title: Risk reduction in dominant temporal lobe epilepsy surgery combining fMRI/DTI maps, neuronavigation and intraoperative 1.5-Tesla MRI.
abstract: BACKGROUND
  In dominant temporal lobe epilepsy surgery, speech, memory and visual systems are at risk.
  
  
  OBJECTIVE
  Functional magnetic resonance imaging (fMRI) and diffusion tensor imaging combined with intraoperative neuronavigation and MRI were investigated retrospectively regarding risk reductions for favorable neurological and seizure outcome.
  
  
  METHODS
  Functional imaging risk maps were generated for 14 patients suffering from dominant temporal lobe epilepsy [7 with hippocampal sclerosis (HS), 7 with various lesions] and used for neuronavigation-guided tailored resection. Postoperative neurological and seizure outcome and complications were evaluated.
  
  
  RESULTS
  None of the patients had postoperative speech dysfunction despite 2.3/3.6-cm mean hippocampal/neocortical resection. Verbal memory decline was found in 2 of the 14 (14.3%) patients, correlating with surgical lesions in fMRI memory-activated functional areas in the dominant posterior parahippocampal gyrus. Verbal memory scores did not statistically differ between the HS and the lesional group, neither pre- nor postoperatively. A contralateral visual field defect occurred in 1 patient (7.1%). An Engel class I seizure outcome was found in 12 patients (85.7%), and 11 were completely seizure free (78.6%) at a mean follow-up of 19.5 months.
  
  
  CONCLUSIONS
  This retrospectively investigated protocol led to an excellent neurological and seizure outcome and a low complication rate in dominant temporal lobe epilepsy surgery.
authors.affiliation: Department of Neurosurgery, University Hospital Erlangen, Erlangen, Germany.
authors.forename: Karl
authors.initials: K
authors.lastname: Rössler
authors.forename: Bjoern
authors.initials: B
authors.lastname: Sommer
authors.forename: Peter
authors.initials: P
authors.lastname: Grummich
authors.forename: Hajo M
authors.initials: HM
authors.lastname: Hamer
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Pauli
authors.forename: Roland
authors.initials: R
authors.lastname: Coras
authors.forename: Ingmar
authors.initials: I
authors.lastname: Blümcke
authors.forename: Michael
authors.initials: M
authors.lastname: Buchfelder
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D056324:Diffusion Tensor Imaging / Q000379:methods*; D004833:Epilepsy, Temporal Lobe / Q000175:diagnosis* / Q000378:metabolism / Q000601:surgery*; D005260:Female; D006801:Humans; D064795:Intraoperative Neurophysiological Monitoring / Q000379:methods*; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D038361:Neuronavigation / Q000379:methods*; D012189:Retrospective Studies; D040242:Risk Reduction Behavior; D055815:Young Adult