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3-T intraoperative MRI (iMRI) for pediatric epilepsy surgery

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Abstract

Purpose

Three-tesla intraoperative MRI (iMRI) is a promising tool that could help confirm complete resections and disconnections in pediatric epilepsy surgery, leading to improved outcomes. However, a large proportion of epileptogenic pathologies in children are poorly defined on imaging, which brings into question the utility of iMRI for these cases. Our aim was to compare postoperative seizure outcomes between iMRI- and non-iMRI-based epilepsy surgeries.

Methods

We performed a comparative retrospective analysis of non-iMRI- versus iMRI-based epilepsy surgeries with 2-year follow-up. Patients were stratified into well-defined cases (WDCs), poorly defined cases (PDCs), and diffuse hemispheric cases (DHCs). Primary outcomes were rates of complete seizure freedom and surgical complications. Secondary outcomes included good (Engel class I/II) seizure outcome, extent of resection/disconnection, and operative duration. Regression models were used to adjust for confounding.

Results

Thirty-nine iMRI-based and 39 non-iMRI-based surgeries were included. The distributions of age, sex, and lesion class in each era were similar, but the distributions of individual pathologies varied. Seizure freedom and complication rates at 2-year follow-up were not different between the groups, but Engel class I/II outcome was more common in the iMRI group. Extent of resection/disconnection and length of surgery were similar in both groups. PDCs had the worst outcomes, which were unchanged by the use of iMRI.

Conclusion

Three-tesla iMRI-based epilepsy surgery may have the potential to improve patient outcomes. However, we conclude that iMRI, in its current state of use at our institute, does not improve outcomes for children undergoing epilepsy surgery. Given that its use appears safe, further research on this technology is warranted, particularly for the most challenging PDCs.

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Acknowledgments

We would like to dedicate this article in the memory of Dr. Denis Melançon who was a brilliant pioneering neuroradiologist who contributed significantly to the use and interpretation of MRI and who was a tremendous colleague and friend.

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Authors and Affiliations

  1. Division of Neurosurgery, Department of Pediatric Surgery, Montreal Children’s Hospital, McGill University Health Centre, Montreal, QC, Canada

    Nebras M. Warsi, Oliver Lasry, Adel Farah, Jose L. Montes, Jeffrey Atkinson, Jean-Pierre Farmer & Roy W. R. Dudley

  2. Department of Epidemiology, Biostatistics and Occupational Health, Faculty of Medicine, McGill University, 1020 Pine Avenue West, Montréal, QC, H3A 1A2, Canada

    Oliver Lasry

  3. Department of Medical Imaging, Montreal Children’s Hospital, McGill University Health Centre, Montreal, QC, Canada

    Christine Saint-Martin

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  1. Nebras M. Warsi
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  2. Oliver Lasry
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Corresponding author

Correspondence to Oliver Lasry.

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Ethics

The present study was approved by the Research Ethics Board of the Montreal Children’s Hospital.

Conflict of interest

None of the authors has any conflict of interest to disclose.

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Warsi, N.M., Lasry, O., Farah, A. et al. 3-T intraoperative MRI (iMRI) for pediatric epilepsy surgery. Childs Nerv Syst 32, 2415–2422 (2016). https://doi.org/10.1007/s00381-016-3263-3

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  • DOI: https://doi.org/10.1007/s00381-016-3263-3

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