The influence of lesion volume, perilesion resection volume, and completeness of resection on seizure outcome after resective epilepsy surgery for cortical dysplasia in children

Oluigbo, Chima; Wang, Jichuan; Whitehead, Matthew T.; Magge, Suresh N.; Myseros, John S.; Yaun, Amanda L.; Depositario-Cabacar, Dewi; Gaillard, William D.; Keating, Robert F.

doi:10.3171/2014.10.peds14282

Cited by 46 publications

(42 citation statements)

References 33 publications

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“…Importantly, surgical outcomes in our study are consistent with those reported by Sommer et al and considerably improved over conventional resection both in our current study and in the literature. 23 Prior studies of resection of lesional epilepsy adjacent to regions of eloquent cortex in pediatric patients have reported complete seizure freedom (Engel Class I) rates of 43%-64%. 1,2,8,24 Patients in the conventional resection cohort developed postoperative neurological deficits at a higher rate than patients undergoing iMRI-assisted resection (p = 0.02).…”

Section: Discussionmentioning

confidence: 99%

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

Sacino¹,

Murnick

et al. 2016

FOC

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OBJECTIVE Previous studies have demonstrated that an important factor in seizure freedom following surgery for lesional epilepsy in the peri-eloquent cortex is completeness of resection. However, aggressive resection of epileptic tissue localized to this region must be balanced with the competing objective of retaining postoperative neurological functioning. The objective of this study was to investigate the role of intraoperative MRI (iMRI) as a complement to existing epilepsy protocol techniques and to compare rates of seizure freedom and neurological deficit in pediatric patients undergoing resection of perieloquent lesions. METHODS The authors retrospectively reviewed the medical records of pediatric patients who underwent resection of focal cortical dysplasia (FCD) or heterotopia localized to eloquent cortex regions at the Children's National Health System between March 2005 and August 2015. Patients were grouped into two categories depending on whether they underwent conventional resection (n = 18) or iMRI-assisted resection (n = 11). Patient records were reviewed for factors including demographics, length of hospitalization, postoperative seizure freedom, postoperative neurological deficit, and need for reoperation. Postsurgical seizure outcome was assessed at the last postoperative follow-up evaluation using the Engel Epilepsy Surgery Outcome Scale. RESULTS At the time of the last postoperative follow-up examination, 9 (82%) of the 11 patients in the iMRI resection group were seizure free (Engel Class I), compared with 7 (39%) of the 18 patients in the control resection group (p = 0.05). Ten (91%) of the 11 patients in the iMRI cohort achieved gross-total resection (GTR), compared with 8 (44%) of 18 patients in the conventional resection cohort (p = 0.02). One patient in the iMRI-assisted resection group underwent successful reoperation at a later date for residual dysplasia, compared with 7 patients in the conventional resection cohort (with 2/7 achieving complete resection). Four (36%) of the patients in the iMRI cohort developed postoperative neurological deficits, compared with 15 patients (83%) in the conventional resection cohort (p = 0.02). CONCLUSIONS These results suggest that in comparison with a conventional surgical protocol and technique for resection of epileptic lesions in peri-eloquent cortex, the incorporation of iMRI led to elevated rates of GTR and postoperative seizure freedom. Furthermore, this study suggests that iMRI-assisted surgeries are associated with a reduction in neurological deficits due to intraoperative damage of eloquent cortex.

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Section: Discussionmentioning

confidence: 99%

“…23 In the iMRI cohort, ECoG was performed in 9 of the 11 resections but was not used in patients with deep lesions that posed a significant risk of vascular injury. Intraoperative neurophysiological monitoring of somatosensory evoked potentials (SSEPs) and motor evoked potentials (MEPs) was used in all cases.…”

Section: Surgical Proceduresmentioning

confidence: 99%

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

Sacino¹,

Murnick

et al. 2016

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“…15 However, intraoperative detection of epileptogenic cortical dyplastic tissue remains a challenge, often precluding a com- plete extirpation and resulting in unnecessary repeat operations. Neuronavigation with iMRI guidance has been previously reported to aid in increased rates of complete resection and seizure freedom in temporal and extratemporal lobe epilepsy.…”

Section: Discussionmentioning

confidence: 99%

“…However, meta-analysis has shown that the most significant predictor of postoperative seizure freedom is completeness of resection of the dysplastic cortical tissue. 2,6,7,15,19 Gross complete extirpation of the lesion is, however, limited by difficulty in intraoperative identification of FCD tissue.The application of intraoperative MRI (iMRI) as a safe and effective tool for real-time assistance in intractable epilepsy surgery has previously been demonstrated. 3,8,9,21,24,25 Our objective in this study was to assess the impact of iMRI on intraoperative evaluation, surgical course of reabbreviations ECoG = electrocorticography; FCD = focal cortical dysplasia; iMRI = intraoperative MRI; OE = operative event; OR = operating room; SPGR = spoiled gradient echo recalled; 3DGM = 3D gyral map.…”

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Intraoperative MRI–guided resection of focal cortical dysplasia in pediatric patients: technique and outcomes

Sacino¹,

Ho²,

Murnick

et al. 2016

PED

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OBJECTIVE Previous meta-analysis has demonstrated that the most important factor in seizure freedom following surgery for focal cortical dysplasia (FCD) is completeness of resection. However, intraoperative detection of epileptogenic dysplastic cortical tissue remains a challenge, potentially leading to a partial resection and the need for reoperation. The objective of this study was to determine the role of intraoperative MRI (iMRI) in the intraoperative detection and localization of FCD as well as its impact on surgical decision making, completeness of resection, and seizure control outcomes. METHODS The authors retrospectively reviewed the medical records of pediatric patients who underwent iMRI-assisted resection of FCD at the Children's National Health System between January 2014 and April 2015. Data reviewed included demographics, length of surgery, details of iMRI acquisition, postoperative seizure freedom, and complications. Postsurgical seizure outcome was assessed utilizing the Engel Epilepsy Surgery Outcome Scale. RESULTS Twelve consecutive pediatric patients (8 females and 4 males) underwent iMRI-guided resection of FCD lesions. The mean age at the time of surgery was 8.8 years ± 1.6 years (range 0.7 to 18.8 years), and the mean duration of follow up was 3.5 months ± 1.0 month. The mean age at seizure onset was 2.8 years ± 1.0 year (range birth to 9.0 years). Two patients had Type 1 FCD, 5 patients had Type 2A FCD, 2 patients had Type 2B FCD, and 3 patients had FCD of undetermined classification. iMRI findings impacted intraoperative surgical decision making in 5 (42%) of the 12 patients, who then underwent further exploration of the resection cavity. At the time of the last postoperative follow-up, 11 (92%) of the 12 patients were seizure free (Engel Class I). No patients underwent reoperation following iMRI-guided surgery. CONCLUSIONS iMRI-guided resection of FCD in pediatric patients precluded the need for repeat surgery. Furthermore, it resulted in the achievement of complete resection in all the patients, leading to a high rate of postoperative seizure freedom.

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Interictal pattern on scalp electroencephalogram predicts excellent surgical outcome of epilepsy caused by focal cortical dysplasia

Wan

Wang

et al. 2022

Epilepsia Open

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Objective Focal cortical dysplasia (FCD) represents an essential cause of drug‐resistant epilepsy with surgery as an effective treatment option. This study aimed to identify the important predictors of favorable surgical outcomes and the impact of the interictal scalp electroencephalogram (EEG) patterns in predicting postsurgical seizure outcomes. Methods We retrospectively evaluated 210 consecutive patients between 2015 and 2019. They were diagnosed with FCD by pathology, underwent resection, and had at least one year of postsurgical follow‐up. Predictors of seizure freedom were analyzed. Results Based on the information at the latest follow‐up, seizure outcome was classified as Engel Class I (seizure‐free) in 81.4% and Engel Class II‐IV (non‐seizure‐free) in 18.6% of patients. There were 43, 105, and 62 cases of FCD type I, type II, and type III, respectively. The interictal EEG showed a repetitive discharge pattern (REDP) in 87 (41.4%) patients, polyspike discharge pattern (PDP) in 41 (19.5%), and the coexistence of REDP and PDP in the same location in 32 (15.2%) patients. The analyzed patterns in order of frequency were repetitive discharges lasting 5 seconds or more (32.4%); polyspikes (16.7%); RED type 1 (11.4%); continuous epileptiform discharges occupying >80% of the recording (11.4%); RED type 2 (6.2%); brushes (3.3%); focal, fast, continuous spikes (2.4%); focal fast rhythmic epileptiform discharges (1.43%); and frequent rhythmic bursting epileptiform activity (1.4%). The coexistence of REDP and PDP in the same location on scalp EEG and complete resection of the assumed epileptogenic zone (EZ) was independently associated with favorable postsurgical prognosis. Significance Resective epilepsy surgery for intractable epilepsy caused by FCD has favorable outcomes. Interictal scalp EEG patterns were revealed to be predictive of excellent surgical outcomes and may help clinical decision‐making and enable better presurgical evaluation.

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The influence of lesion volume, perilesion resection volume, and completeness of resection on seizure outcome after resective epilepsy surgery for cortical dysplasia in children

Cited by 46 publications

References 33 publications

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

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

Intraoperative MRI–guided resection of focal cortical dysplasia in pediatric patients: technique and outcomes

Interictal pattern on scalp electroencephalogram predicts excellent surgical outcome of epilepsy caused by focal cortical dysplasia

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