Outcome after individualized stereoelectroencephalography (sEEG) implantation and navigated resection in patients with lesional and non-lesional focal epilepsy

Thorsteinsdottir, Jun; Vollmar, Christian; Tonn, Jörg-Christian; Kreth, Friedrich-Wilhelm; Noachtar, Soheyl und Peraud, Aurelia (2019): Outcome after individualized stereoelectroencephalography (sEEG) implantation and navigated resection in patients with lesional and non-lesional focal epilepsy. In: Journal of Neurology, Bd. 266, Nr. 4: S. 910-920

Abstract

BackgroundRefined localization of the epileptogenic zone (EZ) in patients with pharmacoresistant focal epilepsy proceeding to resective surgery might improve postoperative outcome. We here report seizure outcome after stereo EEG (sEEG) evaluation with individually planned stereotactically implanted depth electrodes and subsequent tailored resection.MethodsA cohort of consecutive patients with pharmacoresistant focal epilepsy, evaluated with a non-invasive evaluation protocol and invasive monitoring with personalized, stereotactically implanted depth electrodes for sEEG was analyzed. Co-registration of post-implantation CT scan to presurgical MRI data was used for 3D reconstructions of the patients' brain surface and mapping of neurophysiology data. Individual multimodal 3D maps of the EZ were used to guide subsequent tailored resections. The outcome was rated according to the Engel classification.ResultsOut of 914 patients who underwent non-invasive presurgical evaluation, 85 underwent sEEG, and 70 were included in the outcome analysis. Median follow-up was 31.5months. Seizure-free outcome (Engel class I A-C, ILAE class 1-2) was achieved in 83% of the study cohort. Patients exhibiting lesional and non-lesional (n=42, 86% vs. n=28, 79%), temporal and extratemporal (n=45, 80% vs. n=25, 84%), and right- and left-hemispheric epilepsy (n=44, 82% vs. n=26, 85%) did similarly well. This remains also true for those with an EZ adjacent to or distant from eloquent cortex (n=21, 86% vs. n=49, 82%). Surgical outcome was independent of resected tissue volume.ConclusionFavourable post-surgical outcome can be achieved in patients with resistant focal epilepsy, using individualized sEEG evaluation and tailored navigated resection, even in patients with non-lesional or extratemporal focal epilepsy.

• Dokumententyp: Zeitschriftenartikel
• Fakultät: Medizin
• Themengebiete: 600 Technik, Medizin, angewandte Wissenschaften > 610 Medizin und Gesundheit
• ISSN: 0340-5354
• Sprache: Englisch