Tailored Surgery Guided by Intraoperative Electrocorticography in Temporal Lobe Encephaloceles: A Case Series
Abstract number :
3.449
Submission category :
9. Surgery / 9A. Adult
Year :
2024
Submission ID :
210
Source :
www.aesnet.org
Presentation date :
12/9/2024 12:00:00 AM
Published date :
Authors :
Presenting Author: Niccolò Biagioli, MD – University of Modena and Reggio Emilia
Sofia Morandi, Dr. – SSD of Clinical Neurophysiology - Department of Head and Neck Neuroscience, AOU of Modena
Giada Giovannini, PhD – AOU Modena Academic Hospital
Anna Elisabetta Vaudano, MD, PhD – University of Modena and Reggio Emilia
Niccolò Orlandi, MD – University of Modena and Reggio Emilia
Vincenzo Tramontano, Dr. – SSD of Clinical Neurophysiology - Department of Head and Neck Neuroscience, AOU of Modena
Giacomo Pavesi, MD. – SC of Neurosurgery, Head and Neck Neuroscience Department, AOU of Modena
stefano meletti, MD, PhD – University of Modena and Reggio Emilia, Italy
Rationale:
Temporal lobe encephalocele (TE) can lead to medically refractory epilepsy, warranting surgical intervention; however, there is still a lack of consensus about the appropriate surgical approach. This case series illustrates the potential effectiveness of iEcoG in guiding tailored lobectomy procedures for TE.
Methods:
Patients underwent serial intraoperative electrocorticography (iECoG) recordings with strip electrodes placed on the temporal pole cortex before resection, on the surgical neocortical margin of the resection and, lastly, on the mesial temporal structures. Both bipolar and referential electrode montages were reviewed to identify epileptiform activity and help guide surgical planning.
Results:
Patient 1: 38-year-old male with temporal seizures started 6 months before, with left temporal pole encephalocele. iECoG show sporadic spikes on the neocortical temporal surface before surgical resection, while no epileptic activity was recorded on the amygdala and hippocampus. Therefore, the mesial structures were spared. Pathology: FCD-Ia.
Patient 2: 20-year-old male, with high frequency seizures started 1 years in advance, with 2 TE at neuroimaging. iECoG revealed frequent irregular spiking on the neocortical temporal surface before surgical resection and persistent epileptic activity on the posterior temporal resection margin, so the surgical procedure was extended until the sylvian vein. No epileptic activity was seen on the hippocampus thus it was spared. Pathology: cortical dyslamination.
Patient 3: 72-year-old female with seizures started more than 20 years in advance with extensive right temporopolar encephalocele. iECoG recorded sporadic epileptic activity in anterior section close to the borders of the encephalocele, sparing resection borders and temporo-mesial structures. Pathology: gliosis.
Patient4: 52-year-old female with long history of seizures with small left temporopolar encephalocele. iECoG revealed mild sporadic spikes close on the TE, no pathological activities reported on the resection border and temporo-mesial structures. In last 2 cases small polectomy was performed. Pathology: gliosis. All patients are in Engel class IA.
Conclusions: Resection of the encephalocele and associated cortex is often sufficient to provide seizure control. However, it is difficult to determine the extent of adjacent temporal lobe that should be resected. These 4 cases demonstrate the usefulness of ECoG for a tailored surgical resection according to the irritative zone.
Bibliography
1. Panov F et alia. Epilepsy with temporal encephalocele: Characteristics of electrocorticography and surgical outcome. Epilepsia. 2016 Feb;57(2):e33-8.
2. Mikula AL, et alia. Medial Temporal Encephalocele and Medically Intractable Epilepsy: A Tailored Inferior Temporal Lobectomy and Case Report. Oper Neurosurg (Hagerstown). 2020 Jan 1;18(1):E19- E22.
3. Smith et alia. (2023). Drug-resistant temporal lobe epilepsy with temporal encephaloceles: How far to resect. Epilepsy and Behavior, 148.
Funding: I did not receive any funds for this study
Surgery