Frameless Stereotactic Functional Neuronavigation Combined with Intraoperative Magnetic Resonance Imaging as a Strategy in Highly Eloquent Located Tumors Causing EpilepsySommer B.a · Grummich P.a · Hamer H.b · Bluemcke I.c · Coras R.c · Buchfelder M.a · Roessler K.a
aDepartment of Neurosurgery, bDepartment of Neurology, Epilepsy Center, and cDepartment of Neuropathology, University Hospital Erlangen, Erlangen, Germany
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Article / Publication Details
Background: Intractable epilepsy due to tumors located in highly eloquent brain regions is often considered surgically inaccessible because of a high risk of postoperative neurological deterioration. Intraoperative MRI and functional navigation contribute to overcome this problem. Objectives: To retrospectively investigate the long-term results and impact of functional neuronavigation and 1.5-tesla intraoperative MRI on patients who underwent surgery of tumors associated with epilepsy located close to or within eloquent brain areas. Methods: Nineteen patients (9 female, 10 male, mean age 41.4 ± 13.4 years, 11 low-grade and 8 high-grade glial tumors) were evaluated preoperatively using BOLD imaging, diffusion-tensor imaging tractography and magnetoencephalography. Functional data were implemented into neuronavigation in this multimodal approach. Results: In 14 of 19 patients (74%), complete resection was achieved, and in 5 patients significant tumor volume reduction was accomplished. Eight of 14 (57%) complete resections were achieved only by performing an intraoperative image update. Neurological deterioration was found permanently in 2 patients. After a mean follow-up of 43.8 ± 23.8 months, 15 patients (79%) became seizure free (Engel class Ia). Conclusions: Despite the highly eloquent location of tumors causing intractable epilepsy, our multimodal approach led to complete resection in more than two-thirds of patients with an acceptable neurological morbidity and excellent long-term seizure control.
© 2013 S. Karger AG, Basel
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