclerosis (78.8%), and LEAT (75.8%). Operative revisions that resulted from infection occurred in 0.3% of the patients, from hematomas in 1.6%, and from hydrocephalus in 0.8%. Severe visual field defects were found in 5.2% of the patients, aphasia in 5.7%, and hemiparesis in 2.7%, and the total mortality rate was 0%. CONCLUSIONS Neuronavigation combined with iMRI was beneficial during surgical procedures for epilepsy and led to favorable seizure outcome with few specific complications. A significantly higher resection volume associated with a higher chance of favorable seizure outcome was found, especially in lesional epilepsy involving LEAT or diffuse glioma.

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“…Were extracted 15 studies (1,(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31), which included 867 patients (Tables 1 and 2). A ow-chart describing the study selection was created and is displayed in Figure 1.…”

Section: Data Extractionmentioning

confidence: 99%

“…Most common surgical indication in LE ( gure 2, upper part) was dysembrioplastic neuroepithelial tumor (DNET) and gangliogliomas (n=167), cavernomas (n=102), gangliogliomas (n=84), DNET (n=16), HH (n=14), WHO grade II astrocytoma (n=13) and pilocytic astrocytoma (n=10) (1,(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31). In NLE this frequently included ( gure 2, lower part) sclerosis (n=221), dysplasia (n=103), ischemia (n=8) and gliosis (n=33) (1,(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31).…”

Section: Surgical Indicationsmentioning

confidence: 99%

Combined Use of Intraoperative Magnetic Resonance Imaging and Neuronavigation for Microsurgical Approach of Intractable Epilepsy:a Systematic Review and Meta-analysis

Tuleasca

Peciu-Florianu

Chochoi

et al. 2022

Preprint

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IntroductionEpilepsy is a major feature of multiple types of lesional epilepsy (LE) and non-lesional (NLE). However, there is an important heterogeneity in the use of such nomenclature. A favorable outcome is correlated to an identifiable cause and the extent of resection. Here, we evaluate the use of intraoperative MRI (iMRI) combined with neuronavigation, in improving the complete and/or adequate resection rates in patients with intractable epilepsy of various etiologies. We further discuss whether this results in better clinical outcomes. Material and methodsA medical librarian performed a comprehensive review of literature, searching the Medline®, Embase®, Index Medicus® and Cochrane® databases. Two reviewers independently applied following inclusion criteria: reports of at least two cases of any age undergoing microsurgical resection for epilepsy surgery, the use of iMRI as mandatory for intraoperative assessment, evaluation of LE versus NLE, describing if second resection after iMRI was necessary, detailing the extent of resection, qualitative reports of seizure outcome (Engel class). ResultsWe report 15 studies, encompassing 867 patients, with various types of LE and NLE. Most common surgical indications for the use of iMRI in LE were dysembrioplastic neuroepithelial tumor (DNET) and gangliogliomas, cavernomas, hypothalamic hamartomas, or primary brain tumors. For NLE these were sclerosis, dysplasia, ischemia and gliosis, which are further separately detailed in a supplementary material. With the use of iMRI, the rate of complete or adequate resection significantly increased from 74.8% (95% confidence interval (CI) 67.3-82.3%) to 97.6% (95% confidence interval (CI) 95.8-99.3%). Hundred and twenty-six cases out of 820 underwent additional resection after iMRI, for an overall rate of 24.4% (range 16.9-31.8). This was translated in an overall clinical benefit with 77.1% (95% CI 71-83.2%) Engel class I at last follow-up (p<0.001).DiscussionIntraoperative MRI might improve the extent of resection in LE and NLE. This might translate into a favorable clinical outcome (Engel class I as high as 77%). This is fairly comparable to what one expects in temporal lobe epilepsy surgery. We suggest that iMRI is beneficial when proposed in selected cases of intractable epilepsy. However, the reader should take into account that such data are not provided by randomized controlled trials and that such conclusions should be carefully interpreted.

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Impact of intraoperative MRI on outcomes in epilepsy surgery: preliminary experience of two years

Abstract: iMRI increases the extent of resection mainly in lesional epilepsy surgeries translating into good seizure outcomes but not found to be much beneficial in prototype mesial temporal sclerosis surgeries and disconnection surgeries.

Cited by 17 publications

References 20 publications

Technical aspects of pediatric epilepsy surgery: Report of a multicenter, multinational web‐based survey by the ILAE Task Force on Pediatric Epilepsy Surgery

Technical aspects of pediatric epilepsy surgery: Report of a multicenter, multinational web‐based survey by the ILAE Task Force on Pediatric Epilepsy Surgery

Resective surgery for medically refractory epilepsy using intraoperative MRI and functional neuronavigation: the Erlangen experience of 415 patients

Combined Use of Intraoperative Magnetic Resonance Imaging and Neuronavigation for Microsurgical Approach of Intractable Epilepsy:a Systematic Review and Meta-analysis

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