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Excision of Cortical Dysplasia in the Language Area with Use of a Surgical Navigator: A Case Report
Author(s) -
Ozlen Fatma,
Nakajima Shin,
Chabrerie Alexandra,
Leventon Michael E.,
Grimson Eric,
Kikinis Ron,
Jolesz Ferenc,
Black Peter McL.
Publication year - 1998
Publication title -
epilepsia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.687
H-Index - 191
eISSN - 1528-1167
pISSN - 0013-9580
DOI - 10.1111/j.1528-1157.1998.tb01338.x
Subject(s) - cortical dysplasia , lesion , medicine , magnetic resonance imaging , epilepsy , dysplasia , cortex (anatomy) , epilepsy surgery , radiology , surgery , neuroscience , psychology , pathology , psychiatry
Summary:Purpose : We have developed an intraoperative optical tracking‐based navigational system that allows localization in the operative space. Using three‐dimensional reconstruction, this system has provided precise spatial information for intraoperative cortical mapping in patients with intractable epilepsy in whom the lesion lies close to eloquent cortex. Methods: A 23‐year‐old man with intractable complex partial seizures (CPS) presented to our institution. Proton‐density magnetic resonance imaging (MRI) showed a 3‐cm lesion which lay 2 cm beneath the left frontal operculum. A three dimensional model of the patient was reconstructed using MR modalities. Intraoperatively, subdural grid and strips were placed over the lesion and their electrodes were registered to the three‐dimensional model, which was displayed on a monitor. The navigational system was used to localize each electrode on the three‐dimensional model. By the second operation, the sites of seizure activity were established and recorded on the three‐dimensional model. A bipolar stimulator was also used to determine the speech area. Results: The lesion, which proved to be cortical dysplasia, was removed completely and the cortical speech area was avoided. During the postoperative period, the patient had no neurological symptoms and no seizure activity. Conclusions: The localization of a lesion and its correlation with epileptogenic foci is important in optimizing treatment in patients with cortical dysplasia. Our navigational system provided accurate localization of the lesion and correlation with the epileptogenic focus and related eloquent cortex. We believe that the safe removal of the lesion was facilitated by this system.