Multilobar Resections for 3T MRI-Negative Epilepsy: Worth the Trouble?

Area of Science:

• Neurosurgery
• Epileptology
• Neuroradiology

Background:

• Multilobar resections are performed in up to one third of surgeries for drug-resistant epilepsy cases with negative magnetic resonance imaging (MRI).
• Data on the efficacy and safety of multilobar resections in MRI-negative epilepsy are limited, leading to ongoing debate regarding their risk-benefit ratio.

Purpose of the Study:

• To investigate the postoperative seizure outcomes in patients with MRI-negative drug-resistant focal epilepsy who underwent multilobar epilepsy surgery.

Main Methods:

• Retrospective analysis of four consecutive patients with 3 Tesla (3T) MRI-negative findings and drug-resistant focal epilepsy.
• All patients underwent multilobar epilepsy surgery at the institution.

Main Results:

• The mean age at first surgery was 28.5 years; two patients required frontotemporal resections, and two required temporo-parieto-occipital resections.
• Histopathology revealed mild cortical malformations in two patients and focal cortical dysplasia in two others.
• At a median follow-up of 3.3 years, two patients were seizure-free (Engel class Ia), one had improved seizure control (Engel class Ic), and one showed worthwhile improvement (Engel class IIb). No complications occurred.

Conclusions:

• Multilobar epilepsy surgery can be effective for selected MRI-negative epilepsy patients, offering lasting seizure control and favorable outcomes.
• Comprehensive preoperative evaluation is crucial for successful outcomes.
• Reoperation may be beneficial for patients with recurrent seizures after initial resection.