Combining pyramidal tract mapping, microscopic-based neuronavigation, and intraoperative magnetic resonance imaging improves outcome of epilepsy foci resection in the sensorimotor cortex

Abstract

AIM:To explore the clinical value of combining pyramidal tract mapping, microscopic-based neuronavigation, and intraoperative magnetic resonance imaging (iMRI) in the surgical treatment of epileptic foci involving sensorimotor cortex. MATERIAL and METHODS:We retrospectively analyzed 69 patients with focal epilepsy involving motor and sensory cortex. The surgical operations in Group I (n=38) were performed under the guidance of conventional neuronavigation, and the operations of Group II (n=31) were aided by combining pyramidal tract mapping, microscopic-based neuronavigation and the iMRI technique. Chi square test was used to compare seizure outcome and neurological deficits across groups. RESULTS: 7 patients (18.4%) in Group I, and 3 patients (9.7%) in Group II didn't recover to the level of preoperative strength within one year post-operation. The 2-year follow-up survey showed that more patients in Group II compared to Group I (71% vs. 55.3%, p=0.181) had a good outcome (Engel class I ~ II). CONCLUSION:The techniques of combining pyramidal tract mapping, microscopic-based neuronavigation and iMRI aid in precise mapping and hence resection of epileptic foci in sensorimotor cortex, which lead to improvement of surgical efficacy and significant reduction of postoperative loss of function. KEywORDS:Intraoperative magnetic resonance imaging (iMRI), Microscopic-based neuronavigation, Pyramidal tract mapping, Epilepsy in the sensorimotor cortex ÖZ AMAÇ: Sensorimotor korteksle ilgili epileptik odakların cerrahi tedavisinde piramidal traktus haritalama, mikroskopi tabanlı nöronavigasyon ve intraoperatif manyetik rezonans görüntülemenin (iMRG) birleştirilmesinin klinik değerini incelemek. yÖNTEM ve GEREÇLER: Motor ve duyusal korteksle ilgili fokal epilepsili 69 hastayı retrospektif olarak inceledik. Grup I'deki (n = 38) cerrahi operasyonlar, geleneksel nöronavigasyon ile yapılırken, Grup II (n = 31) operasyonları piramidal traktus haritalama, mikroskopi tabanlı nöronavigasyon ve iMRG tekniği birleştirilerek yapıldı. Gruplar arasında epileptik nöbet açısından sonucu ve nörolojik defisitleri karşılaştırmak için Ki kare testi kullanıldı.BULGULAR: Grup I'de 7 hasta (%18,4) ve Grup II'de 3 hasta (% 9,7) operasyon sonrası bir yıl içinde preoperatif güç düzeyine ulaşamadı. 2 yıllık izlem anketi Grup I ile karşılaştırıldığında Grup II'de daha fazla hastanın iyi bir sonuç (Engel seviye I -II) elde ettiğini gösterdi. SONUÇ:Piramidal traktus haritalama, mikroskopi tabanlı nöronavigasyon ve iMRG hassas haritalamaya ve böylece sensorimotor kortekste epileptik odakların rezeksiyonuna, sonuçta da cerrahi etkinliğin artmasına ve postoperatif işlevsel kayıpta önemli azalmaya yardımcıdır. ANAHTAR SÖZCÜKLER:İntraoperatif manyetik rezonans görüntüleme (iMRG), Mikroskopi bazlı nöronavigasyon, Piramidal traktus haritalama, Sensorimotor kortekste epilepsi

Systematic review of the efficacy in seizure control and safety of neuronavigation in epilepsy surgery: The need for well-designed prospective studies

“…A satisfactory seizure outcome (Engel class I and II) was found in 90.36% of patients who underwent surgery with neuronavigation. Including the results described by Cui et al, the rate of good seizure outcome was 82.37% [14].…”

“…However, a detailed analysis of these studies shows that some authors have the tendency to describe all their series of good results only. More realistically, Cui et al observed that among 69 patients with focal epilepsy treated by surgery with neuronavigation, 62.31% had a good outcome (Engel I and II) [14]. Meanwhile, five studies excluded from this specific analysis described postoperative status as ''free of seizures'', ''partial control'' or ''without control'', and thus not allowing an accurate measurement of postoperative outcomes [15][16][17][18][19].…”

The role of intraoperative MRI in resective epilepsy surgery for peri-eloquent cortex cortical dysplasias and heterotopias in pediatric patients

“…To counter this, iMRI has been successfully integrated with these imaging techniques in lesional epilepsy surgery. 7,32 In addition to traditional intraoperative CT and MRI, further technologies such as advanced intraoperative ultrasonography and intraoperative elasticity imaging may better aid in real-time identification of dysplastic lesions and in more accurate depiction of margins. 5,18 Furthermore, intraoperative ultrasonography has been shown to successfully integrate with functional MRI and DTI to provide an intraoperative update to neuronavigation accounting for brain shift.…”

Digital technology in clinical surgery and rehabilitation

“…При необходимости хирург имеет возможность переключать операционный микроскоп между реальным и виртуальным изображением либо совмещать первое и второе. Навигационная система состоит из станции планирования, ИК и электромагнитной антенны, различных навигируемых хирургических инструментов [11][12][13].…”