Hana Malikova MD, Presenter: Nothing to Disclose

Zdenek Vojtech MD, Abstract Co-Author: Nothing to Disclose

Jan Sroubek, Abstract Co-Author: Nothing to Disclose

Mesial temporal lobe epilepsy (MTLE) is the most common epilepsy diagnosis in adults. Surgery brings seizure relief in 60-70% of patients. Anterior temporal resection (ATL) is commonly used for surgical therapy. The resection extent of mesial structures is often discussed in literature and it is known that the amount of resected tissues often varies considerably. The aim of the study was to compare the resection extent and complication rate in patients with and without intraoperative MRI evaluation during ATL procedure.

We included 34 MTLE patients treated by ATL for MTLE: 13 of them underwent intraoperative MRI evaluation of the resection extent and 21 patients did not. MRI volumetry of mesial temporal structures was done preoperatively and 1 year after ATL.

In patients without intraoperative MRI, the volume resection of the hippocampus was 89.1±10.7% and of the amygdala was 77.4±23.6%. In patients with intraoperative MRI, the volume resection of the hippocampus was 83.2±14.3% and of the amygdala was 84.8±15.4%. The following complications were observed in patients without intraoperative MRI: 4.8% of purulent meningitis; 4.8% of clinically silent infarction; 4.8% manifest infarction (1 case with transient dysphasia). In patients with intraoperative MRI the following complications developed: 15.4% of clinically non-silent infarctions (one case with transient dysphasia, one case with transient hemiparesis); 15.4% of silent infarctions. We did not find any death cases or persistent neurological deficit more than 1 year after ATL. Two years after ATL both groups had comparable seizure control, 84.6% patients were seizure free in group with intraoperative MRI and 71.4% without intraoperative MRI.

Intraoperative MRI evaluation brought more ischemic complications without effect on the resection extent. We speculate that intraoperative MRI brings more infarctions due to the prolonged time of operation (approximately 1 hour more) probably vasospasm may play a role.

Intraoperative MRI evaluation of the resection extent in case of ATL should be carefully considered due to the risk more ischemic complications.

Malikova, H, Vojtech, Z, Sroubek, J, Intraoperative MRI in Anterior Temporal Lobectomy for Mesial Temporal Lobe Epilepsy: Does Intraoperative MRI Improve the Resection Extent?  .  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14005276.html