Impact of intraoperative MRI on pediatric epilepsy surgery for focal cortical dysplasia

IF 1.9 4区医学 Q3 CLINICAL NEUROLOGY

Journal of Clinical Neuroscience Pub Date : 2024-11-26 DOI:10.1016/j.jocn.2024.110940

Arthur R. Kurzbuch , Ben Cooper , John Kitchen , Andrea McLaren , Volker Tronnier , Jonathan R. Ellenbogen , on behalf of the NorCESS Team

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引用次数: 0

Abstract

Background

Complete resection is essential for achieving seizure freedom in children with drug-resistant epilepsy due to focal cortical dysplasia (FCD). However, identifying altered structures intraoperatively can be challenging, potentially leading to reoperations. This study assessed the impact of intraoperative MRI (iMRI).

Methods

We conducted a single-center retrospective study at Alder Children’s Hospital from 2013 to 2022. The study included all children diagnosed with FCD, analyzing demographics, iMRI use, the rate of continued iMRI-guided surgery and reoperations, histology, and seizure outcomes at 1-year follow-up.

Results

Thirty-two pediatric patients (median age: 10 years, 21 males and 11 females) underwent surgery for FCD. Of them 8 (25 %) had FCD Type I, 19 (59.4 %) had FCD Type II, and 1 patient (3.1 %) had FCD Type III. iMRI was used in 27 patients (84.4 %), and 17 (63 %) of these patients required further iMRI-guided surgery. Four patients underwent reoperation in a separate session. At 1-year follow-up, seizure outcomes in the iMRI group were Engel I in 15 patients (71.4 %), Engel II in 4 (19 %), and Engel III and IV in 1 patient (4.8 %) each. Five patients (15.6 %) had superficially localized lesions and underwent surgery without iMRI. None of them required reoperation, and four (80 %) were seizure-free at 1 year. Seven patients were lost to follow-up.

Conclusion

iMRI plays a significant role in identifying residual epileptogenic tissue in surgery for FCD, influencing surgical decisions and leading to additional iMRI-guided resections. Most patients with iMRI-guided surgery achieved favorable seizure outcomes (Engel I) at 1 year of follow-up. Long-term follow-up is needed to validate these findings and to confirm sustained seizure control.

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术中磁共振成像对治疗局灶性皮质发育不良的小儿癫痫手术的影响

背景对于因局灶性皮质发育不良（FCD）导致的耐药性癫痫患儿来说，完全切除是获得癫痫发作自由的关键。然而，术中识别改变的结构具有挑战性，可能导致再次手术。本研究评估了术中磁共振成像（iMRI）的影响。方法我们于2013年至2022年在奥尔德儿童医院开展了一项单中心回顾性研究。研究纳入了所有确诊为 FCD 的儿童，分析了人口统计学、iMRI 的使用、iMRI 指导下继续手术和再次手术的比例、组织学以及随访 1 年的癫痫发作结果。结果32 名儿童患者（中位年龄：10 岁，21 名男性和 11 名女性）接受了 FCD 手术。其中 8 例（25%）为 FCD I 型，19 例（59.4%）为 FCD II 型，1 例（3.1%）为 FCD III 型。27 例患者（84.4%）使用了 iMRI，其中 17 例（63%）需要在 iMRI 指导下进一步手术。有四名患者在另一个疗程中接受了再次手术。在 1 年的随访中，iMRI 组患者的癫痫发作结果为：15 名患者（71.4%）为恩格尔 I 型，4 名患者（19%）为恩格尔 II 型，1 名患者（4.8%）为恩格尔 III 型和 IV 型。5 名患者（15.6%）的病灶局部较浅，在未进行 iMRI 检查的情况下接受了手术。他们中没有人需要再次手术，其中 4 人（80%）在 1 年后癫痫不再发作。结论 iMRI 在识别 FCD 手术中的残余致痫组织方面发挥着重要作用，可影响手术决策并导致 iMRI 指导下的额外切除。大多数在 iMRI 指导下接受手术的患者在随访 1 年后都获得了良好的癫痫发作预后（Engel I）。需要进行长期随访来验证这些发现并确认癫痫发作得到了持续控制。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Clinical Neuroscience 医学-临床神经学

CiteScore

4.50

自引率

0.00%

发文量

402

审稿时长

40 days

期刊介绍： This International journal, Journal of Clinical Neuroscience, publishes articles on clinical neurosurgery and neurology and the related neurosciences such as neuro-pathology, neuro-radiology, neuro-ophthalmology and neuro-physiology. The journal has a broad International perspective, and emphasises the advances occurring in Asia, the Pacific Rim region, Europe and North America. The Journal acts as a focus for publication of major clinical and laboratory research, as well as publishing solicited manuscripts on specific subjects from experts, case reports and other information of interest to clinicians working in the clinical neurosciences.