The Usefulness of 3D-Surface Rendering of the MRI in Surgical Treatment of Patients with Intractable Neocortical Epilepsy

ABSTRACT

BACKGROUND: This study is designed to indicate the role of 3D-surface rendering of the MRI in defining and resect-ing the epileptogenic zone. METHODS: 25 healthy volunteers and 55 patients were studied. Conventional MRI and 3D-surface rendering were performed. Sulcal and gyral patterns were assesed by a neuroradiologist and a neurologist with-out the clinical informations. Chronic video-EEG monitoring with surface and subdural grid electrodes, and PET were done. Resection was performed based on data of the EEG recordings and 3D-surface rendering. RESULTS: Conventional MRI identified structural abnormality ("MRI-identifiable lesion") in 20 patients. 20 of 35 patients without structural abnormality in conventional MRI revealed abnormal sulcal and gyral patterns in 3D-surface rendering of MRI ("3D-identifiable lesion"). Subdural grid EEGs recorded focal or diffuse ictal EEG onset from the region of "3D-identifiable lesion". Histopathologic findings revealed cortical dysplasia in 48 and neocortical gliosis in seven. Overall surgical out-come, at the average follow up period of 32.5 months, showed class I in 63.6%, class II in 25.5%, and class III in 10.9%. Among 20 patients with "MRI-identifiable lesion", 80% were in class I and 20% were in class II. Among 35 patients without "MRI-identifiable lesion", 54.3% were in class I, 28.6% were class II, and 17.1% were in class III. 80% of 20 patients with "3D-identifiable lesion" showed class I and 20% of 15 patients without "3D-identifiable lesion" showed class I. CONCLUSIONS: Identification of "MRI-identifiable lesion" or "3D-identifiable lesion" was of value in defining the epileptogenic zone. Resection of "MRI-identifiable lesion" or "3D-identifiable lesion", which were epilep-togenic in EEGs, promised a good surgical outcome.