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Intraoperative real-time guidance using ShearWave Elastography for epilepsy surgery.

Bertrand Mathon1, Aymeric Amelot2, Alexandre Carpentier1

  • 1AP-HP, GHU La Pitié-Salpêtrière - Charles Foix, Department of Neurosurgery, F-75013, Paris, France; Sorbonne University, UPMC Univ., Paris 06, F-75005, Paris, France; Brain and Spine Institute (ICM, INSERM, UMRS 1127, CNRS, UMR 7225), Paris, France.

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Summary

ShearWave elastography (SWE) improves intraoperative detection of the epileptogenic zone in epilepsy surgery. This noninvasive technique enhances lesion visualization, leading to better seizure control in drug-resistant epilepsy patients.

Keywords:
Brain surgeryCavernomaCortical dysplasiaImaging guidanceIntraoperative techniqueUltrasound

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Area of Science:

  • Neurosurgery
  • Medical Imaging
  • Epileptology

Background:

  • Epilepsy surgery outcomes depend on precise resection of the epileptogenic zone.
  • ShearWave elastography (SWE) offers quantitative, real-time tissue elasticity mapping.
  • SWE can differentiate between normal and pathological brain tissue.

Purpose of the Study:

  • To evaluate the effectiveness of SWE in guiding epileptogenic zone detection during epilepsy surgery.
  • To assess SWE's contribution to improving surgical precision in drug-resistant focal epilepsy.

Main Methods:

  • Prospective analysis of 28 patients with severe, drug-resistant focal epilepsy undergoing SWE-guided resection.
  • Comparison of SWE imaging with conventional B-mode ultrasound for lesion visualization.
  • Assessment of postoperative MRI and 1-year seizure outcomes (ILAE class 1).

Main Results:

  • SWE detected significant stiffness differences in 92.8% of cases, compared to 71.4% for B-mode.
  • SWE identified 3 of 4 MRI-negative focal cortical dysplasias, missed by B-mode.
  • 85.7% of patients achieved seizure freedom (ILAE class 1) one year post-surgery.

Conclusions:

  • SWE enhances intraoperative detection of epileptogenic lesions in epilepsy surgery.
  • SWE is a valuable tool for both cryptogenic and lesional epilepsy cases.
  • Further studies with larger cohorts are needed to confirm long-term seizure outcomes.