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01-12-2016 | Original Paper

3-T intraoperative MRI (iMRI) for pediatric epilepsy surgery

Authors: Nebras M. Warsi, Oliver Lasry, Adel Farah, Christine Saint-Martin, Jose L. Montes, Jeffrey Atkinson, Jean-Pierre Farmer, Roy W. R. Dudley

Published in: Child's Nervous System | Issue 12/2016

Abstract

Purpose

Three-tesla intraoperative MRI (iMRI) is a promising tool that could help confirm complete resections and disconnections in pediatric epilepsy surgery, leading to improved outcomes. However, a large proportion of epileptogenic pathologies in children are poorly defined on imaging, which brings into question the utility of iMRI for these cases. Our aim was to compare postoperative seizure outcomes between iMRI- and non-iMRI-based epilepsy surgeries.

Methods

We performed a comparative retrospective analysis of non-iMRI- versus iMRI-based epilepsy surgeries with 2-year follow-up. Patients were stratified into well-defined cases (WDCs), poorly defined cases (PDCs), and diffuse hemispheric cases (DHCs). Primary outcomes were rates of complete seizure freedom and surgical complications. Secondary outcomes included good (Engel class I/II) seizure outcome, extent of resection/disconnection, and operative duration. Regression models were used to adjust for confounding.

Results

Thirty-nine iMRI-based and 39 non-iMRI-based surgeries were included. The distributions of age, sex, and lesion class in each era were similar, but the distributions of individual pathologies varied. Seizure freedom and complication rates at 2-year follow-up were not different between the groups, but Engel class I/II outcome was more common in the iMRI group. Extent of resection/disconnection and length of surgery were similar in both groups. PDCs had the worst outcomes, which were unchanged by the use of iMRI.

Conclusion

Three-tesla iMRI-based epilepsy surgery may have the potential to improve patient outcomes. However, we conclude that iMRI, in its current state of use at our institute, does not improve outcomes for children undergoing epilepsy surgery. Given that its use appears safe, further research on this technology is warranted, particularly for the most challenging PDCs.

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Title: 3-T intraoperative MRI (iMRI) for pediatric epilepsy surgery
Authors: Nebras M. Warsi
Oliver Lasry
Adel Farah
Christine Saint-Martin
Jose L. Montes
Jeffrey Atkinson
Jean-Pierre Farmer
Roy W. R. Dudley
Publication date: 01-12-2016
Publisher: Springer Berlin Heidelberg
Published in: Child's Nervous System / Issue 12/2016
Print ISSN: 0256-7040
Electronic ISSN: 1433-0350
DOI: https://doi.org/10.1007/s00381-016-3263-3

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

3-T intraoperative MRI (iMRI) for pediatric epilepsy surgery

Abstract

Purpose

Methods

Results

Conclusion

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

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