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Epilepsy surgery of dysembryoplastic neuroepithelial tumors using advanced multitechnologies with combined neuroimaging and electrophysiological examinations.

Shinoda J, Yokoyama K, Miwa K, Ito T, Asano Y, Yonezawa S, Yano H - Epilepsy Behav Case Rep (2013)

Bottom Line: In all cases, technology beyond the routine workup was critical to success.As DNT may arise in any supratentorial and intracortical locations within or near the critical area of the brain, meticulous surgical strategies are necessary to avoid neurological deficits.We demonstrate in the following three cases how adjunct procedures using advanced multitechnologies with neuroimaging and electrophysiological examinations may be utilized to ensure success in DNT surgery.

View Article: PubMed Central - PubMed

Affiliation: Chubu Medical Center for Prolonged Traumatic Brain Dysfunction and Section of Neurosurgery, Kizawa Memorial Hospital, Department of Clinical Brain Sciences, Gifu University Graduate School of Medicine, Japan.

ABSTRACT

Purpose: We report three cases of dysembryoplastic neuroepithelial tumor (DNT) with intractable epilepsy which were successfully treated with surgery.

Methods: In all cases, technology beyond the routine workup was critical to success. Preoperative magnetic resonance imaging, (18)F-fluorodeoxyglucose positron emission tomography (PET), (11)C-methionine-PET, interictal electroencephalography, and intraoperative electrocorticography were utilized in all patients. In individual cases, however, additional procedures such as preoperative magnetoencephalography (Case 1), diffusion tensor fiber tractography, a neuronavigation system, and intraoperative somatosensory-evoked potential (Case 2), and fiber tractography and the neuronavigation-guided fence-post tube technique (Case 3) were instrumental.

Results: In all the cases, the objectives of total tumor resection, resection of the epileptogenic zone, and complete postoperative seizure control and the avoidance of surgical complications were achieved.

Conclusions: Dysembryoplastic neuroepithelial tumor is commonly associated with medically intractable epilepsy, and surgery is frequently utilized. As DNT may arise in any supratentorial and intracortical locations within or near the critical area of the brain, meticulous surgical strategies are necessary to avoid neurological deficits. We demonstrate in the following three cases how adjunct procedures using advanced multitechnologies with neuroimaging and electrophysiological examinations may be utilized to ensure success in DNT surgery.

No MeSH data available.


Related in: MedlinePlus

Case 1. Intraoperative ECoG prior to lesion resection showing interictal spikes, with representative ECoGs shown from different two sites (A and B). Epileptiform discharges which emerged on ECoG before lesion resection disappeared after lesion resection as shown on representative ECoGs from two different sites (C and D).
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f0010: Case 1. Intraoperative ECoG prior to lesion resection showing interictal spikes, with representative ECoGs shown from different two sites (A and B). Epileptiform discharges which emerged on ECoG before lesion resection disappeared after lesion resection as shown on representative ECoGs from two different sites (C and D).

Mentions: The patient, a 43-year-old woman, presented with a 20-year history of complex partial seizures occasionally followed by generalized tonic–clonic convulsive seizures. Despite treatment for over two years with multiple anticonvulsants, she continued to have seizures several times a month. Her MRI showed a relatively well-demarcated, small, mass lesion (1.8 × 1.8 × 1.8 cm) in the left medial temporal lobe, which presented with hypointensity on a T1-weighted image (T1WI), hyperintensity on T2WI, hypointensity with a surrounding high intensity ring in fluid attenuated inversion recovery (FLAIR), no gadolinium (Gd) enhancement, low uptake in MET-PET, and hypo-uptake in FDG-PET (Figs. 1A, B, C, and D). Preoperative interictal EEG did not show any significant epileptogenic activity. Preoperative interictal MEG, however, showed clustered dipoles in the region lateral to the tumor (Figs. 1E and F). A combined total tumor resection and left anterior temporal lobectomy was performed. Intraoperative ECoG monitoring was used to verify complete resection of the EZ, which was defined as the peritumoral region with interictal spikes on the intraoperative ECoG (Figs. 1G and H, 2A and B). Epileptiform discharges, which emerged on ECoG before resection of the lesion, disappeared after lesion resection (Figs. 2C and D). There were no surgical complications. The tumor was histologically diagnosed as a DNT. The patient was continued on anticonvulsants for 12 months postoperatively. Following cessation of the anticonvulsants, she remained seizure-free as of nine years following surgery. Postoperative interictal EEGs have not shown any significant epileptogenic activity (Engel class I [9]).


Epilepsy surgery of dysembryoplastic neuroepithelial tumors using advanced multitechnologies with combined neuroimaging and electrophysiological examinations.

Shinoda J, Yokoyama K, Miwa K, Ito T, Asano Y, Yonezawa S, Yano H - Epilepsy Behav Case Rep (2013)

Case 1. Intraoperative ECoG prior to lesion resection showing interictal spikes, with representative ECoGs shown from different two sites (A and B). Epileptiform discharges which emerged on ECoG before lesion resection disappeared after lesion resection as shown on representative ECoGs from two different sites (C and D).
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Related In: Results  -  Collection

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getmorefigures.php?uid=PMC4150595&req=5

f0010: Case 1. Intraoperative ECoG prior to lesion resection showing interictal spikes, with representative ECoGs shown from different two sites (A and B). Epileptiform discharges which emerged on ECoG before lesion resection disappeared after lesion resection as shown on representative ECoGs from two different sites (C and D).
Mentions: The patient, a 43-year-old woman, presented with a 20-year history of complex partial seizures occasionally followed by generalized tonic–clonic convulsive seizures. Despite treatment for over two years with multiple anticonvulsants, she continued to have seizures several times a month. Her MRI showed a relatively well-demarcated, small, mass lesion (1.8 × 1.8 × 1.8 cm) in the left medial temporal lobe, which presented with hypointensity on a T1-weighted image (T1WI), hyperintensity on T2WI, hypointensity with a surrounding high intensity ring in fluid attenuated inversion recovery (FLAIR), no gadolinium (Gd) enhancement, low uptake in MET-PET, and hypo-uptake in FDG-PET (Figs. 1A, B, C, and D). Preoperative interictal EEG did not show any significant epileptogenic activity. Preoperative interictal MEG, however, showed clustered dipoles in the region lateral to the tumor (Figs. 1E and F). A combined total tumor resection and left anterior temporal lobectomy was performed. Intraoperative ECoG monitoring was used to verify complete resection of the EZ, which was defined as the peritumoral region with interictal spikes on the intraoperative ECoG (Figs. 1G and H, 2A and B). Epileptiform discharges, which emerged on ECoG before resection of the lesion, disappeared after lesion resection (Figs. 2C and D). There were no surgical complications. The tumor was histologically diagnosed as a DNT. The patient was continued on anticonvulsants for 12 months postoperatively. Following cessation of the anticonvulsants, she remained seizure-free as of nine years following surgery. Postoperative interictal EEGs have not shown any significant epileptogenic activity (Engel class I [9]).

Bottom Line: In all cases, technology beyond the routine workup was critical to success.As DNT may arise in any supratentorial and intracortical locations within or near the critical area of the brain, meticulous surgical strategies are necessary to avoid neurological deficits.We demonstrate in the following three cases how adjunct procedures using advanced multitechnologies with neuroimaging and electrophysiological examinations may be utilized to ensure success in DNT surgery.

View Article: PubMed Central - PubMed

Affiliation: Chubu Medical Center for Prolonged Traumatic Brain Dysfunction and Section of Neurosurgery, Kizawa Memorial Hospital, Department of Clinical Brain Sciences, Gifu University Graduate School of Medicine, Japan.

ABSTRACT

Purpose: We report three cases of dysembryoplastic neuroepithelial tumor (DNT) with intractable epilepsy which were successfully treated with surgery.

Methods: In all cases, technology beyond the routine workup was critical to success. Preoperative magnetic resonance imaging, (18)F-fluorodeoxyglucose positron emission tomography (PET), (11)C-methionine-PET, interictal electroencephalography, and intraoperative electrocorticography were utilized in all patients. In individual cases, however, additional procedures such as preoperative magnetoencephalography (Case 1), diffusion tensor fiber tractography, a neuronavigation system, and intraoperative somatosensory-evoked potential (Case 2), and fiber tractography and the neuronavigation-guided fence-post tube technique (Case 3) were instrumental.

Results: In all the cases, the objectives of total tumor resection, resection of the epileptogenic zone, and complete postoperative seizure control and the avoidance of surgical complications were achieved.

Conclusions: Dysembryoplastic neuroepithelial tumor is commonly associated with medically intractable epilepsy, and surgery is frequently utilized. As DNT may arise in any supratentorial and intracortical locations within or near the critical area of the brain, meticulous surgical strategies are necessary to avoid neurological deficits. We demonstrate in the following three cases how adjunct procedures using advanced multitechnologies with neuroimaging and electrophysiological examinations may be utilized to ensure success in DNT surgery.

No MeSH data available.


Related in: MedlinePlus