title: Magnetoencephalography-guided resection of epileptogenic foci in children.
abstract: OBJECTIVE
  Resective surgery is increasingly used in the management of pediatric epilepsy. Frequently, invasive monitoring with subdural electrodes is required to adequately map the epileptogenic focus. The risks of invasive monitoring include the need for 2 operations, infection, and CSF leak. The aim of this study was to evaluate the feasibility and outcomes of resective epilepsy surgery guided by magnetoencephalography (MEG) in children who would have otherwise been candidates for electrode implantation.
  
  
  METHODS
  The authors reviewed the records of patients undergoing resective epilepsy surgery at the Hospital for Sick Children between 2001 and 2010. They identified cases in which resections were based on MEG data and no intracranial recordings were performed. Each patient's chart was reviewed for presentation, MRI findings, MEG findings, surgical procedure, pathology, and surgical outcome.
  
  
  RESULTS
  Sixteen patients qualified for the study. All patients had localized spike clusters on MEG and most had abnormal findings on MRI. Resection was carried out in each case based on the MEG data linked to neuronavigation and supplemented with intraoperative neuromonitoring. Overall, 62.5% of patients were seizure free following surgery, and 20% of patients experienced an improvement in seizures without attaining seizure freedom. In 2 cases, additional surgery was performed subsequently with intracranial monitoring in attempts to obtain seizure control.
  
  
  CONCLUSIONS
  MEG is a viable alternative to invasive monitoring with intracranial electrodes for planning of resective surgery in carefully selected pediatric patients with localization-related epilepsy. Good candidates for this approach include patients who have a well-delineated, localized spike cluster on MEG that is concordant with findings of other preoperative evaluations and patients with prior brain pathologies that make the implantation of subdural and depth electrodes somewhat problematic.
authors.affiliation: Division of Neurosurgery, Arkansas Children's Hospital;
authors.forename: Gregory W
authors.initials: GW
authors.lastname: Albert
authors.forename: George M
authors.initials: GM
authors.lastname: Ibrahim
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Otsubo
authors.forename: Ayako
authors.initials: A
authors.lastname: Ochi
authors.forename: Cristina Y
authors.initials: CY
authors.lastname: Go
authors.forename: O Carter
authors.initials: OC
authors.lastname: Snead
authors.forename: James M
authors.initials: JM
authors.lastname: Drake
authors.forename: James T
authors.initials: JT
authors.lastname: Rutka
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D004567:Electrodes, Implanted; D004828:Epilepsies, Partial / Q000601:surgery; D004827:Epilepsy / Q000601:surgery*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007223:Infant; D008279:Magnetic Resonance Imaging; D015225:Magnetoencephalography; D008297:Male; D038361:Neuronavigation / Q000379:methods*; D012640:Seizures / Q000601:surgery; D013355:Subdural Space; D016896:Treatment Outcome
keywords: EEG = electroencephalography; MEG; MEG = magnetoencephalography; PET = positron emission tomography; SPECT = single-photon emission CT; VEEG = video EEG; fMRI = functional MRI; intractable epilepsy; magnetoencephalography; surgery