title: The diagnostic utility of 3D electroencephalography source imaging in pediatric epilepsy surgery.
abstract: OBJECTIVE
  The aim of this study was to investigate the utility of three-dimensional electroencephalography source imaging (3D-ESI) with low-resolution electroencephalographic data in the pediatric noninvasive presurgical evaluation, and to compare the findings with positron emission tomography (PET) and ictal single-photon emission computed tomography (iSPECT).
  
  
  METHODS
  We retrospectively selected 60 patients from a database of 594 patients who underwent excisional surgery for drug-resistant epilepsy. Patients were <18 years at time of surgery, had at least one presurgical volumetric brain magnetic resonance imaging (MRI), and at least 1 year of outcome data. 3D-ESI was performed with NeuroScan software CURRY V.7.0. For each patient the surgical resection was planned utilizing 3D-ESI as an adjunctive tool to supplement MRI and electrocorticographic data. Our analyses addressed three critical variables: pathology (focal cortical dysplasia vs. other pathologies), imaging (MRI negative vs. positive cases), and surgery (temporal resection vs. extratemporal and multilobar resections). We also compared the localizing utility and surgical outcome of 3D-ESI findings with PET, iSPECT, and the colocalized surgical resection. Statistical analyses were performed using the Statistical Package for the Social Sciences, Version 20.
  
  
  RESULTS
  Mean age at surgery was 11.18 years (range 1-18 years). 3D-ESI showed a strong correlation with the surgical resection cavity (65.0%), particularly within the temporal lobe. 3D-ESI demonstrated better localization in MRI-negative cases (78.6%), which was not statistically significant. 3D-ESI also correlated with a superior surgical outcome profile compared to PET and iSPECT.
  
  
  CONCLUSIONS
  Our findings demonstrate that 3D-ESI data obtained with low-resolution electroencephalography achieves reasonably accurate noninvasive localization of epileptic spikes in pediatric focal epilepsy, especially in temporal lobe and MRI-negative cases, and is comparable to iSPECT and PET. Given its lesser expense and lack of radiation exposure, 3D-ESI is a useful and efficient tool for evaluating surgical candidacy in pediatric epilepsy surgery centers, particularly if PET and iSPECT are unavailable.
authors.affiliation: Child Neurology Unit, IRCCS, Institute of Neurological Sciences of Bologna, Bologna, Italy.
authors.forename: Angelo
authors.initials: A
authors.lastname: Russo
authors.affiliation: Department of Neurology and Comprehensive Epilepsy Program, Brain Institute, Nicklaus Children's Hospital, Miami, Florida, U.S.A.
authors.forename: Prasanna
authors.initials: P
authors.lastname: Jayakar
authors.affiliation: Department of Neurology and Comprehensive Epilepsy Program, Brain Institute, Nicklaus Children's Hospital, Miami, Florida, U.S.A.
authors.forename: Matt
authors.initials: M
authors.lastname: Lallas
authors.affiliation: Department of Neurology and Comprehensive Epilepsy Program, Brain Institute, Nicklaus Children's Hospital, Miami, Florida, U.S.A.
authors.forename: Ian
authors.initials: I
authors.lastname: Miller
authors.affiliation: Department of Neurology and Comprehensive Epilepsy Program, Brain Institute, Nicklaus Children's Hospital, Miami, Florida, U.S.A.
authors.forename: Ann
authors.initials: A
authors.lastname: Hyslop
authors.affiliation: Neuropsychology Section, Brain Institute, Nicklaus Children's Hospital, Miami, Florida, U.S.A.
authors.forename: Brandon
authors.initials: B
authors.lastname: Korman
authors.affiliation: Department of Neurology and Comprehensive Epilepsy Program, Brain Institute, Nicklaus Children's Hospital, Miami, Florida, U.S.A.
authors.forename: Catalina
authors.initials: C
authors.lastname: Dunoyer
authors.affiliation: Department of Neurology and Comprehensive Epilepsy Program, Brain Institute, Nicklaus Children's Hospital, Miami, Florida, U.S.A.|Department of Neurology, University of Miami Miller School of Medicine, Miami, Florida, U.S.A.
authors.forename: Trevor
authors.initials: T
authors.lastname: Resnick
authors.affiliation: Department of Neurology and Comprehensive Epilepsy Program, Brain Institute, Nicklaus Children's Hospital, Miami, Florida, U.S.A.|Department of Neurology, University of Miami Miller School of Medicine, Miami, Florida, U.S.A.
authors.forename: Michael
authors.initials: M
authors.lastname: Duchowny
mesh_terms: D000293:Adolescent; D000704:Analysis of Variance; D001921:Brain / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D000069279:Drug Resistant Epilepsy / Q000175:diagnosis* / Q000601:surgery*; D004569:Electroencephalography; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000379:methods*; D007223:Infant; D008279:Magnetic Resonance Imaging; D008297:Male; D049268:Positron-Emission Tomography; D015899:Tomography, Emission-Computed, Single-Photon; D016896:Treatment Outcome
keywords: EEG; Electric source imaging; Epilepsy surgery; Focus localization; Temporal lobe epilepsy