Abstract
Purpose
Seizure freedom following resection of focal cortical dysplasia (FCD) correlates with complete resection of the dysplastic cortical tissue. However, difficulty with intraoperative identification of the lesion may limit the ability to achieve the surgical objective of complete extirpation of these lesions. Intraoperative magnetic resonance imaging (iMRI) may aid in FCD resections. The objective of this study is to compare rates of postoperative seizure freedom, completeness of resection, and need for reoperation in patients undergoing iMRI-assisted FCD resection versus conventional surgical techniques.
Methods
We retrospectively reviewed the medical records of pediatric subjects who underwent surgical resection of FCD at Children’s National Medical Center between March 2005 and April 2015.
Results
At the time of the last postoperative follow-up, 11 of the 12 patients (92 %) in the iMRI resection group were seizure free (Engel Class I), compared to 14 of the 42 patients (33 %) in the control resection group (p = 0.0005). All 12 of the iMRI patients (100 %) achieved complete resection, compared to 24 of 42 patients (57 %) in the control group (p = 0.01). One (8 %) patient from the iMRI-assisted resection group has required reoperation, compared to 17 (40 %) patients in the control resection group.
Conclusion
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.
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References
Alexandre V Jr, Walz R, Bianchin MM, Velasco TR, Terra-Bustamante VC, Wichert-Ana L, et al. (2006) Seizure outcome after surgery for epilepsy due to focal cortical dysplastic lesions. Seizure 15(6):420–427
Bower RS, Wirrell EC, Eckel LJ, Wong-Kisiel LC, Nickels KC, Wetjen NM (2015) Repeat resective surgery in complex pediatric refractory epilepsy: lessons learned. J Neurosurg Pediatr 16(1):94–100
Cohen-Gadol AA, Ozduman K, Bronen RA, Kim JH, Spencer DD (2004) Long-term outcome after epilepsy surgery for focal cortical dysplasia. J Neurosurg 101(1):55–65
Cruz VB, Prayson RA (2012) Neuropathology in patients with multiple surgeries for medically intractable epilepsy. Ann Diag Pathol 16(6):447–453
Fauser S, Bast T, Altenmuller DM, Schulte-Monting J, Strobl K, Steinhoff BJ, et al. (2008) factors influencing surgical outcome in patients with focal cortical dysplasia. J Neurol Neurosurg Psychiatry 79(1):103–105
Fauser S, Essang C, Altenmuller DM, Staack AM, Steinhoff BJ, Strobl K, et al. (2015) Long-term seizure outcome in 211 patients with focal cortical dysplasia. Epilepsia 56(1):66–76
Fountas KN, King DW, Meador KJ, Lee GP, Smith JR (2004) Epilepsy in cortical dysplasia: factors affecting surgical outcome. Stereotact Funct Neurosurg 82(1):26–30
Gonzalez-Martinez JA, Srikijvilaikul T, Nair D, Bingaman WE (2007) Long-term seizure outcome in reoperation after failure of epilepsy surgery. Neurosurgery 60(5):873–880 discussion 873-80
Hall WA, Kowalik K, Liu H, Truwit CL, Kucharezyk J (2003) Costs and benefits of intraoperative MR-guided brain tumor resection. Acta Neurochirurgica Suppl 85:137–142
Harvey AS, Cross JH, Shinnar S, Mathern GW (2008) & ILAE pediatric epilepsy surgery survey Taskforce. Defining the spectrum of international practice in pediatric epilepsy surgery patients. Epilepsia 49(1):146–155
Holmes MD, Wilensky AJ, Ojemann LM, Ojemann GA (1999) Predicting outcome following reoperation for medically intractable epilepsy. Seizure 8(2):103–106
Kim DW, Lee SK, Chu K, Park KI, Lee SY, Lee CH, et al. (2009) Predictors of surgical outcome and pathologic considerations in focal cortical dysplasia. Neurology 72(3):211–216
Krsek P, Maton B, Jayakar P, Dean P, Korman B, Rey G, et al. (2009) Incomplete resection of focal cortical dysplasia is the main predictor of poor postsurgical outcome. Neurology 72(3):217–223
Krsek P, Maton B, Korman B, Pacheco-Jacome E, Jayakar P, Dunoyer C, et al. (2008) Different features of histopathological subtypes of pediatric focal cortical dysplasia. Ann Neurol 63(6):758–769
Krsek P, Pieper T, Karlmeier A, Hildebrandt M, Kolodziejczyk D, Winkler P, et al. (2009) Different presurgical characteristics and seizure outcomes in children with focal cortical dysplasia type I or II. Epilepsia 50(1):125–137
Lietard C, Thebaud V, Besson G, Lejeune B (2008) Risk factors for neurosurgical site infections: an 18-month prospective survey. J Neurosurg 109(4):729–734
Makary M, Chiocca EA, Erminy N, Antor M, Bergese SD, Abdel-Rasoul M, et al. (2011) Clinical and economic outcomes of low-field intraoperative MRI-guided tumor resection neurosurgery. J Magn Reson Imaging: JMRI 34(5):1022–1030
Mellerio C, Labeyrie MA, Chassoux F, Roca P, Alami O, Plat M, et al. (2014) 3 T MRI improves the detection of transmantle sign in type 2 focal cortical dysplasia. Epilepsia 55(1):117–122
Oluigbo CO, Wang J, Whitehead MT, Magge S, Myseros JS, Yaun A, et al. (2015) The influence of lesion volume, perilesion resection volume, and completeness of resection on seizure outcome after resective epilepsy surgery for cortical dysplasia in children. J Neurosurg Pediatr 15(6):644–650
Park CK, Kim SK, Wang KC, Hwang YS, Kim KJ, Chae JH, et al. (2006) Surgical outcome and prognostic factors of pediatric epilepsy caused by cortical dysplasia. Child’s Nervous System: ChNS: Off J Int Soc Pediatr Neurosurg 22(6):586–592
Ramantani G, Strobl K, Stathi A, Brandt A, Schubert-Bast S, Wiegand G, et al. (2013) Reoperation for refractory epilepsy in childhood: a second chance for selected patients. Neurosurgery 73(4):695–704 discussion 704
Roessler K, Sommer B, Grummich P, Coras R, Kasper BS, Hamer HM, et al. (2014) Improved resection in lesional temporal lobe epilepsy surgery using neuronavigation and intraoperative MR imaging: favourable long term surgical and seizure outcome in 88 consecutive cases. Seizure 23(3):201–207
Rowland NC, Englot DJ, Cage TA, Sughrue ME, Barbaro NM, Chang EF (2012) A meta-analysis of predictors of seizure freedom in the surgical management of focal cortical dysplasia. J Neurosurg 116(5):1035–1041
Sarkis RA, Jehi LE, Bingaman WE, Najm IM (2010) Surgical outcome following resection of rolandic focal cortical dysplasia. Epilepsy Res 90(3):240–247
Schwartz TH, Spencer DD (2001) Strategies for reoperation after comprehensive epilepsy surgery. J Neurosurg 95(4):615–623
Shah MN, Leonard JR, Inder G, Gao F, Geske M, Haydon DH, et al. (2012) Intraoperative magnetic resonance imaging to reduce the rate of early reoperation for lesion resection in pediatric neurosurgery. J Neurosurg Pediatr 9(3):259–264
Siegel AM, Cascino GD, Meyer FB, Marsh WR, Scheithauer BW, Sharbrough FW (2006) surgical outcome and predictive factors in adult patients with intractable epilepsy and focal cortical dysplasia 2006. Acta Neurol Scand 113(2):65–71
Siegel AM, Cascino GD, Meyer FB, McClelland RL, So EL, Marsh WR, et al. (2004) Resective reoperation for failed epilepsy surgery: seizure outcome in 64 patients. Neurology 63(12):2298–2302
Sommer B, Grummich P, Coras R, Kasper BS, Blumcke I, Hamer HM, et al. (2013) Integration of functional neuronavigation and intraoperative MRI in surgery for drug-resistant extratemporal epilepsy close to eloquent brain areas. Neurosurg Focus 34(4):E4
Wang ZI, Alexopoulos AV, Jones SE, Jaisani Z, Najm IM, Prayson RA (2013) The pathology of magnetic-resonance-imaging-negative epilepsy. Modern Pathology Off J United States Canadian Acad Pathol Inc 26(8):1051–1058
Widdess-Walsh P, Diehl B, Najm I (2006) Neuroimaging of focal cortical dysplasia. J Neuroimaging Off J Am Soc Neuroimaging 16(3):185–196
Widdess-Walsh P, Kellinghaus C, Jeha L, Kotagal P, Prayson R, Bingaman W, et al. (2005) Electro-clinical and imaging characteristics of focal cortical dysplasia: Correlation with pathological subtypes. Epilepsy Res 67(1–2):25–33
Acknowledgments
We wish to acknowledge Ling Cai, Ph.D., and Chaojie Yang, B.S., for their assistance with statistical analysis.
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Sacino, M.F., Ho, CY., Whitehead, M.T. et al. Resective surgery for focal cortical dysplasia in children: a comparative analysis of the utility of intraoperative magnetic resonance imaging (iMRI). Childs Nerv Syst 32, 1101–1107 (2016). https://doi.org/10.1007/s00381-016-3070-x
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DOI: https://doi.org/10.1007/s00381-016-3070-x