Abstract | PURPOSE: To investigate the value of intraoperative MR imaging (iopMRI) combined with neuronavigation to avoid intraoperative underestimation of the resection amount during surgery of lesional temporal lobe epilepsy (LTLE) patients. METHODS: We retrospectively investigated 88 patients (40 female, 48 male, mean age 37.2 yrs, from 12 to 69 yrs, 41 left sided lesions) with LTLE operated at our department, including 40.9% gangliogliomas (GG), 26.1% cavernomas (CM), 10.2% dysembryoplastic neuroepithelial tumours ( DNT) and 11.4% focal cortical dysplasias (FCD), excluding hippocampal sclerosis. RESULTS: Complete resection was achieved in 85 of 88 patients (96.6%), as proven by postoperative MRI 6 months after surgery. In contrast, the routine first iopMR imaging before closure revealed radical resection in only 66 of these 88 patients (75%). After re-intervention, the second iopMR imaging demonstrated complete resection in 19 more patients. Thus, as a direct effect of iopMRI and neuronavigation, overall resection rate was increased by 21.6%. An excellent seizure outcome Engel Class I was found in 76.1% of patients during a mean follow-up of 26.4 months, irrespective of histological entity (74% in CM, 75% in GG, 78% in DNT and 60% in FCD). No severe postoperative complications occurred; permanent superior visual field defects were detected in 10.2% and permanent dysphasia/ dyscalculia in 1.1%. CONCLUSION: Refined surgery using neuronavigation combined with iopMR imaging in LTLE surgery led to radical resection in 96.6% of the patients, due to immediate correction of underestimated resection in 21.6% of patients. This protocol resulted in a favourable seizure outcome and a low complication rate.
|
Authors | Karl Roessler, Bjoern Sommer, Peter Grummich, Roland Coras, Burkhard Sebastian Kasper, Hajo Martinus Hamer, Ingmar Blumcke, Hermann Stefan, Michael Buchfelder |
Journal | Seizure
(Seizure)
Vol. 23
Issue 3
Pg. 201-7
(Mar 2014)
ISSN: 1532-2688 [Electronic] England |
PMID | 24355699
(Publication Type: Journal Article)
|
Copyright | Copyright © 2013 British Epilepsy Association. Published by Elsevier Ltd. All rights reserved. |
Topics |
- Adolescent
- Adult
- Anterior Temporal Lobectomy
(methods)
- Brain
(blood supply, pathology)
- Child
- Diffusion Magnetic Resonance Imaging
(instrumentation, methods)
- Epilepsy, Temporal Lobe
(diagnosis, surgery)
- Female
- Humans
- Intraoperative Period
- Magnetic Resonance Imaging
(instrumentation, methods)
- Male
- Middle Aged
- Neuronavigation
- Retrospective Studies
- Treatment Outcome
- Young Adult
|