Surgery for focal cortical dysplasia in children using intraoperative mapping

Thomé, Úrsula; Rosset, Sara S.; Funayama, Sandra Souza; Santos, Antônio Carlos dos; Santos, Marcelo Volpon; Sakamoto, Américo Ceiki; Machado, Hélio Rubens

doi:10.1007/s00381-014-2459-7

Cited by 18 publications

(9 citation statements)

References 64 publications

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“…The proportion of patients achieving a favorable outcome in our meta-analysis is higher than in surgical series of histopathologically confirmed FCD that included MRI-positive and MRI-negative patients. 8,9,28-31 A previous meta-analysis of 37 such studies found that 55.8 ± 16.2% of patients with histopathologically confirmed FCD achieved Engel class I outcome at last follow-up. 11 These data reinforce the importance of identifying lesions suggestive of FCD on MRI because they can guide more effective surgical resections.…”

Section: Discussionmentioning

confidence: 99%

Seizure Outcome After Surgery for MRI-Diagnosed Focal Cortical Dysplasia

et al. 2022

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Objective:Focal cortical dysplasia (FCD) has been associated with poorer post-surgical seizure outcomes compared to other pathologies. FCD surgical series have been assembled on the basis of a histological diagnosis, including patients with abnormal as well as normal pre-operative MRI. However, in clinical workflow, patient selection for surgery is based on pre-operative findings, including MRI. We performed a systematic review and meta-analysis of the literature to determine the rate and predictors of favorable seizure outcome after surgery for MRI-detected FCD.Methods:We devised our study protocol in accordance with PRISMA guidelines and registered the protocol with PROSPERO. We searched MEDLINE, EMBASE, and Web of Science for studies of patients followed for ≥12 months after resective surgery for drug-resistant epilepsy with MRI-detected FCD. Random-effects meta-analysis was used to calculate the proportion of patients attaining a favorable outcome, defined as Engel Class I, ILAE Classes 1-2, or “seizure-free” status. Meta-regression was performed to investigate sources of heterogeneity.Results:Our search identified 3,745 references. Of these, 35 studies (total of 1,353 patients) were included. Most studies (89%) followed patients for ≥24 months post-surgery. The overall post-surgical favorable outcome rate was 70% (95% CI: 64-75). There was high inter-study heterogeneity. Favorable outcome was associated with complete resection of the FCD lesion [risk ratio, RR=2.42 (95% CI: 1.55-3.76), p<0.001] and location of the FCD lesion in the temporal lobe [RR=1.38 (95% CI: 1.07-1.79), p=0013], but not lesion extent, intracranial EEG use, or FCD histological type. The number of FCD histological types included in the same study accounted for 7.6% of the observed heterogeneity.Conclusions:70% of patients with drug-resistant epilepsy and MRI features of FCD attain a favorable seizure outcome following resective surgery. Our findings can be incorporated in routine pre-operative counselling and reinforce the importance of resecting completely the MRI-detected FCD where this is safe and feasible.

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Section: Discussionmentioning

confidence: 99%

Seizure Outcome After Surgery for MRI-Diagnosed Focal Cortical Dysplasia

et al. 2022

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“…This has led to the development of improved and optimized solutions to the IUS images acquired during surgery. It is our opinion that the integrated 2D IUS and ultrasound installed BL systems using preoperative MRI gives better appreciation of the lesion dimensions in the axial, coronal and sagittal planes 3D views, which can improve the extent of resection Additionally, the use of ultrasound navigation software with BL systems integration enables the scanning and reconstruction of 3D ultrasound data noticeably faster than with intraoperative MRI, and this allows that the surgery is quicker and more efficient; this means that the surgical workflow is practically uninterrupted [14,15]. In a study carried out at their institution, Sacino et al investigated the use of intraoperative MRI and found that it increased the length of the procedure by 1.5 to 3 hours.…”

Section: Discussionmentioning

confidence: 99%

Optimization of intraoperative ultrasound navigation during focal cortical dysplasia surgery: a case report

Simfukwe

Sufianov

2022

jour

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Intraoperative ultrasound (IUS) is known to be an effective method for neuronavigation during surgical treatment of intractable seizures caused by focal cortical dysplasia (FCD). However, the 2-dimensional (2D) IUS has poor image quality and low spatial resolution. We describe via a case report how Ultrasound integrated Brainlab (BL) – Navigation software was used to optimize 2D IUS and thereby reduce these challenges.Case report: We present a case report of a 22-year-old female patient with a long-standing history of seizures. The patient was treated with more than two anti-epileptic drugs without any clinical efﬁcacy. In 2022 she was diagnosed with temporal lobe FCD. We performed a temporal lobe lesionectomy using optimized IUS BL-Navigation that provided enhanced 3-dimensional (3D) images.Discussion: The extent of resection of the underlying FCD lesion is a key factor in determining whether a patient achieves meaningful seizure freedom after surgery. While the 2D IUS offers admirable characteristics that have been used as an aid during surgery, it is our view that IUS enhanced 3D BL-Navigation offers better appreciation of FCD lesions and therefore improves the extent of resection.

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“…Previous studies have identified a “critical pattern” of discharges lasting ≥2 s highly significant . In smaller series, other authors have used a semiquantitative scale in patients with either FCD or glioneuronal tumors .…”

Section: Discussionmentioning

confidence: 99%

“…Previous studies have identified a "critical pattern" of discharges lasting ≥2 s highly significant. 25 In smaller series, other authors have used a semiquantitative scale in patients with either FCD or glioneuronal tumors. 8,26 In their assessments, discharges were categorized as sporadic, bursts, continuous, or recruiting.…”

Section: Clinical Implications Of Ecog Abnormalitiesmentioning

confidence: 99%

Preresection intraoperative electrocorticography (ECoG) abnormalities predict seizure‐onset zone and outcome in pediatric epilepsy surgery

et al. 2016

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SUMMARYObjective: The predictive value of intraoperative electrocorticography (ECoG) in pediatric epilepsy surgery is unknown. In a population of children undergoing ECoG followed typically by invasive extraoperative monitoring (IEM) and resection, we aimed to determine the relationship between frequent ECoG abnormalities and the seizure onset zone and outcome after resection. Methods: We retrospectively identified 103 children with preresection ECoG of sufficient technical quality. ECoG records were scored based on electrode location and frequency, blinded to the seizure-onset zone and outcome. Electrographic seizure and spike locations were identified. Locations of seizures and spike populations were then compared to the location of seizure-onset zone defined by IEM using subdural electrodes and resection margin. Results: Electrographic seizures were identified in 11 (11%) of 103 patients. A spike population of one or more was noted in 79 (77%) of 103 patients. In 50 (63%) of 79 patients, spike populations correlated with seizure-onset zone location. The overall surgical outcome was good (ILAE 1 to 3) in 53 (52%) of 101 patients. Outcome was good in seven (78%) of nine patients when electrographic seizure location was resected. The best outcomes were obtained with resection of both the seizure-onset zone and ECoG abnormalities to include seizures and spike locations (22/33 good outcome, 67%, p = 0.008). There was a significantly better outcome in children with complete resection of ECoG-identified spike populations (14/26, 62% good outcome) compared to when none were resected (4/14, 29%, p = 0.043). Significance: Electrographic seizures and frequent spikes are frequently seen on preresection ECoG in children. The brain locations corresponding to these discharges are highly concordant with the seizure-onset zone; resection of these regions is correlated with good seizure outcome. Further research is needed to design interventions that increase the reliability of ECoG prediction of the epileptogenic zone and obviate the need for IEM.

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Surgery for focal cortical dysplasia in children using intraoperative mapping

Abstract: Tailored resection of FCD lesions for intractable epilepsy can be safely performed in children with a good seizure outcome and low complication rate. Epilepsy surgery should be considered for all patients with FCD and refractory epilepsy.

Cited by 18 publications

References 64 publications

Seizure Outcome After Surgery for MRI-Diagnosed Focal Cortical Dysplasia

Seizure Outcome After Surgery for MRI-Diagnosed Focal Cortical Dysplasia

Optimization of intraoperative ultrasound navigation during focal cortical dysplasia surgery: a case report

Preresection intraoperative electrocorticography (ECoG) abnormalities predict seizure‐onset zone and outcome in pediatric epilepsy surgery

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