Neuroimaging in epilepsy surgery: a review

Area of Science:

• Neurology
• Neurosurgery
• Radiology

Background:

• Shift from invasive monitoring to neuroimaging for epilepsy surgery selection.
• Video-electroencephalography (EEG) is vital for diagnosis and seizure onset localization.

Purpose of the Study:

• To highlight the pivotal role of neuroimaging, especially MRI, in selecting patients for epilepsy surgery.
• To discuss the diagnostic capabilities of various neuroimaging techniques in identifying potential surgical targets.

Main Methods:

• Visual and quantitative analysis of magnetic resonance imaging (MRI) scans.
• Review of studies correlating MRI findings with surgical outcomes.
• Inclusion of functional imaging techniques like ictal single photon emission computed tomography (SPECT) and positron emission tomography (PET).

Main Results:

• MRI detects common epilepsy causes like hippocampal sclerosis, cortical dysplasia, and cavernomas.
• The presence of a visible lesion on MRI is associated with optimal postoperative results.
• Functional imaging provides valuable corroborative evidence for seizure focus localization.

Conclusions:

• Neuroimaging, primarily MRI, is the cornerstone for selecting epilepsy surgery candidates.
• Visible lesions on MRI predict better surgical outcomes.
• Ancillary functional imaging aids in confirming seizure focus and improving surgical planning.