Three-dimensional brain surface visualization for epilepsy surgery of focal cortical dysplasia.
Focal cortical dysplasia (FCD) causes medically intractable seizures in 5-10% of adult epilepsy patients, but patients can become seizure free through surgical resection. The authors present the utility of three-dimensional surface visualization (3DSV) that expands on existing imaging datasets to highlight surface vasculature as a tool for achieving more successful resections in patients with FCD. In this prospective series of six patients, preoperative 3DSV was performed for planning the surgical approach to the lesion and for intraoperative guidance. Reconstructions involved volume rendering of a contrast-enhanced dataset to visualize surface venous vasculature. Postoperatively, five of the six patients had complete resections, with one patient having a subtotal resection due to proximity to crucial vasculature. We report that 3DSV is a useful tool for surgical planning, since topographical relationships between lesion location and surface vasculature landmarks are less likely to change with surgical progress.
Department of Neurosurgery, Massachusetts General Hospital, 55 Fruit Street, White 502, Boston, MA 02114, USA; Harvard Medical School, Boston, MA, USA.
Jimmy C
JC
Yang
Department of Neurosurgery, Massachusetts General Hospital, 55 Fruit Street, White 502, Boston, MA 02114, USA; Harvard Medical School, Boston, MA, USA.
Joshua P
JP
Aronson
Department of Neurosurgery, Massachusetts General Hospital, 55 Fruit Street, White 502, Boston, MA 02114, USA; Harvard Medical School, Boston, MA, USA.
Gavin P
GP
Dunn
Department of Neurosurgery, Massachusetts General Hospital, 55 Fruit Street, White 502, Boston, MA 02114, USA; Harvard Medical School, Boston, MA, USA.
Patrick J
PJ
Codd
Harvard Medical School, Boston, MA, USA; Department of Radiology, Massachusetts General Hospital, Boston, MA, USA.
Bradley R
BR
Buchbinder
Department of Neurosurgery, Massachusetts General Hospital, 55 Fruit Street, White 502, Boston, MA 02114, USA; Harvard Medical School, Boston, MA, USA. Electronic address: eeskandar@partners.org.
Emad N
EN
Eskandar
D000328:Adult; D001921:Brain / Q000473:pathology*; D004827:Epilepsy / Q000601:surgery*; D006801:Humans; D021621:Imaging, Three-Dimensional; D008279:Magnetic Resonance Imaging; D008297:Male; D054220:Malformations of Cortical Development / Q000150:complications; D019635:Neurosurgical Procedures / Q000379:methods*; D055815:Young Adult
3D imaging; Brain imaging; Epilepsy; Focal cortical dysplasia