Surgical Strategy and Outcomes for Epileptic Patients with Focal Cortical Dysplasia or Dysembryoplastic Neuroepithelial Tumor

OBJECTIVEThe aim of this study was to elucidate the surgical strategy for focal cortical dysplasia (FCD) based on the interictal analysis on magnetoencephalography (MEG). For this purpose, the correlation between the spike onset zone (Sp-OZ) and the spike peak zone (Sp-PZ) on MEG was evaluated to clarify the differences in the Sp-OZ and its correlation with Sp-PZ in FCD subtypes to develop an appropriate surgical strategy.METHODSForty-one FCD patients (n = 17 type I, n = 13 type IIa, and n = 11 type IIb) were included. The Sp-OZ was identified by the summation of gradient magnetic-field topography (GMFT) magnitudes at interictal MEG spike onset, and Sp-PZ was defined as the distribution of the equivalent current dipole (ECD) at spike peak. Correlations between Sp-OZ and Sp-PZ distributions were evaluated and compared with clinical factors and seizure outcomes retrospectively.RESULTSGood seizure outcomes (Engel class I) were obtained significantly more often in patients with FCD type IIb (10/11, 90.9%) than those with type IIa (4/13, 30.8%; p = 0.003) and type I (6/17, 35.3%; p = 0.004). The Sp-OZ was significantly smaller (1 or 2 gyri) in type IIb (10, 90.9%) than in type IIa (4, 30.8%; p = 0.003) or type I (9, 53.0%; p = 0.036). Concordant correlations between the Sp-OZ and Sp-PZ were significantly more frequent in type IIb (7, 63.6%) than in type IIa (1, 7.7%; p = 0.015) or type I (1, 5.8%; p = 0.004). Complete resection of the Sp-OZ achieved significantly better seizure outcomes (Engel class I: 9/10, 90%) than incomplete resection (11/31, 35.5%) (p = 0.003). In contrast, complete resection of the Sp-PZ showed no significant difference in good seizure outcomes (9/13, 69.2%) compared with incomplete resection (11/28, 39.3%).CONCLUSIONSThe Sp-OZ detected by MEG using GMFT and its correlation with Sp-PZ were related to FCD subtypes. A discordant distribution between Sp-OZ and Sp-PZ in type I and IIa FCD indicated an extensive epileptogenic zone and a complex epileptic network. Type IIb showed a restricted epileptogenic zone with the smaller Sp-OZ and concordance between Sp-OZ and Sp-PZ. Complete resection of the Sp-OZ provided significantly better seizure outcomes than incomplete resection. Complete resection of the Sp-PZ was not related to seizure outcomes. There was a definite difference in the epileptogenic zone among FCD subtypes; hence, an individual surgical strategy taking into account the correlation between the Sp-OZ and Sp-PZ should be considered.

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The value of double inversion recovery MRI sequence in assessment of epilepsy patients

Egyptian Journal of Radiology and Nuclear Medicine ◽

10.1186/s43055-021-00604-z ◽

2021 ◽

Vol 52 (1) ◽

Author(s):

Mohamed Abdelbar Abdelmaksoud Aly ◽

Tarek Mohamed Saleh ◽

Amr Mohamed Ahmed Elfatatry ◽

Moataz Mohamed Montasser

Keyword(s):

Pulse Sequence ◽

Focal Cortical Dysplasia ◽

Cortical Dysplasia ◽

Inversion Recovery ◽

Added Value ◽

Double Inversion Recovery ◽

Mesial Temporal Sclerosis ◽

Recovery Sequence ◽

Epileptic Patients ◽

Multiple Characteristics

Abstract Background The double inversion recovery (DIR) pulse sequence was introduced several years ago and since that it grew important value in clinical neuroimaging. We aimed to assess the added value of double inversion recovery in evaluation of epileptic patients. Results In mesial temporal sclerosis, the measured contrast parameters (SNR, CR, CNR and AI) were found to be significantly higher in DIR than in FLAIR and T2 sequences. In cases of focal cortical dysplasia, significantly higher CNR and AI in DIR than in T2 and FLAIR. Also DIR showed higher detection of the increased cortical thickness and cortical signal intensity than the T2 and FLAIR sequences. In tuberous sclerosis cases, the DIR showed higher visibility of the lesions than the T2 and FLAIR. Also DIR showed higher ability to detected grey-white matters junction blurring. Conclusions Our study concluded that the greatest value of the double inversion recovery sequence is its higher ability in detecting multiple characteristics of the lesions in a one sequence.

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Dysembryoplastic neuroepithelial tumor (DNET) and focal cortical dysplasia: Case report of two pediatric patients with imaging features

International Journal of Diagnostic Imaging ◽

10.5430/ijdi.v4n2p31 ◽

2017 ◽

Vol 4 (2) ◽

pp. 31 ◽

Cited By ~ 1

Author(s):

Monwabisi Makola ◽

Kim Maria Cecil

Keyword(s):

Case Report ◽

Clinical Course ◽

Focal Cortical Dysplasia ◽

Early Stage ◽

Cortical Dysplasia ◽

Dysembryoplastic Neuroepithelial Tumor ◽

Imaging Features ◽

Spectroscopic Analyses ◽

Early Imaging ◽

Pediatric Presentation

We describe the clinical course and imaging features from two children diagnosed with focal cortical dysplasia and dysembryoplastic neuroepithelial tumor. These two children share similar pathology, however, this case report illustrates how their clinical presentation, management and imaging features differed with one treated primarily as a neoplasm, while the other as focal cortical dysplasia. These two patients illustrate the characteristics and challenges encountered with pediatric presentation of DNET and FCD. For patient 1, the clinical course, imaging and spectroscopic analyses reflected at early stage the ultimate pathological features of the lesion. In contrast, for patient 2, the early imaging features minimize what ultimately is predominately DNET.

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