Combining MEG and MRI with neuronavigation for treatment of an epileptiform spike focus in the precentral region
Autor: | Niels Birbaumer, R. Siekmann, Hagen Schiffbauer, Frank Duffner, Dirk Freudenstein, Ernst H. Grote, Hubert Preissl |
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Rok vydání: | 2003 |
Předmět: |
Pathology
medicine.medical_specialty Neuronavigation medicine.diagnostic_test business.industry Brain tumor Magnetic resonance imaging Magnetoencephalography medicine.disease medicine.anatomical_structure Cortex (anatomy) Medicine Surgery Ictal Neurology (clinical) Epileptic seizure Radiology medicine.symptom business Motor cortex |
Zdroj: | Surgical Neurology. 59:40-45 |
ISSN: | 0090-3019 |
Popis: | BACKGROUND Epileptic foci are often located in the vicinity but not necessarily within the boundaries of intra-axial brain tumors. Resection of these tumors is based on two major goals: first, maximizing tumor removal without provoking new neurologic deficits, and second, minimizing epileptic seizure activity. Magnetic source imaging (MSI) depicts the generators of magnetic fields overlaid on individual magnetic resonance (MR) images. Established application areas are lesions located adjacent to or partly within the sensory and motor cortex, or in the depth of the brain, necessitating a surgical approach through functionally highly relevant cortical regions. Magnetoencephalography (MEG) is also applicable for epileptiform spike foci recording during interictal activity. CASE DESCRIPTION A patient with a recurrent glioma close to the Rolandic cortex scheduled for epilepsy and tumor surgery was investigated with MSI. The MSI data showed an epileptiform spike focus outside the tumor boundaries. The resulting MSI images were integrated into our neuronavigation system. This procedure allowed for the preoperative identification of the sensory and motor cortex, the precise localization of the epileptiform spike focus, and careful planning of the surgical procedure. In this case, we were able to safely resect the recurrent tumor and the epileptiform spike focus under general anesthesia using MSI-based neuronavigational guidance but no conventional intraoperative mapping techniques. CONCLUSION Magnetic source imaging can be a valuable, noninvasive method for planning and performing tumor resections in high-risk brain regions, especially if an epileptiform spike focus has to be localized and included into the resection strategy. |
Databáze: | OpenAIRE |
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