Functional Magnetic Resonance Imaging Localization of Ictal Onset to a Dysplastic Cleft with Simultaneous Sensorimotor Mapping: Intraoperative Electrophysiological Confirmation and Postoperative Follow-up: Technical Note

Functional Magnetic Resonance Imaging Localization of Ictal Onset to a Dysplastic Cleft with... AbstractINTRODUCTION:Although technically challenging to obtain, ictal functional magnetic resonance imaging has been used to localize ictal onset zones in a small number of patients. We used this technique to demonstrate the inherent epileptogenicity of dysplastic cortex.METHODS:We present a 16-year-old female patient with intractable leftsided sensorimotor seizures and a congenital dysplastic cleft lying along the right rolandic fissure. Preoperative functional magnetic resonance imaging (blood oxygen level-dependent sequence, 1.5 T) localized the motor and sensory cortices to the anterior border of the cleft. During a speech activation run, the patient experienced a 20-second seizure. Initial activation was seen within the dysplastic cortex along the deep posterior margin of the cleft. Intraoperative median nerve stimulation produced a distinct N20/P20 wave inversion over the dysplastic cleft. Stimulation mapping performed with the patient awake confirmed the location of the sensorimotor cortex on the anterior border of the cleft, and preresection electrocorticography identified abundant interictal spikes along the posterior border after opening the cleft.RESULTS:After surgical resection of the dysplastic cortex, the patient exhibited transient minimal weakness and mild neglect, which resolved within 1 week. Two years after surgery, she was neurologically intact and seizure-free.CONCLUSION:This study used functional magnetic resonance imaging to demonstrate the inherent epileptogenicity of dysplastic cortex and to simultaneously map ictal and functional cortex. The N20 wave inversion be a useful intraoperative tool for identifying the central sulcus (or its equivalent), even in the presence of abnormal cortical architecture. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Neurosurgery Oxford University Press

Functional Magnetic Resonance Imaging Localization of Ictal Onset to a Dysplastic Cleft with Simultaneous Sensorimotor Mapping: Intraoperative Electrophysiological Confirmation and Postoperative Follow-up: Technical Note

Functional Magnetic Resonance Imaging Localization of Ictal Onset to a Dysplastic Cleft with Simultaneous Sensorimotor Mapping: Intraoperative Electrophysiological Confirmation and Postoperative Follow-up: Technical Note

Ictal Functional MRI in Dysplastic Cortex 639 reop erative neurosurgical p lan nin g Functional Magnetic Resonance Imaging has been greatly aided by the p o ssi­ bility of p erform in g functional m agnetic Localization o f Ictal Onset to a resonance im aging (fM RI) using c o n ­ ventional 1.5-T scanners. Su ccessfu l lo­ Dysplastic Cleft with Simultaneous calization of visual, sen so rim o to r, and language areas using the blood oxygen Sensorimotor Mapping: Intraoperative lev el-d ep en d en t con trast tech niq u e in both norm al v o lu n teers and presurgical Electrophysiological Confirmation and cand id ates has been reported (3, 5, 11, 13, 17, 20, 29, 31, 34, 37, 42). Briefly, this Postoperative Follow-up: Technical Note technique takes a d v a n ta g e of the u n c o u ­ pling of blood flow and oxy g en utiliza­ tion in activated cortical tissue (16), re­ sulting in a decrease in p aram a g n etic Theodore H. Schwartz, M.D., Stanley R. Resor, Jr., M.D., d eo x y h e m o g lo b in in local capillaries Robert De La Paz, M.D., Robert R. Goodman, M.D., Ph.D. and veins. G rad ien t echo T2* and T2- w eighted m agnetic reso n an ce (M R) im ­ Departments of Neurological Surgery (TH S, RRG) and Neurology (SRR), The Neurological Institute of New York, and Department of Neuroradiology (RDLP), ages d em o n strate this ch an g e as an in­ Columbia-Presbyterian M edical Center, New York, New York crease in signal (36). The key to the successful surgical treatm ent of m ed ically intractable ep i­ lepsy is the accurate identification of INTRODUCTION: Although technically challenging to obtain, ictal func­ ep ilep togenic cortex and su rro u n d in g tional magnetic resonance imaging has been used to localize ictal onset functionally im p ortant brain. L o ca liza ­ tion of the ictal onset zone in patients zones in a small number of patients. We used this technique to demon­ with m edically intractable ep ilep sy m ay...
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Publisher
Oxford University Press
Copyright
© Published by Oxford University Press.
ISSN
0148-396X
eISSN
1524-4040
D.O.I.
10.1097/00006123-199809000-00150
Publisher site
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Abstract

AbstractINTRODUCTION:Although technically challenging to obtain, ictal functional magnetic resonance imaging has been used to localize ictal onset zones in a small number of patients. We used this technique to demonstrate the inherent epileptogenicity of dysplastic cortex.METHODS:We present a 16-year-old female patient with intractable leftsided sensorimotor seizures and a congenital dysplastic cleft lying along the right rolandic fissure. Preoperative functional magnetic resonance imaging (blood oxygen level-dependent sequence, 1.5 T) localized the motor and sensory cortices to the anterior border of the cleft. During a speech activation run, the patient experienced a 20-second seizure. Initial activation was seen within the dysplastic cortex along the deep posterior margin of the cleft. Intraoperative median nerve stimulation produced a distinct N20/P20 wave inversion over the dysplastic cleft. Stimulation mapping performed with the patient awake confirmed the location of the sensorimotor cortex on the anterior border of the cleft, and preresection electrocorticography identified abundant interictal spikes along the posterior border after opening the cleft.RESULTS:After surgical resection of the dysplastic cortex, the patient exhibited transient minimal weakness and mild neglect, which resolved within 1 week. Two years after surgery, she was neurologically intact and seizure-free.CONCLUSION:This study used functional magnetic resonance imaging to demonstrate the inherent epileptogenicity of dysplastic cortex and to simultaneously map ictal and functional cortex. The N20 wave inversion be a useful intraoperative tool for identifying the central sulcus (or its equivalent), even in the presence of abnormal cortical architecture.

Journal

NeurosurgeryOxford University Press

Published: Sep 1, 1998

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