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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 2. T1WI showing a well-demarcated hypointensity mass lesion in the left frontal lobe (A). The tumor shows low uptake in MET-PET (fused with T1WI) (B) and hypo-uptake in FDG-PET (fused with T1WI) (C). Fiber tractography showing that the left pyramidal tract is located posteromediocaudal to the tumor (D and E) and that the left arcuate fasciculus is located caudolateral to the tumor (F and G). Postoperative T1WI showed the tumor to be totally resected (H).
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f0015: Case 2. T1WI showing a well-demarcated hypointensity mass lesion in the left frontal lobe (A). The tumor shows low uptake in MET-PET (fused with T1WI) (B) and hypo-uptake in FDG-PET (fused with T1WI) (C). Fiber tractography showing that the left pyramidal tract is located posteromediocaudal to the tumor (D and E) and that the left arcuate fasciculus is located caudolateral to the tumor (F and G). Postoperative T1WI showed the tumor to be totally resected (H).

Mentions: The patient, a five-year-old girl, presented a four-month history of complex partial seizures occurring a few times a day. Anticonvulsants reduced the seizure frequency to a few times a week. Her MRI showed a relatively well-demarcated mass lesion (3.0 × 3.0 × 4.0 cm) in the left frontal lobe extending to the left lateral ventricle wall, which presented with hypointensity on T1WI, hyperintensity on T2WI, hypointensity with a surrounding high intensity irregular ring on FLAIR, no Gd enhancement, low uptake in MET-PET, and hypo-uptake in FDG-PET (Figs. 3A, B, and C). Preoperative interictal EEG showed frequent epileptiform spike discharges on the left frontal region. Fiber tractography showed that the left pyramidal tract lay just posteromediocaudal to the tumor (Figs. 3D and E) and that the left arcuate fasciculus lay just caudolateral to the tumor (Figs. 3F and G). In the surgery, at first, the left central sulcus was identified using intraoperative SEP (Fig. 4). A total tumor resection with careful resection of the EZ, which was defined as the peritumoral regions with interictal spikes on the intraoperative ECoG, was performed using a neuronavigation system under monitoring of the intraoperative ECoG (Figs. 3H, 5A and B). Epileptiform discharges, which emerged on ECoG before the lesion was resected, completely disappeared after lesion resection (Figs. 5C and D). She had no surgical complications. The tumor was histologically diagnosed as a DNT. She was continued on anticonvulsants for 12 months postoperatively. She remains seizure-free and off anticonvulsants as of her most recent follow-up three years after surgery. Her postoperative interictal EEG has 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 2. T1WI showing a well-demarcated hypointensity mass lesion in the left frontal lobe (A). The tumor shows low uptake in MET-PET (fused with T1WI) (B) and hypo-uptake in FDG-PET (fused with T1WI) (C). Fiber tractography showing that the left pyramidal tract is located posteromediocaudal to the tumor (D and E) and that the left arcuate fasciculus is located caudolateral to the tumor (F and G). Postoperative T1WI showed the tumor to be totally resected (H).
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Related In: Results  -  Collection

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getmorefigures.php?uid=PMC4150595&req=5

f0015: Case 2. T1WI showing a well-demarcated hypointensity mass lesion in the left frontal lobe (A). The tumor shows low uptake in MET-PET (fused with T1WI) (B) and hypo-uptake in FDG-PET (fused with T1WI) (C). Fiber tractography showing that the left pyramidal tract is located posteromediocaudal to the tumor (D and E) and that the left arcuate fasciculus is located caudolateral to the tumor (F and G). Postoperative T1WI showed the tumor to be totally resected (H).
Mentions: The patient, a five-year-old girl, presented a four-month history of complex partial seizures occurring a few times a day. Anticonvulsants reduced the seizure frequency to a few times a week. Her MRI showed a relatively well-demarcated mass lesion (3.0 × 3.0 × 4.0 cm) in the left frontal lobe extending to the left lateral ventricle wall, which presented with hypointensity on T1WI, hyperintensity on T2WI, hypointensity with a surrounding high intensity irregular ring on FLAIR, no Gd enhancement, low uptake in MET-PET, and hypo-uptake in FDG-PET (Figs. 3A, B, and C). Preoperative interictal EEG showed frequent epileptiform spike discharges on the left frontal region. Fiber tractography showed that the left pyramidal tract lay just posteromediocaudal to the tumor (Figs. 3D and E) and that the left arcuate fasciculus lay just caudolateral to the tumor (Figs. 3F and G). In the surgery, at first, the left central sulcus was identified using intraoperative SEP (Fig. 4). A total tumor resection with careful resection of the EZ, which was defined as the peritumoral regions with interictal spikes on the intraoperative ECoG, was performed using a neuronavigation system under monitoring of the intraoperative ECoG (Figs. 3H, 5A and B). Epileptiform discharges, which emerged on ECoG before the lesion was resected, completely disappeared after lesion resection (Figs. 5C and D). She had no surgical complications. The tumor was histologically diagnosed as a DNT. She was continued on anticonvulsants for 12 months postoperatively. She remains seizure-free and off anticonvulsants as of her most recent follow-up three years after surgery. Her postoperative interictal EEG has 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