Warsi Nebras M, Lasry Oliver, Farah Adel, Saint-Martin Christine, Montes Jose L, Atkinson Jeffrey, Farmer Jean-Pierre, Dudley Roy W R
Division of Neurosurgery, Department of Pediatric Surgery, Montreal Children's Hospital, McGill University Health Centre, Montreal, QC, Canada.
Department of Epidemiology, Biostatistics and Occupational Health, Faculty of Medicine, McGill University, 1020 Pine Avenue West, Montréal, QC, H3A 1A2, Canada.
Childs Nerv Syst. 2016 Dec;32(12):2415-2422. doi: 10.1007/s00381-016-3263-3. Epub 2016 Oct 18.
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.
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.
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.
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.
3特斯拉术中磁共振成像（iMRI）是一种很有前景的工具，有助于在小儿癫痫手术中确认完全切除和离断，从而改善手术效果。然而，儿童中很大一部分致痫性病变在影像学上难以明确界定，这使得iMRI在这些病例中的实用性受到质疑。我们的目的是比较基于iMRI和非iMRI的癫痫手术的术后癫痫发作结果。
我们对基于非iMRI和iMRI的癫痫手术进行了比较性回顾性分析，并进行了2年的随访。患者被分为明确界定病例（WDC）、界定不清病例（PDC）和弥漫性半球病例（DHC）。主要结局是完全无癫痫发作率和手术并发症。次要结局包括良好（恩格尔I/II级）癫痫发作结局、切除/离断范围和手术持续时间。使用回归模型来调整混杂因素。
纳入了39例基于iMRI的手术和39例基于非iMRI的手术。每个时期的年龄、性别和病变类别分布相似，但个体病理分布有所不同。两组在2年随访时的无癫痫发作率和并发症发生率没有差异，但恩格尔I/II级结局在iMRI组中更为常见。两组的切除/离断范围和手术长度相似。PDC的结局最差，使用iMRI后并无改善。
基于3特斯拉iMRI的癫痫手术可能有改善患者结局的潜力。然而，我们得出结论，就我们研究所目前的使用状态而言，iMRI并不能改善接受癫痫手术儿童的结局。鉴于其使用似乎是安全的，有必要对该技术进行进一步研究，特别是针对最具挑战性的PDC。
