INTRODUCTION: To analyze the diagnostic accuracy of MRI in patients undergoing parietal and occipital lobe epilepsy surgery. METHODS: In a retrospective study, we analyzed MRI scans and neuropathology reports of 42 patients who had undergone resective epilepsy surgery in the parietal and occipital lobe between 1998 and 2003. We evaluated, whether lesions were precisely characterized by MRI and whether lesion characterization allowed to estimate postsurgical seizure outcome. RESULTS: Within the categories epilepsy associated tumors, focal cortical dysplasias, vascular malformations, scarring, and others, MRI was concordant with histopathology in 36 of 42 (86%) lesions. Among the discordant lesions, one lesion was re-classified following MRI-histopathology synopsis, another two lesions represented new tumor entities (angiocentric neuroepithelial tumor, isomorphic astrocytoma) which have been described recently. Seizure freedom (Engel class I) one year following surgery was achieved in 25 patients (60%). Seizure outcome was different for lesion categories (Engel class I: epilepsy associated tumors, 62%; focal cortical dysplasias, 71%; vascular malformations, 75%; scarring, 40%), and was unchanged if no lesion was found on preoperative MRI. CONCLUSION: If MRI and histopathology are discordant, not only the MRI findings may be debatable. MRI lesion detection is important, since chance of seizure freedom is low if no lesion is detected.
INTRODUCTION: To analyze the diagnostic accuracy of MRI in patients undergoing parietal and occipital lobe epilepsy surgery. METHODS: In a retrospective study, we analyzed MRI scans and neuropathology reports of 42 patients who had undergone resective epilepsy surgery in the parietal and occipital lobe between 1998 and 2003. We evaluated, whether lesions were precisely characterized by MRI and whether lesion characterization allowed to estimate postsurgical seizure outcome. RESULTS: Within the categories epilepsy associated tumors, focal cortical dysplasias, vascular malformations, scarring, and others, MRI was concordant with histopathology in 36 of 42 (86%) lesions. Among the discordant lesions, one lesion was re-classified following MRI-histopathology synopsis, another two lesions represented new tumor entities (angiocentric neuroepithelial tumor, isomorphic astrocytoma) which have been described recently. Seizure freedom (Engel class I) one year following surgery was achieved in 25 patients (60%). Seizure outcome was different for lesion categories (Engel class I: epilepsy associated tumors, 62%; focal cortical dysplasias, 71%; vascular malformations, 75%; scarring, 40%), and was unchanged if no lesion was found on preoperative MRI. CONCLUSION: If MRI and histopathology are discordant, not only the MRI findings may be debatable. MRI lesion detection is important, since chance of seizure freedom is low if no lesion is detected.
Authors: Siobhan West; Sarah J Nevitt; Jennifer Cotton; Sacha Gandhi; Jennifer Weston; Ajay Sudan; Roberto Ramirez; Richard Newton Journal: Cochrane Database Syst Rev Date: 2019-06-25
Authors: Annika K Wefers; Damian Stichel; Daniel Schrimpf; Roland Coras; Mélanie Pages; Arnault Tauziède-Espariat; Pascale Varlet; Daniel Schwarz; Figen Söylemezoglu; Ute Pohl; José Pimentel; Jochen Meyer; Ekkehard Hewer; Anna Japp; Abhijit Joshi; David E Reuss; Annekathrin Reinhardt; Philipp Sievers; M Belén Casalini; Azadeh Ebrahimi; Kristin Huang; Christian Koelsche; Hu Liang Low; Olinda Rebelo; Dina Marnoto; Albert J Becker; Ori Staszewski; Michel Mittelbronn; Martin Hasselblatt; Jens Schittenhelm; Edmund Cheesman; Ricardo Santos de Oliveira; Rosane Gomes P Queiroz; Elvis Terci Valera; Volkmar H Hans; Andrey Korshunov; Adriana Olar; Keith L Ligon; Stefan M Pfister; Zane Jaunmuktane; Sebastian Brandner; Ruth G Tatevossian; David W Ellison; Thomas S Jacques; Mrinalini Honavar; Eleonora Aronica; Maria Thom; Felix Sahm; Andreas von Deimling; David T W Jones; Ingmar Blumcke; David Capper Journal: Acta Neuropathol Date: 2019-09-28 Impact factor: 17.088