Resective surgery for focal cortical dysplasia in children: a comparative analysis of the utility of intraoperative magnetic resonance imaging (iMRI)

Sacino, Matthew F; Ho, Cheng‐Ying; Whitehead, Matthew T.; Zelleke, Tesfaye; Magge, Suresh N.; Myseros, John S.; Keating, Robert F.; Gaillard, William D.; Oluigbo, Chima

doi:10.1007/s00381-016-3070-x

Cited by 12 publications

(5 citation statements)

References 33 publications

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“…Hence, a total of 110 patients with a definite pathological diagnosis of FCD IIa were retrospectively analysed, and the proportion of patients with Engel I was found to be 65.4% which was close to the results of other studies (34). At present, there are numerous studies on refractory epilepsy in children, and the prognosis is satisfactory (35). However, there is a shortage of studies on refractory epilepsy in adults.…”

Section: Discussionmentioning

confidence: 99%

Clinical characteristics and epilepsy outcomes following surgery caused by focal cortical dysplasia (type IIa) in 110 adult epileptic patients

Sun

Che

Qin

et al. 2017

Experimental and Therapeutic Medicine

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The aim of the present study was to investigate the effects of surgical intervention of focal cortical dysplasia (FCD) IIa on the outcome of epilepsy, and to evaluate the prognostic factors of seizure freedom. Patient data from epilepsy surgeries were retrospectively reviewed at the Second Affiliated Hospital of Dalian Medical University between 2007 and 2015. A total of 110 patients with a definite pathological diagnosis of FCD IIa were included. Moreover, the clinical characteristics, seizure outcome and quality of life in adults with FCD IIa were evaluated. The Engel seizure outcome achievements were class I in 72, class II in 20, class III in 11 and class IV in 7 patients. In addition, the Engel seizure outcome was relevant with the resection range of the lesions (P=0.028). The assessments of electrocorticography (ECoG) patterns and magnetic resonance imaging (MRI) are relevant to determining the extent of the resection, which may influence the surgery outcome (P=0.001 and P=0.023). Using multivariate regression analyses, the extent of resection, seizure frequency, preoperative ECoG and location of resection were the most important risk factors for seizure recurrence. The results of quality of life in epilepsy-10 scoring revealed that the quality of life improved significantly following surgery (P<0.01). Moreover, surgical intervention, EcoG, MRI positioning and complete resection helped to have improved seizure control, relief of anxiety and quality of life. All these observations strongly recommend an early consideration of epilepsy surgery in FCD IIa patients.

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Section: Discussionmentioning

confidence: 99%

Clinical characteristics and epilepsy outcomes following surgery caused by focal cortical dysplasia (type IIa) in 110 adult epileptic patients

Sun

Che

Qin

et al. 2017

Experimental and Therapeutic Medicine

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“…New peri‐interventional and interventional techniques have emerged in recent years. The use of intraoperative MRI during surgery for resection of FCD in pediatric patients has been reported, with promising initial results about improved postoperative seizure freedom and completeness of lesion resection . MR‐guided laser interstitial thermal therapy for deep lesions as hypothalamic hamartomas has shown exciting results, but the role in pediatric lesional epilepsy surgery has yet to be determined …”

Section: Advances In Evaluation and Treatment Of Children With Epilepsymentioning

confidence: 99%

“…The use of intraoperative MRI during surgery for resection of FCD in pediatric patients has been reported, with promising initial results about improved postoperative seizure freedom and completeness of lesion resection. 43 MR-guided laser interstitial thermal therapy for deep lesions as hypothalamic hamartomas has shown exciting results, 44 but the role in pediatric lesional epilepsy surgery has yet to be determined. 45 When the seizure focus is adjacent to eloquent cortex, more willingness to consider aggressive surgical resections, even in the face of anticipated neurological deficits, such as non-disabling motor or sensory difficulties, has been observed over the last few years.…”

Section: Advances In Evaluation and Treatment Of Children With Epilepsymentioning

confidence: 99%

Surgery for epileptogenic cerebral dysplasia in children

Hidalgo

Weiner

2016

Develop Med Child Neuro

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New developments in diagnostic methods, technical improvements in the surgical field, and a better understanding of the effects of epilepsy on the developing brain are contributing to the general observation that more children with epilepsy are being treated surgically. Malformations of cortical development are the most common cause of seizures in pediatric surgical candidates, and the best predictor of seizure freedom after surgery appears to be the complete removal of the epileptogenic lesion. To achieve this goal in challenging cases, such as magnetic resonance imaging-negative or multifocal lesions, a staged approach with pre- and/or post-resective invasive electroencephalography monitoring has increasingly been used at a number of centers. As the experience with this approach has grown, and the risks and benefits are better understood, a larger number of patients with epilepsy have been identified as potential surgical candidates. In this review, a number of the recent developments in pediatric epilepsy surgery are discussed.

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“…IMRI guidance proved particularly useful in patients with epilepsy and lesions such as FCD, long‐term epilepsy‐associated tumor (LEAT), cavernoma, or arteriovenous malformation. It might also be of help in patients whose foci are being investigated by depth‐electrode monitoring 44‐46 . A retrospective study including patients with refractory epilepsy and FCD submitted to surgery with IMRI monitoring showed that 75% of the patients had complete resection and 89% of them had Engel class I outcome.…”

Section: Introductionmentioning

confidence: 99%

“…A retrospective study including patients with refractory epilepsy and FCD submitted to surgery with IMRI monitoring showed that 75% of the patients had complete resection and 89% of them had Engel class I outcome. 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 .…”

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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Resective surgery for focal cortical dysplasia in children: a comparative analysis of the utility of intraoperative magnetic resonance imaging (iMRI)

Abstract: Our results suggest that the utilization of iMRI during surgery for resection of FCD results in improved postoperative seizure freedom, completeness of lesion resection, and reduction in the need for reoperation.

Cited by 12 publications

References 33 publications

Clinical characteristics and epilepsy outcomes following surgery caused by focal cortical dysplasia (type IIa) in 110 adult epileptic patients

Clinical characteristics and epilepsy outcomes following surgery caused by focal cortical dysplasia (type IIa) in 110 adult epileptic patients

Surgery for epileptogenic cerebral dysplasia in children

How technology is driving the landscape of epilepsy surgery

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