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. 2018 May 1:19:487-496.
doi: 10.1016/j.nicl.2018.04.034. eCollection 2018.

Coregistrating magnetic source and magnetic resonance imaging for epilepsy surgery in focal cortical dysplasia

Burkhard S Kasper  1 , Karl Rössler  2 , Hajo M Hamer  3 , Arnd Dörfler  4 , Ingmar Blümcke  5 , Roland Coras  6 , Julie Roesch  7 , Angelika Mennecke  8 , Jörg Wellmer  9 , Björn Sommer  10 , Bogdan Lorber  11 , Johannes D Lang  12 , Wolfgang Graf  13 , Hermann Stefan  14 , Stefan Schwab  15 , Michael Buchfelder  16 , Stefan Rampp  17
Affiliations

Coregistrating magnetic source and magnetic resonance imaging for epilepsy surgery in focal cortical dysplasia

Burkhard S Kasper et al. Neuroimage Clin. .

Abstract

Background: Epilepsy surgery for focal cortical dysplasia type II (FCD II) offers good chances for seizure freedom, but remains a challenge with respect to lesion detection, defining the epileptogenic zone and the optimal resection strategy. Integrating results from magnetic source imaging from magnetoencephalography (MEG) with magnetic resonance imaging (MRI) including MRI postprocessing may be useful for optimizing these goals.

Methods: We here present data from 21 adult FCD II patients, investigated during a 10 year period and evaluated including magnetic source imaging. 16 patients had epilepsy surgery, i.e. histopathologically verified FCD II, and a long follow up. We present our analysis of epileptogenic zones including MEG in relation to structural data according to MRI data and relate these results to surgical outcomes.

Results: FCD II in our cohort was characterized by high MEG yield and localization accuracy and MEG showed impact on surgical success-rates. MEG source localizations were detected in 95.2% of patients and were as close as 12.3 ± 8,1 mm to the MRI-lesion. After a mean follow up of >3 years, we saw >80% Engel I outcomes, with more favourable outcomes when the MEG source was completely resected (Fishers exact test 0,033).

Conclusion: We argue for a high value of conducting a combined MEG-MRI approach in the presurgical workup and the resection strategy in patients with FCD II related epilepsy.

Keywords: Focal cortical dysplasia; Magnetic source imaging, epilepsy surgery.

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Figures

Fig. 1
Fig. 1
Illustrative MRI examples from bottom-of-sulcus dysplasias (BOS), all FLAIR (see arrows); patient IDs as indicated.
Fig. 2
Fig. 2
A/B MEG-MRI and MEG-MAP coregistrations, illustrative examples. Upper rows: 3 lesional planes from 3D-FLAIR; Lower Rows: 3 corresponding planes from MAP; red dot indicates source localization from MEG, green cursor is focused on the FCD. A: patient 9; B: patient 8 (see Table 1, Table 2).
Fig. 3
Fig. 3
Ictal (red dot) and interictal (blue dot) MEG sources in close proximity to each other and the lesion as illustrated in multiplanar FLAIR (upper row), and MAP (lower row); patient 10. (For interpretation of the references to colour in this figure legend, the reader is referred to the web version of this article.)
Fig. 4
Fig. 4
A/B. MEG sources in relation to resection cavities in patients with two surgeries: A: patient 11; continuing seizures after 1st surgery, sustained seizure freedom after 2nd surgery years later. As illustrated, the 2nd surgery (lower row, intraoperative MRI) included the MEG-source, which had remained unresected by the 1st intervention; B: patient 1: persisting seizures after 2nd surgery, MEG source in unresected edge area despite large resection volume.
See this image and copyright information in PMC

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