Minimally resective epilepsy surgery in MRI-negative children

被引:6
作者
Hyslop, Ann [1 ]
Miller, Ian [1 ]
Bhatia, Sanjiv [2 ,3 ]
Resnick, Trevor [1 ,4 ]
Duchowny, Michael [1 ,4 ]
Jayakar, Prasanna [1 ]
机构
[1] Univ Miami, Dept Neurol, Miami Childrens Hosp, Miami, FL USA
[2] Univ Miami, Dept Neurosurg, Miami Childrens Hosp, Miami, FL USA
[3] Univ Miami, Miller Sch Med, Dept Neurosurg, Miami, FL 33136 USA
[4] Univ Miami, Miller Sch Med, Dept Neurol, Miami, FL 33136 USA
关键词
epilepsy surgery; MRI-negative; seizure freedom; focal epilepsy; EEG; SPECT; PET; ECoG; FOCAL CORTICAL DYSPLASIA; CONSENSUS CLASSIFICATION; INCOMPLETE RESECTION; NEOCORTICAL EPILEPSY; INTRACTABLE EPILEPSY; INTRACRANIAL EEG; ICTAL SPECT; PREDICTORS; OUTCOMES;
D O I
10.1684/epd.2015.0766
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
Aim. Performing epilepsy surgery on children with non-lesional brain MRI often results in large lobar or multilobar resections. The aim of this study was to determine if smaller resections result in a comparable rate of seizure freedom. Methods. We reviewed 25 children who had undergone focal corticectomies restricted to one aspect of a single lobe or the insula at our institution within a 5.5-year period. Data collected in the comprehensive non-invasive pre-surgical evaluation (including scalp video-EEG, volumetric MRI, functional MRI, EEG source localization, and SPECT and PET), as well as from invasive recordings performed in each patient, was reviewed. Data from each functional modality was identified as convergent or divergent with the epileptogenic zone using image coregistration. Specific biomarkers (from extra-operative and invasive testing) previously indicated to be indicative of focal epileptogenicity were used to further tailor each resection to an epileptogenic epicentre. Tissue pathology and postoperative outcomes were obtained from all 25 patients. Results. Two years postoperatively, 15/25 (60%) children were seizure-free, three (12%) experienced > 90% reduction in seizure frequency, two (8%) had a 50-90% reduction in seizure frequency, and the remaining five (20%) had no change in seizure burden. There was no significant difference in outcome based on numerous pre- and postoperative factors including location of resection, the number of preoperative functional tests providing convergent data, and tissue pathology. Conclusion. In MRI-negative children with focal epilepsy, an epileptogenic epicentre within a larger epileptogenic zone can be identified when specific biomarkers are recognized on non-invasive and invasive testing. When such children undergo resection of a small, well-defined epileptogenic epicentre, favourable outcomes can be achieved.
引用
收藏
页码:263 / 274
页数:12
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