Re-review of MRI with post-processing in nonlesional patients in whom epilepsy surgery has failed.
Management of MRI-negative patients with intractable focal epilepsy after failed surgery is particularly challenging. In this study, we aim to investigate whether MRI post-processing could identify relevant targets for the re-evaluation of MRI-negative patients who failed the initial resective surgery. We examined a consecutive series of 56 MRI-negative patients who underwent resective surgery and had recurring seizures at 1-year follow-up. T1-weighted volumetric sequence from the pre-surgical MRI was used for voxel-based MRI post-processing which was implemented in a morphometric analysis program (MAP). MAP was positive in 15 of the 56 patients included in this study. In 5 patients, the MAP+ regions were fully resected. In 10 patients, the MAP+ regions were not or partially resected: two out of the 10 patients had a second surgery including the unresected MAP+ region, and both became seizure-free; the remaining 8 patients did not undergo further surgery, but the unresected MAP+ regions were concordant with more than one noninvasive modality in 7. In the 8 patients who had unresected MAP+ regions and intracranial-EEG before the previous surgery, the unresected MAP+ regions were concordant with ictal onset in 6. Our data suggest that scrutiny of the presurgical MRI guided by MRI post-processing may reveal relevant targets for reoperation in nonlesional epilepsies. MAP findings, when concordant with the patient's other noninvasive data, should be considered when planning invasive evaluation/reoperation for this most challenging group of patients.
Epilepsy Center, Cleveland Clinic, 9500 Euclid Avenue, Desk S-51, Cleveland, OH, 44195, USA. wangi2@ccf.org.
Z Irene
ZI
Wang
Pediatric Neurology, Phramongkutklao Hospital, Bangkok, Thailand.
P
P
Suwanpakdee
Neuroradiology, Imaging Institute, Cleveland Clinic, Cleveland, OH, USA.
S E
SE
Jones
Neurology, Sanford USD Medical Center, Sioux Falls, SD, USA.
Z
Z
Jaisani
Epilepsy Center, Cleveland Clinic, 9500 Euclid Avenue, Desk S-51, Cleveland, OH, 44195, USA.
Ahsan N V
AN
Moosa
Epilepsy Center, Cleveland Clinic, 9500 Euclid Avenue, Desk S-51, Cleveland, OH, 44195, USA.
I M
IM
Najm
Neurology, University of Greifswald, Greifswald, Germany.
F
F
von Podewils
Epilepsy Center, Cleveland Clinic, 9500 Euclid Avenue, Desk S-51, Cleveland, OH, 44195, USA.
R C
RC
Burgess
Epilepsy Center, Cleveland Clinic, 9500 Euclid Avenue, Desk S-51, Cleveland, OH, 44195, USA.
B
B
Krishnan
Anatomic Pathology, Cleveland Clinic, Cleveland, OH, USA.
R A
RA
Prayson
Neurosurgery, Cleveland Clinic, Cleveland, OH, USA.
J A
JA
Gonzalez-Martinez
Neurosurgery, Cleveland Clinic, Cleveland, OH, USA.
W
W
Bingaman
Epilepsy Center, Cleveland Clinic, 9500 Euclid Avenue, Desk S-51, Cleveland, OH, 44195, USA.
A V
AV
Alexopoulos
D000293:Adolescent; D000328:Adult; D000368:Aged; D001921:Brain / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000601:surgery; D002648:Child; D000069279:Drug Resistant Epilepsy / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000601:surgery*; D000069280:Electrocorticography; D004828:Epilepsies, Partial / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D008279:Magnetic Resonance Imaging / Q000379:methods; D015225:Magnetoencephalography; D008297:Male; D054220:Malformations of Cortical Development / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery; D008875:Middle Aged; D019635:Neurosurgical Procedures; D049268:Positron-Emission Tomography; D012086:Reoperation; D012189:Retrospective Studies; D017211:Treatment Failure; D055815:Young Adult
Epilepsy; Failed surgery; Focal cortical dysplasia; MRI-negative; Presurgical evaluation; Voxel-based morphometry