Risk Reduction in Dominant Temporal Lobe Epilepsy Surgery Combining fMRI/DTI Maps, Neuronavigation and Intraoperative 1.5-Tesla MRI.

Stereotact Funct Neurosurg. 2015;93(3):168-177

Authors: Rössler K, Sommer B, Grummich P, Hamer HM, Pauli E, Coras R, Blümcke I, Buchfelder M

Abstract
BACKGROUND: In dominant temporal lobe epilepsy surgery, speech, memory and visual systems are at risk.
OBJECTIVE: Functional magnetic resonance imaging (fMRI) and diffusion tensor imaging combined with intraoperative neuronavigation and MRI were investigated retrospectively regarding risk reductions for favorable neurological and seizure outcome.
METHODS: Functional imaging risk maps were generated for 14 patients suffering from dominant temporal lobe epilepsy [7 with hippocampal sclerosis (HS), 7 with various lesions] and used for neuronavigation-guided tailored resection. Postoperative neurological and seizure outcome and complications were evaluated.
RESULTS: None of the patients had postoperative speech dysfunction despite 2.3/3.6-cm mean hippocampal/neocortical resection. Verbal memory decline was found in 2 of the 14 (14.3%) patients, correlating with surgical lesions in fMRI memory-activated functional areas in the dominant posterior parahippocampal gyrus. Verbal memory scores did not statistically differ between the HS and the lesional group, neither pre- nor postoperatively. A contralateral visual field defect occurred in 1 patient (7.1%). An Engel class I seizure outcome was found in 12 patients (85.7%), and 11 were completely seizure free (78.6%) at a mean follow-up of 19.5 months.
CONCLUSION: This retrospectively investigated protocol led to an excellent neurological and seizure outcome and a low complication rate in dominant temporal lobe epilepsy surgery. © 2015 S. Karger AG, Basel.

PMID: 25832914 [PubMed - as supplied by publisher]