Background: Complete resection is essential for achieving seizure freedom in children with drug-resistant epilepsy due to focal cortical dysplasia (FCD). However, identifying altered structures intraoperatively can be challenging, potentially leading to reoperations. This study assessed the impact of intraoperative MRI (iMRI).
Methods: We conducted a single-center retrospective study at Alder Children's Hospital from 2013 to 2022. The study included all children diagnosed with FCD, analyzing demographics, iMRI use, the rate of continued iMRI-guided surgery and reoperations, histology, and seizure outcomes at 1-year follow-up.
Results: Thirty-two pediatric patients (median age: 10 years, 21 males and 11 females) underwent surgery for FCD. Of them 8 (25 %) had FCD Type I, 19 (59.4 %) had FCD Type II, and 1 patient (3.1 %) had FCD Type III. iMRI was used in 27 patients (84.4 %), and 17 (63 %) of these patients required further iMRI-guided surgery. Four patients underwent reoperation in a separate session. At 1-year follow-up, seizure outcomes in the iMRI group were Engel I in 15 patients (71.4 %), Engel II in 4 (19 %), and Engel III and IV in 1 patient (4.8 %) each. Five patients (15.6 %) had superficially localized lesions and underwent surgery without iMRI. None of them required reoperation, and four (80 %) were seizure-free at 1 year. Seven patients were lost to follow-up.
Conclusion: iMRI plays a significant role in identifying residual epileptogenic tissue in surgery for FCD, influencing surgical decisions and leading to additional iMRI-guided resections. Most patients with iMRI-guided surgery achieved favorable seizure outcomes (Engel I) at 1 year of follow-up. Long-term follow-up is needed to validate these findings and to confirm sustained seizure control.
Keywords: Epilepsy; Focal cortical dysplasia; Intraoperative MRI; Pediatric.
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