Intraoperative Magnetic-Resonance Tomography and Neuronavigation During Resection of Focal Cortical Dysplasia Type II in Adult Epilepsy Surgery Offers Better Seizure Outcomes

Rössler, Karl; Kasper, Burkhard S.; Heynold, Elisabeth; Coras, Roland; Rampp, Stefan; Hamer, Hajo M.; Blümcke, Ingmar; Buchfelder, Michael

doi:10.1016/j.wneu.2017.09.100

Cited by 20 publications

(10 citation statements)

References 22 publications

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“…Accordingly, seizure semiology often appears complex and surface EEG recordings may not show localized epileptic discharges or ictal patterns at all. Epilepsy surgery offers good chances for FCD II patients ( Rössler et al, 2017 ), but localizing the epileptogenic zone and surgery is a challenge in FCD II ( Guerrini et al, 2015 , Fauser and Zentner, 2012 ) since lesions often reside in close relation to eloquent cortex and lesion borders are not exactly defined by MRI ( Tassi et al, 2001 ). Currently, many FCD II lesions are visualized presurgically by optimized magnetic resonance imaging (MRI) ( Urbach et al, 2002 , Wagner et al, 2011 , Martin et al, 2017 ).…”

Section: Introductionmentioning

confidence: 99%

Coregistrating magnetic source and magnetic resonance imaging for epilepsy surgery in focal cortical dysplasia

Kasper

Rössler

Hamer

et al. 2018

NeuroImage: Clinical

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BackgroundEpilepsy surgery for focal cortical dysplasia type II (FCD II) offers good chances for seizure freedom, but remains a challenge with respect to lesion detection, defining the epileptogenic zone and the optimal resection strategy. Integrating results from magnetic source imaging from magnetoencephalography (MEG) with magnetic resonance imaging (MRI) including MRI postprocessing may be useful for optimizing these goals.MethodsWe here present data from 21 adult FCD II patients, investigated during a 10 year period and evaluated including magnetic source imaging. 16 patients had epilepsy surgery, i.e. histopathologically verified FCD II, and a long follow up. We present our analysis of epileptogenic zones including MEG in relation to structural data according to MRI data and relate these results to surgical outcomes.ResultsFCD II in our cohort was characterized by high MEG yield and localization accuracy and MEG showed impact on surgical success-rates. MEG source localizations were detected in 95.2% of patients and were as close as 12.3 ± 8,1 mm to the MRI-lesion. After a mean follow up of >3 years, we saw >80% Engel I outcomes, with more favourable outcomes when the MEG source was completely resected (Fishers exact test 0,033).ConclusionWe argue for a high value of conducting a combined MEG-MRI approach in the presurgical workup and the resection strategy in patients with FCD II related epilepsy.

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Section: Introductionmentioning

confidence: 99%

Coregistrating magnetic source and magnetic resonance imaging for epilepsy surgery in focal cortical dysplasia

Kasper

Rössler

Hamer

et al. 2018

NeuroImage: Clinical

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“…As pathological changes in the cortex are difficult to reverse, surgical resection is considered a strategy to treat cortical dysplasia‐related epilepsy. A series of clinical studies have demonstrated favourable outcome after surgical resection with the help of image positioning . However, the manifestation of cortical dysplasia is not always typical and is often uncertain in clinical practice.…”

Section: Significance Of Stage‐dependent Adam10 In Epilepsymentioning

confidence: 99%

“…4 Hence, the incremental modulation of ADAM10 in amyloidogenic processes seems to be limited to treating epileptic seizures in AD. 96 However, the manifestation of cortical dysplasia is not always typical and is often uncertain in clinical practice. Thus, there is an urgent need to determine how these patients can be identified, particularly in the early processes of cortical dysplasia, as this recognition is necessary for early intervention.…”

Section: Biological Effects By Targeting Adam10mentioning

confidence: 99%

Stage‐dependent involvement of ADAM10 and its significance in epileptic seizures

Zhou

Tao

Cai

et al. 2019

J Cellular Molecular Medi

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The prevalence of epileptic seizures in Alzheimer's disease (AD) has attracted an increasing amount of attention in recent years, and many cohort studies have found several risk factors associated with the genesis of seizures in AD. Among these factors, young age and severe dementia are seemingly contradictory and independent risk factors, indicating that the pathogenesis of epileptic seizures is, to a certain extent, stage‐dependent. A disintegrin and metalloproteinase domain‐containing protein 10 (ADAM10) is a crucial α‐secretase responsible for ectodomain shedding of its substrates; thus, the function of this protein depends on the biological effects of its substrates. Intriguingly, transgenic models have demonstrated ADAM10 to be associated with epilepsy. Based on the biological effects of its substrates, the potential pathogenic roles of ADAM10 in epileptic seizures can be classified into amyloidogenic processes in the ageing stage and cortical dysplasia in the developmental stage. Therefore, ADAM10 is reviewed here as a stage‐dependent modulator in the pathogenesis of epilepsy. Current data regarding ADAM10 in epileptic seizures were collected and reviewed for potential pathogenic roles (ie amyloidogenic processes and cortical dysplasia) and regulatory mechanisms (ie transcriptional and posttranscriptional regulation). These findings are then discussed in terms of the significance of the stage‐dependent functions of ADAM10 in epilepsy. Several potential targets for seizure control, such as candidate transcription factors and microRNAs that regulate ADAM10, as well as potential genetic screening tools for the early recognition of cortical dysplasia, have been suggested but must be studied in more detail.

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“…Segmentation of lesions and planning of approach trajectories may be carried out by using the planning software (Figure 4). Other scanning modalities like single‐photon emission computerized tomography (SPECT), positron emission tomography (PET), or magnetoencephalography (MEG) images could be fused to recent preoperative scans and used for defining the resection volume or targeting a lesion 41,42 . Intraoperative scans might determine the amount of a lesion's resection compared to the preplanned lesion contours obtained from metabolic or anatomic scans.…”

Section: Introductionmentioning

confidence: 99%

“…The use of IMRI appeared to yield a higher rate of seizure‐free patients, especially when additional resection was performed after residual FCD was shown on intraoperative scanning (73% vs 38% in Engel IA, P < .05) 41,44 . Incomplete resection of LEATs due to proximity to eloquent brain regions or misevaluation of the resected volume is a strong negative predictor for local tumor recurrence and persisting seizures 42,45,46 . The combined use of IMRI and neuronavigation yielded a 70% seizure‐free rate in patients with LEATs 45 .…”

Section: Introductionmentioning

confidence: 99%

How technology is driving the landscape of epilepsy surgery

et al. 2020

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This article emphasizes the role of the technological progress in changing the landscape of epilepsy surgery and provides a critical appraisal of robotic applications, laser interstitial thermal therapy, intraoperative imaging, wireless recording, new neuromodulation techniques, and high-intensity focused ultrasound. Specifically, (a) it relativizes the current hype in using robots for stereo-electroencephalography (SEEG) to increase the accuracy of depth electrode placement and save operating time; (b) discusses the drawback of laser interstitial thermal therapy (LITT) when it comes to the need for adequate histopathologic specimen and the fact that the concept of stereotactic disconnection is not new; (c) addresses the ratio between the benefits and expenditure of using intraoperative magnetic resonance imaging (MRI), that is, the high technical and personnel expertise needed that might restrict its use to centers with a high case load, including those unrelated to epilepsy; (d) soberly reviews the advantages, disadvantages, and future potentials of neuromodulation techniques with special emphasis on the differences between closed and open-loop systems; and (e) provides a critical outlook on the clinical implications of focused ultrasound, wireless recording, and multipurpose electrodes that are already on the horizon. This outlook shows that although current ultrasonic systems do have some limitations in delivering the acoustic energy, further advance of this technique may lead to novel treatment paradigms. Furthermore, it highlights that new data streams from multipurpose electrodes and wireless transmission of intracranial recordings will become available soon once some critical developments will be achieved such as electrode fidelity, data processing and storage, heat conduction as well as rechargeable technology. A better understanding of modern epilepsy surgery will help to demystify epilepsy surgery for the patients and the treating physicians and thereby reduce the surgical treatment gap. K E Y W O R D Sepilepsy surgery, high-intensity focused ultrasound, intraoperative MRI, laser ablation, neuromodulation, robots 842 |

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Intraoperative Magnetic-Resonance Tomography and Neuronavigation During Resection of Focal Cortical Dysplasia Type II in Adult Epilepsy Surgery Offers Better Seizure Outcomes

Cited by 20 publications

References 22 publications

Coregistrating magnetic source and magnetic resonance imaging for epilepsy surgery in focal cortical dysplasia

Coregistrating magnetic source and magnetic resonance imaging for epilepsy surgery in focal cortical dysplasia

Stage‐dependent involvement of ADAM10 and its significance in epileptic seizures

How technology is driving the landscape of epilepsy surgery

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