title: Excision of cortical dysplasia in the language area with use of a surgical navigator: a case report.
abstract: OBJECTIVE
  We have developed an intraoperative optical tracking-based navigational system that allows localization in the operative space. Using three-dimensional reconstruction, this system has provided precise spatial information for intraoperative cortical mapping in patients with intractable epilepsy in whom the lesion lies close to eloquent cortex.
  
  
  METHODS
  A 23-year-old man with intractable complex partial seizures (CPS) presented to our institution. Proton-density magnetic resonance imaging (MRI) showed a 3-cm lesion which lay 2 cm beneath the left frontal operculum. A three-dimensional model of the patient was reconstructed using MR modalities. Intraoperatively, subdural grid and strips were placed over the lesion and their electrodes were registered to the three-dimensional model, which was displayed on a monitor. The navigational system was used to localize each electrode on the three-dimensional model. By the second operation, the sites of seizure activity were established and recorded on the three-dimensional model. A bipolar stimulator was also used to determine the speech area.
  
  
  RESULTS
  The lesion, which proved to be cortical dysplasia, was removed completely and the cortical speech area was avoided. During the postoperative period, the patient had no neurological symptoms and no seizure activity.
  
  
  CONCLUSIONS
  The localization of a lesion and its correlation with epileptogenic foci is important in optimizing treatment in patients with cortical dysplasia. Our navigational system provided accurate localization of the lesion and correlation with the epileptogenic focus and related eloquent cortex. We believe that the safe removal of the lesion was facilitated by this system.
authors.affiliation: Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115, USA.
authors.forename: F
authors.initials: F
authors.lastname: Ozlen
authors.forename: S
authors.initials: S
authors.lastname: Nakajima
authors.forename: A
authors.initials: A
authors.lastname: Chabrerie
authors.forename: M E
authors.initials: ME
authors.lastname: Leventon
authors.forename: E
authors.initials: E
authors.lastname: Grimson
authors.forename: R
authors.initials: R
authors.lastname: Kikinis
authors.forename: F
authors.initials: F
authors.lastname: Jolesz
authors.forename: P M
authors.initials: PM
authors.lastname: Black
mesh_terms: D000328:Adult; D001931:Brain Mapping / Q000379:methods*; D002540:Cerebral Cortex / Q000002:abnormalities* / Q000601:surgery*; D002541:Cerebral Decortication; D004828:Epilepsies, Partial / Q000601:surgery*; D006801:Humans; D007091:Image Processing, Computer-Assisted; D007802:Language; D008279:Magnetic Resonance Imaging / Q000379:methods* / Q000706:statistics & numerical data; D008297:Male; D008953:Models, Anatomic; D012984:Software; D013238:Stereotaxic Techniques / Q000295:instrumentation*