Effect of Functional MRI, Tractography and Intraoperative Neuronavigation on the Success Rate of Lesional Epilepsy Surgery in Sina Hospital

Introduction & Intractable epilepsy can be catastrophic for the patient as well as his/her caregivers. If a lesion is responsible, potential growth of the mass will be an important source of new concerns. When evacuation is planned, every tool that can help the surgeon to recognize the so called “epileptogenic zone”, and can facilitate safe and total removal of the lesion would be precious. The aim of conducting this study is to evaluate the benefit of using functional MRI (fMRI), tractography, and neuronavigation on achieving total resection, seizure freedom, and decreased neurological complications for the lesions located adjacent or within the eloquent cortex of brain.
Thirty three patients were enrolled and randomized into two groups: traditional surgery (16 patients) and surgery with fMRI, tractography and neuronavigation (17 patients). Patients were followed. Extent of resection, success of intervention to provide seizure freedom or worthwhile improvement, and neurological complications were assessed, recorded and compared between the two groups.
As for demographic and important prognostic factors, no significant difference was found between the two groups. Total and total-plus resections were achieved more in the fMRI group but the difference was not significant (P-value=0.07). No significant difference was observed with regard to permanent neurological complications. However, satisfactory results in reducing or eradicating seizures were significantly more noticed in fMRI group (88.23% versus 68.75% in the traditional surgery group, with P-value=0.04).
Concomitant use of presurgical fMRI, tractography, and neuronavigation during the surgical procedure for lesional epilepsy may be helpful for providing better seizure control.