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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 3. T1WI after the first surgery showing a partially resected, well-demarcated, hypointensity mass lesion in the left posterior temporal lobe (A). Two years later, T1WI showing tumor progression (B). The tumor showed low uptake in MET-PET (fused with T1WI) (C) and hypo-uptake in FDG-PET (fused with T1WI) (D). Fiber tractography showed the left visual tract (arrow) to be mediorostral to the tumor (E and F). This is a photograph showing the neuronavigation-guided fence-post tube technique used in the surgery (G). Postoperative T1WI showed that the tumor was totally resected (H).
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f0030: Case 3. T1WI after the first surgery showing a partially resected, well-demarcated, hypointensity mass lesion in the left posterior temporal lobe (A). Two years later, T1WI showing tumor progression (B). The tumor showed low uptake in MET-PET (fused with T1WI) (C) and hypo-uptake in FDG-PET (fused with T1WI) (D). Fiber tractography showed the left visual tract (arrow) to be mediorostral to the tumor (E and F). This is a photograph showing the neuronavigation-guided fence-post tube technique used in the surgery (G). Postoperative T1WI showed that the tumor was totally resected (H).

Mentions: The patient, a 10-year-old girl, presented with a history of surgery for DNT in the left posterior temporal lobe. She had developed complex partial seizures refractory to anticonvulsants and had seizures a few times a month before the surgery. She underwent a partial resection of the tumor in a community hospital at the age of eight years, and the tumor was diagnosed as a DNT histologically (Fig. 6A). After surgery, she was seizure-free for 12 months on anticonvulsant medication; however, seizures recurred a few times per day. She was referred to our hospital, and her MRI showed a relatively well-demarcated mass lesion (6.5 × 5.0 × 4.0 cm) in the left posterior temporal lobe with a cavity corresponding to the prior area of resection in the posterior portion of the tumor. The tumor presented with hypointensity on T1WI, hyperintensity on T2WI, hypointensity with a surrounding irregular high intensity area in the white matter on FLAIR, and no Gd enhancement (Fig. 6B). The MRI revealed tumor progression, and the tumor intensities were the same as on the prior preoperative imaging (Figs. 6A and B). The tumor showed low uptake in MET-PET and hypo-uptake in FDG-PET (Figs. 6C and D). Preoperative interictal EEG showed frequent epileptiform spike discharges on the left occipitotemporal region. The previous surgery had resulted in right upper quadrant hemianopsia. Fiber tractography showed that the residual left visual tract lay just mediorostral to the tumor (Figs. 6E and F). We performed a complete total tumor resection with careful resection of the EZ, which was defined as the peritumoral region with interictal spikes on the intraoperative ECoG, using a neuronavigation-guided fence-post tube technique with monitoring of intraoperative ECoG (Figs. 6G and H, 7A and B). Epileptiform discharges which emerged on the ECoG completely disappeared after lesion resection (Fig. 7C). She had no surgical complications and exhibited no worsening of the visual field deficit. The tumor was diagnosed as a DNT histologically without malignant transformation. She was maintained on anticonvulsants and had no recurrence five months postoperatively. Postoperative interictal EEG did not show 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 3. T1WI after the first surgery showing a partially resected, well-demarcated, hypointensity mass lesion in the left posterior temporal lobe (A). Two years later, T1WI showing tumor progression (B). The tumor showed low uptake in MET-PET (fused with T1WI) (C) and hypo-uptake in FDG-PET (fused with T1WI) (D). Fiber tractography showed the left visual tract (arrow) to be mediorostral to the tumor (E and F). This is a photograph showing the neuronavigation-guided fence-post tube technique used in the surgery (G). Postoperative T1WI showed that the tumor was totally resected (H).
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Related In: Results  -  Collection

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getmorefigures.php?uid=PMC4150595&req=5

f0030: Case 3. T1WI after the first surgery showing a partially resected, well-demarcated, hypointensity mass lesion in the left posterior temporal lobe (A). Two years later, T1WI showing tumor progression (B). The tumor showed low uptake in MET-PET (fused with T1WI) (C) and hypo-uptake in FDG-PET (fused with T1WI) (D). Fiber tractography showed the left visual tract (arrow) to be mediorostral to the tumor (E and F). This is a photograph showing the neuronavigation-guided fence-post tube technique used in the surgery (G). Postoperative T1WI showed that the tumor was totally resected (H).
Mentions: The patient, a 10-year-old girl, presented with a history of surgery for DNT in the left posterior temporal lobe. She had developed complex partial seizures refractory to anticonvulsants and had seizures a few times a month before the surgery. She underwent a partial resection of the tumor in a community hospital at the age of eight years, and the tumor was diagnosed as a DNT histologically (Fig. 6A). After surgery, she was seizure-free for 12 months on anticonvulsant medication; however, seizures recurred a few times per day. She was referred to our hospital, and her MRI showed a relatively well-demarcated mass lesion (6.5 × 5.0 × 4.0 cm) in the left posterior temporal lobe with a cavity corresponding to the prior area of resection in the posterior portion of the tumor. The tumor presented with hypointensity on T1WI, hyperintensity on T2WI, hypointensity with a surrounding irregular high intensity area in the white matter on FLAIR, and no Gd enhancement (Fig. 6B). The MRI revealed tumor progression, and the tumor intensities were the same as on the prior preoperative imaging (Figs. 6A and B). The tumor showed low uptake in MET-PET and hypo-uptake in FDG-PET (Figs. 6C and D). Preoperative interictal EEG showed frequent epileptiform spike discharges on the left occipitotemporal region. The previous surgery had resulted in right upper quadrant hemianopsia. Fiber tractography showed that the residual left visual tract lay just mediorostral to the tumor (Figs. 6E and F). We performed a complete total tumor resection with careful resection of the EZ, which was defined as the peritumoral region with interictal spikes on the intraoperative ECoG, using a neuronavigation-guided fence-post tube technique with monitoring of intraoperative ECoG (Figs. 6G and H, 7A and B). Epileptiform discharges which emerged on the ECoG completely disappeared after lesion resection (Fig. 7C). She had no surgical complications and exhibited no worsening of the visual field deficit. The tumor was diagnosed as a DNT histologically without malignant transformation. She was maintained on anticonvulsants and had no recurrence five months postoperatively. Postoperative interictal EEG did not show 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