Application value of three-dimensional brain surface reconstruction combined with intraoperative neurophysiological monitoring in the surgical treatment of rolandic intractable epilepsy
Objective To investigate the effectiveness of integrating three-dimensional brain surface reconstruction with intraoperative neurophysiological monitoring in surgical interventions targeting the central zone for drug-refractory epilepsy.Methods A retrospective analysis was conducted on clinical data obtained from 21 patients with drug-refractory epilepsy who underwent surgical resection of the central epileptogenic focus at the Department of Neurosurgery,Beijing Fengtai Hospital between January 2019 and January 2022.Preoperative imaging encompassed three-dimensional brain surface imaging,vascular imaging,and pyramidal tract imaging reconstruction.Image superposition was employed to assess the positional relationship between the epileptogenic focus and the central area.Intraoperative neurophysiological monitoring was used to determine the position of the central sulcus,which was then compared with the results of three-dimensional brain surface reconstruction to identify the locations of the precentral and postcentral gyri.Patients underwent follow-up via telephone or outpatient clinic at 2 weeks,3 months,6 months,12 months,and annually after surgery.The Engel classification was used to evaluate the outcome of epilepsy control,while the modified Rankin scale(mRS)was used to assess the improvement in neurological dysfunction.Results Of the 21 patients,18 cases(85.7％)were successfully located the central sulcus;neurophysiological monitoring and three-dimensional brain surface reconstruction were consistent in localizing the central sulcus.In 2 cases(9.5％),the two methods did not match in positioning the central sulcus.In 1 case(4.8％),the central sulcus was unsuccessfully identified.The surgery of 21 patients was successfully completed,of which 12(57.1％)patients1 surgical resection scope was limited to the central area,and 9(42.9％)patients underwent surgery involving the central area or edge.The removal site of epileptogenic zone was on the left hemisphere in 13 cases and right hemisphere in 8 cases.After surgery,10 cases were pathologically confirmed to have focal cortical dysplasia(FCD),including 6 cases of FCD typeⅡ a and 4 cases of FCD type Ⅱ b.Besides,there were 4 cases of were dysembryoplastic tumors,1 case of ganglioglioma,1 case of cavernous malformation,1 case of glial scar,1 case of tuberous sclerosis,1 case of dual pathology of FCD type Ⅱb and ganglioglioma,1 case of glioblastoma,and 1 case of unspecified type.Six cases(28.6％)developed new neurological dysfunction after surgery(mRS of 2 in 1 case,mRS of4 in 5 cases),of which 4 cases still had neurological dysfunction 2 weeks after surgery(mRS of 2 in 2 cases,and mRS of 3 in 2 cases),but there were varying degrees of improvement compared with before.All 21 patients received clinical follow-up,which lasted for 3.1±0.7 years.The last follow-up showed that 18 cases were Engel grade Ⅰ,2 cases were Engel grade Ⅱ,and 1 case was Engel grade Ⅲ;20 cases(95.2％)had good neurological function(mRS of 1 in 4 cases,mRS of 0 in 16 cases),and 1 case(4.8％)had mild disorder(mRS of 2).Conclusion Three-dimensional reconstruction of the brain surface combined with neuroelectrophysiological monitoring can help to fully remove the epileptogenic area while protecting neurological function,improve the efficacy and safety of surgery,and achieve a good outcome.
Drug resistant epilepsyMonitoring,intraoperativeTreatment outcomeThree-dimensional brain surface visualization
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