Intraoperative magnetic resonance imaging in epilepsy surgery

Area of Science:

• Neurosurgery
• Neuroradiology
• Epileptology

Background:

• Epilepsy surgery aims for tailored resections to minimize tissue removal while maximizing seizure control.
• Accurate assessment of resection extent during surgery is crucial for treatment success.
• Pharmacoresistant epilepsy necessitates advanced surgical interventions.

Purpose of the Study:

• To evaluate the utility of intraoperative magnetic resonance imaging (iMRI) in epilepsy surgery.
• To assess the immediate confirmation of tailored resection or disconnection procedures.
• To enhance surgical efficiency and preserve non-epileptogenic brain tissue.

Main Methods:

• Utilized a Magnetom Open 0.2-T scanner for intraoperative imaging in 61 patients with pharmacoresistant epilepsy.
• Employed a three-dimensional sequence allowing free slice reformatting for detailed visualization.
• Documented the extent of temporal resections and callosotomies in nonlesional and lesional cases.

Main Results:

• iMRI accurately documented tailored resections in nonlesional cases (n=32).
• Complete resection was confirmed in 79% of lesional cases, increasing to 90% with a second look (n=3).
• iMRI enabled reliable intraoperative evaluation and identified incomplete resections, especially in glioma cases.

Conclusions:

• Intraoperative MRI provides reliable, real-time assessment of resection extent in epilepsy surgery.
• The technology facilitates a 'second look' for incomplete resections, improving total resection rates.
• Enhanced understanding of structure-function relationships via iMRI may reduce postoperative neuropsychological deficits.