title: Improved resection in lesional temporal lobe epilepsy surgery using neuronavigation and intraoperative MR imaging: favourable long term surgical and seizure outcome in 88 consecutive cases.
abstract: OBJECTIVE
  To investigate the value of intraoperative MR imaging (iopMRI) combined with neuronavigation to avoid intraoperative underestimation of the resection amount during surgery of lesional temporal lobe epilepsy (LTLE) patients.
  
  
  METHODS
  We retrospectively investigated 88 patients (40 female, 48 male, mean age 37.2 yrs, from 12 to 69 yrs, 41 left sided lesions) with LTLE operated at our department, including 40.9% gangliogliomas (GG), 26.1% cavernomas (CM), 10.2% dysembryoplastic neuroepithelial tumours (DNT) and 11.4% focal cortical dysplasias (FCD), excluding hippocampal sclerosis.
  
  
  RESULTS
  Complete resection was achieved in 85 of 88 patients (96.6%), as proven by postoperative MRI 6 months after surgery. In contrast, the routine first iopMR imaging before closure revealed radical resection in only 66 of these 88 patients (75%). After re-intervention, the second iopMR imaging demonstrated complete resection in 19 more patients. Thus, as a direct effect of iopMRI and neuronavigation, overall resection rate was increased by 21.6%. An excellent seizure outcome Engel Class I was found in 76.1% of patients during a mean follow-up of 26.4 months, irrespective of histological entity (74% in CM, 75% in GG, 78% in DNT and 60% in FCD). No severe postoperative complications occurred; permanent superior visual field defects were detected in 10.2% and permanent dysphasia/dyscalculia in 1.1%.
  
  
  CONCLUSIONS
  Refined surgery using neuronavigation combined with iopMR imaging in LTLE surgery led to radical resection in 96.6% of the patients, due to immediate correction of underestimated resection in 21.6% of patients. This protocol resulted in a favourable seizure outcome and a low complication rate.
authors.affiliation: Department of Neurosurgery, University Hospital Erlangen, Germany. Electronic address: karl.roessler@uk-erlangen.de.
authors.forename: Karl
authors.initials: K
authors.lastname: Roessler
authors.affiliation: Department of Neurosurgery, University Hospital Erlangen, Germany.
authors.forename: Bjoern
authors.initials: B
authors.lastname: Sommer
authors.affiliation: Department of Neurosurgery, University Hospital Erlangen, Germany.
authors.forename: Peter
authors.initials: P
authors.lastname: Grummich
authors.affiliation: Department of Neuropathology, University Hospital Erlangen, Germany.
authors.forename: Roland
authors.initials: R
authors.lastname: Coras
authors.affiliation: Department of Neurology, Epilepsy Centre, University Hospital Erlangen, Germany.
authors.forename: Burkhard Sebastian
authors.initials: BS
authors.lastname: Kasper
authors.affiliation: Department of Neurology, Epilepsy Centre, University Hospital Erlangen, Germany.
authors.forename: Hajo Martinus
authors.initials: HM
authors.lastname: Hamer
authors.affiliation: Department of Neuropathology, University Hospital Erlangen, Germany.
authors.forename: Ingmar
authors.initials: I
authors.lastname: Blumcke
authors.affiliation: Department of Neurology, Epilepsy Centre, University Hospital Erlangen, Germany.
authors.forename: Hermann
authors.initials: H
authors.lastname: Stefan
authors.affiliation: Department of Neurosurgery, University Hospital Erlangen, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Buchfelder
mesh_terms: D000293:Adolescent; D000328:Adult; D038481:Anterior Temporal Lobectomy / Q000379:methods*; D001921:Brain / Q000098:blood supply / Q000473:pathology; D002648:Child; D038524:Diffusion Magnetic Resonance Imaging / Q000295:instrumentation / Q000379:methods; D004833:Epilepsy, Temporal Lobe / Q000175:diagnosis* / Q000601:surgery*; D005260:Female; D006801:Humans; D007432:Intraoperative Period; D008279:Magnetic Resonance Imaging / Q000295:instrumentation / Q000379:methods; D008297:Male; D008875:Middle Aged; D038361:Neuronavigation; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult
keywords: Epilepsy surgery; Intraoperative MR imaging; Lesional temporal lobe epilepsy; Neurological outcome; Neuronavigation; Seizure control