Epilepsy surgery of dysembryoplastic neuroepithelial tumors using advanced multitechnologies with combined neuroimaging and electrophysiological examinations.

ABSTRACT

PURPOSE: We report three cases of dysembryoplastic neuroepithelial tumor (DNT) with intractable epilepsy which were successfully treated with surgery. METHODS: In all cases, technology beyond the routine workup was critical to success. Preoperative magnetic resonance imaging, (18)F-fluorodeoxyglucose positron emission tomography (PET), (11)C-methionine-PET, interictal electroencephalography, and intraoperative electrocorticography were utilized in all patients. In individual cases, however, additional procedures such as preoperative magnetoencephalography (Case 1), diffusion tensor fiber tractography, a neuronavigation system, and intraoperative somatosensory-evoked potential (Case 2), and fiber tractography and the neuronavigation-guided fence-post tube technique (Case 3) were instrumental. RESULTS: In all the cases, the objectives of total tumor resection, resection of the epileptogenic zone, and complete postoperative seizure control and the avoidance of surgical complications were achieved. CONCLUSIONS: Dysembryoplastic neuroepithelial tumor is commonly associated with medically intractable epilepsy, and surgery is frequently utilized. As DNT may arise in any supratentorial and intracortical locations within or near the critical area of the brain, meticulous surgical strategies are necessary to avoid neurological deficits. We demonstrate in the following three cases how adjunct procedures using advanced multitechnologies with neuroimaging and electrophysiological examinations may be utilized to ensure success in DNT surgery.