Background: This study was to describe the evolution of patients who underwent surgical treatment of drug- resistant occipital lobe epilepsy (OLE) at our institution. Methods: We performed a retrospective analysis of data collected from electronic and paper clinical records of 20 patients who were diagnosed of OLE and underwent epilepsy surgery at our institution between 1998 and 2018. We also contacted patients by telephone and asked them to fill out a questionnaire about quality of life in epilepsy (QOLIE-10). Assembled data were analyzed using descriptive statistics. Results: The age at surgery ranged between 19 and 55 years. The period encompassing epilepsy onset and the date of surgery was variable. Semiology of seizures included visual symptoms in 75% of patients. In 90% of cases subdural grids, depth electrodes or a combination of both were used to plan the surgery. The most frequent neuroimaging and histopathological finding was cortical dysplasia (55%). The postoperative follow-up period was up to 15 years. The most common score on the Engel scale was I (70%). Visual deficits increased after surgery. Median score on QOLIE-10 questionnaire was 82.5 (interquartile range: 32.5). Conclusion: Surgical treatment of drug-resistant OLE offers hopeful results to those patients who have run out of pharmacological options and leads to postoperative deficits that are deemed expectable and occasionally acceptable.
Background Brain oncological surgery must pursue maximal tumour resection to achieve oncological benefits while preserving acceptable neurological function. Neuromonitoring techniques and brain mapping have been developed over the last decades to intraoperatively assess the exact location of neurological functions and secure their preservation. However, the fact that they cannot offer preoperative information and require in some cases the patient’s collaboration during displeasing awake surgeries raised the interest during last years on noninvasive techniques offering preoperative functional information. Navigated transcranial magnetic stimulation (nTMS) is a noninvasive technique able to create small magnetic fields and electrically stimulate brain cortex, emulating the effect obtained by cortical direct electrical stimulation (DES). It is a promising tool for performing pre-operative cortical brain mapping. Material and Methods We performed a unicenter prospective descriptive study including patients diagnosed with intra axial brain tumours neighboring cortical zones apparently implicated in motor and/or language functions who were planned for surgical resection. We performed preoperative nTMS (SofTaxic Neuro navigation system 3.0, EMS, Bologna) in all of them to define the location of these functions. Results Between November 2020 and December 2021 we included 18 patients (11 men, 7 women) with a mean age of 56 years (range 29-71). Location (8 temporal, 6 frontal, 3 parietal and 1 insular) and laterality (12 left, 6 right) of the brain tumours were registered. In all cases, cortical brain motor mapping with nTMS was performed with positive results, obtaining a mean anteroposterior diameter of the motor cortex of 22,75 mm. In 11 cases language mapping was also performed, detecting a total of 40 cortical language positive sites (31 frontal, 9 temporal) in those patient’s left hemispheres. No relevant side effects were noticed after nTMS performance. Definitive pathological results after surgery revealed high-grade glioma in 15 cases and low-grade glioma in 3. Conclusion nTMS is a recent noninvasive technique that allows the realization of preoperative cortical brain mapping. The information provided by this technique is of extreme value to better define surgical candidates and to plan brain tumour resection surgeries, according to functional cortical sites identified. The available literature describes its applications, mainly in localizing motor and language cortices, showing good concordance with intraoperative cortical DES, which is still the gold standard technique for brain mapping. Its integration in the pre-operative brain tumour assessment offers important advantages without adding relevant morbidity.
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