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Is intracranial electroencephalography mandatory for MRI-negative neocortical epilepsy surgery?

Is intracranial electroencephalography mandatory for MRI-neg...

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第十六届中国医师协会神经外科医师年会

作者： Zhihao Guo Chao Zhang Xiu Wang Chang Liu Baotian Zhao Jiajie Mo Zhong Zheng Xiaoqiu Shao Jianguo Zhang Kai Zhang Wenhan Hu Department of Neurosurgery Beijing Tiantan HospitalCapital Medical University Department of Neurosurgery Beijing Fengtai Hospital Department of Neurology Beijing Tiantan HospitalCapital Medical University Stereotactic and Functional Neurosurgery Laboratory Beijing Neurosurgical InstituteCapital Medical University Beijing Key Laboratory of Neurostimulation

Objective:MRI-negative focal epilepsy is one of the most challenging cases in epilepsy surgical treatment.Many epilepsy centers recommend intracranial electroencephalography for MRI-negative cases,especially neocortical epilepsy.This retrospective study aimed to explore whether intracranial monitoring is mandatory in MRI-negative neocortical epilepsy surgery and the factors that significantly influence the decision to perform intracranial recording or not.Methods:In this study,consecutive surgical patients with focal MRI-negative neocortical epilepsy were recruited.All patients underwent routine preoperative evaluation according to the dedicated protocol of our epilepsy center to determine the treatment plan.Patients were divided into two groups according to the surgical strategy:a direct group and a stereo-encephalography(SEEG)-guided group.History of epilepsy,seizure frequency,interictal and ictal EEG data,PET data,PET/mri co-registration data,neuropathological findings,and surgical outcomes were compared between the two groups.Multivariate analysis was performed to identify factors influencing the decision to implement SEEG monitoring.Results:Sixty-four patients were included in this study,of whom 19 and 45 underwent direct and SEEG-guided cortical resection,respectively.At an average follow-up of 3.9 years postoperatively,56 patients(87.5%) had Engel class I results without permanent neurological deficits.Surgical outcomes were not significantly different between the direct and SEEG-guided groups(94.7% vs.84.4%).There were significant differences between the two groups in the degree of hypometabolism(focal vs.non-focal,pMRI-negative neocortical epilepsy may yield favorable outcomes with direct cortical resection without intracranial monitoring;PET/mri

关键词： Neocortical epilepsy MRI-negative FDG-PET Intracranial electroencephalography Stereo-electroencephalography

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