The Usefulness of 3D-Surface Rendering of the MRI in Surgical Treatment of Patients with Intractable Neocortical Epilepsy.
- Author:
Eun Jeong KOH
1
;
Ha Young CHOI
;
Yong Keun KWAK
;
Young Hyeon KIM
;
Dai Ha KOH
;
Keun Soo KIM
Author Information
1. Department of Neurosurgery, Chonbuk National University Medical School and Hospital, Korea. hayoungc@moak.chonbuk.ac.kr
- Publication Type:Original Article
- Keywords:
Neocortical epilepsy;
MRI-identifiable lesion;
3D-identifiable lesion
- MeSH:
Electrodes;
Electroencephalography;
Epilepsy*;
Equidae;
Follow-Up Studies;
Gliosis;
Healthy Volunteers;
Humans;
Magnetic Resonance Imaging*;
Malformations of Cortical Development
- From:Journal of the Korean Neurological Association
2002;20(2):169-178
- CountryRepublic of Korea
- Language:Korean
-
Abstract:
BACKGROUND: This study is designed to indicate the role of 3D-surface rendering of the MRI in defining and resect-ing the epileptogenic zone. METHODS: 25 healthy volunteers and 55 patients were studied. Conventional MRI and 3D-surface rendering were performed. Sulcal and gyral patterns were assesed by a neuroradiologist and a neurologist with-out the clinical informations. Chronic video-EEG monitoring with surface and subdural grid electrodes, and PET were done. Resection was performed based on data of the EEG recordings and 3D-surface rendering. RESULTS: Conventional MRI identified structural abnormality ("MRI-identifiable lesion") in 20 patients. 20 of 35 patients without structural abnormality in conventional MRI revealed abnormal sulcal and gyral patterns in 3D-surface rendering of MRI ("3D-identifiable lesion"). Subdural grid EEGs recorded focal or diffuse ictal EEG onset from the region of "3D-identifiable lesion". Histopathologic findings revealed cortical dysplasia in 48 and neocortical gliosis in seven. Overall surgical out-come, at the average follow up period of 32.5 months, showed class I in 63.6%, class II in 25.5%, and class III in 10.9%. Among 20 patients with "MRI-identifiable lesion", 80% were in class I and 20% were in class II. Among 35 patients without "MRI-identifiable lesion", 54.3% were in class I, 28.6% were class II, and 17.1% were in class III. 80% of 20 patients with "3D-identifiable lesion" showed class I and 20% of 15 patients without "3D-identifiable lesion" showed class I. CONCLUSIONS: Identification of "MRI-identifiable lesion" or "3D-identifiable lesion" was of value in defining the epileptogenic zone. Resection of "MRI-identifiable lesion" or "3D-identifiable lesion", which were epilep-togenic in EEGs, promised a good surgical outcome.
