Introduction: Focal Cortical Dysplasia (FCD) is a common cause of intractable epilepsy in children. Seizure freedom following resection of FCD is determined by complete resection of the dysplastic cortical tissue. However, difficulty with intraoperative identification of the FCD lesion may limit the ability to achieve the surgical objective of complete extirpation of these lesions. The use of intraoperative magnetic resonance imaging (iMRI) may aid in real time detection of these lesions and improve seizure control outcomes compared to traditional resective surgery.
Methods: We retrospectively reviewed the medical records of pediatric subjects who underwent surgical resection of FCD at Children’s National Medical Center between March 2005 and April 2014. Subjects were grouped into two categories depending on whether iMRI was employed at surgery. Post-surgical seizure outcome was assessed utilizing the Engel Epilepsy Surgery Outcome Scale.
Results: 12 consecutive patients (8 females and 4 males) with intractable FCD who underwent iMRI assisted FCD resective surgery were compared with 41 consecutive control patients (15 females and 26 males) who underwent standard resection without iMRI. The median age in the iMRI assisted resection group at the time of surgery was 8 years (range 0.7 to 18.8 years), and the mean duration of follow up was 27.3 months (SEM: 3.5 months). At the time of the last postoperative follow up, 11 of the 12 patients (92%) in the iMRI resection group were seizure free (Engel Class I), compared to 18 of the 41 patients (44%) in the control resection group (p = 0.0033).
Conclusions: Our results suggest that the utilization of iMRI during surgery for resection of FCD results in improved post-operative seizure freedom, completeness of lesion resection and reduction in the need for reoperation.
Patient Care: To improve seizure control outcome in children with epilepsy
Learning Objectives: Describes the role of intraoperative MRI in epilepsy surgery in children