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首页> 外文期刊>Neurosurgical focus >The role of intraoperative MRI in resective epilepsy surgery for peri-eloquent cortex cortical dysplasias and heterotopias in pediatric patients
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The role of intraoperative MRI in resective epilepsy surgery for peri-eloquent cortex cortical dysplasias and heterotopias in pediatric patients

机译：术中MRI在小儿围手术期皮层皮质发育异常和异位症切除性癫痫手术中的作用

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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.
机译：目的先前的研究表明，围手术期皮层病变性癫痫术后癫痫发作自由度的重要因素是切除的完整性。但是，必须积极切除位于该区域的癫痫组织，并与保留术后神经功能的竞争目标相平衡。这项研究的目的是调查术中MRI（iMRI）作为现有癫痫规程技术的补充的作用，并比较接受围手术期病灶切除的小儿患者的癫痫发作自由率和神经功能缺损率。方法作者回顾性地回顾了2005年3月至2015年8月在儿童国家卫生系统中接受局灶性皮质发育不良（FCD）切除或定位于雄辩皮质区域的异位症的小儿患者的病历。根据是否将小儿患者分为两类，他们接受了常规切除术（n = 18）或iMRI辅助切除术（n = 11）。对患者记录进行了回顾，以了解人口统计学，住院时间，术后癫痫发作的自由度，术后神经功能缺损以及是否需要再次手术等因素。在最后一次术后随访评估中，使用恩格尔癫痫手术结果量表评估了术后癫痫发作的结局。结果在最后一次术后随访检查时，iMRI切除组的11例患者中有9例（82％）无癫痫发作（Engel I类），而对照组的18例患者中有7例（39％）无癫痫发作切除组（P = 0.05）。 iMRI队列的11例患者中有10例（91％）达到了总切除（GTR），而常规切除队列的18例患者中有8例（44％）（p = 0.02）。 iMRI辅助切除组中的1例患者因残留的不典型增生而在晚些时候成功进行了再次手术，而传统切除术组中有7例（2/7实现了完全切除）。 iMRI队列中有四名患者（36％）发生了术后神经功能缺损，而常规切除队列中有15例患者（83％）（p = 0.02）。结论这些结果表明，与常规手术协议和切除口才好的皮层癫痫病灶的技术相比，iMRI的引入导致GTR率升高和术后癫痫发作自由。此外，这项研究表明，iMRI辅助手术可减少因雄辩皮层的术中损伤所致的神经功能缺损。

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