Utility of neuronavigation and neuromonitoring in epilepsy surgery

Abstract

<jats:p>The management of medically refractory epilepsy poses both a valuable therapeutic opportunity and a formidable technical challenge to epilepsy surgeons. Recent decades have produced significant advancements in the capabilities and availability of adjunctive tools in epilepsy surgery. In particular, image-based neuronavigation and electrophysiological neuromonitoring represent versatile and informative modalities that can assist a surgeon in performing safe and effective resections. In the present article the authors discuss these 2 subjects with reference to how they can be applied and what evidence supports their use. As technologies evolve with demonstrated and potential utility, it is important for all clinicians who deal with epilepsy to understand where neuronavigation and neuromonitoring stand in the present and what avenues for improvement exist for the future.</jats:p>

When the Direct Electrical Cortical Stimulation Failed: A Case Report

“…Therefore, there is considerable effort to develop more non-invasive and reliable techniques for mapping functional areas [11], including fMRI, MEG [12] and PET [7], which have been demonstrated to be useful and highly accurate. Magnetoencephalography and PET can be very helpful, but demand special procedures and expensive equipment, not available in most institutions [12]. On the other hand, functional MRI can be acquired together with structural MRI, which is a routine presurgical procedure.…”

The usefulness of neuronavigation in functional hemispherectomy

“…30 Ever since, several technologies have emerged, making it possible for the surgeon to be guided intra-operatively. [27][28][29][30][31] All major steps of a given neurosurgical procedure potentially benefit from navigation techniques: pre operative planning, skin incision marking and selection of the approach, localization of the lesion, definition of its boundaries and relevant regional anatomy. Currently, the most widespread navigation devices rely on optical systems, where reflective spheres attached to the patient's head clamp are identified by infra-red cameras.…”

“…The introduction of modern neuronavigation guidance in neurosurgery has improved surgical results by increasing accuracy, safety and decreasing surgical time. [26][27][28][29][30][31] The aim of this article is to discuss the usefulness of the neuronavigation in the functional hemispherectomy for refractory epilepsy.…”

Surgical approaches to epilepsy

“…Fusion into a neuronavigation system has been widely practiced [27], and is often the determinant of the size and location of the grid when contemplating invasive recordings ( Figure 6). There is growing evidence that the MEG data on functional localization of the somatosensoryevoked field correlate well with intraoperative maps of sensory-and motor-evoked potentials, and electrocortical stimulation [27].…”