Resective epilepsy surgery is an elective therapy indicated in focal epilepsy patients who are resistant to pharmacotherapy. Every effort should be undertaken to perform the procedures as safe and less traumatic as possible. Neuronavigation could represent a suitable tool to reduce surgical morbidity and increase surgical radicality. Here, we present a series of 41 patients who were operated on for medically intractable epilepsy using neuronavigation. Overall, complication rate was 17% with a favourable seizure outcome of 88% (Engel’s class I/II). Our data suggest that neuronavigation is a valuable surgical technique to accomplish a favourable outcome in epilepsy surgery.
KeywordsNeuronavigationEpilepsy SurgeryOutcome
Hauser, W.A., Annegers, J.F. and Kurland, L.T. (1991) Prevalence of epilepsy in Rochester, Minnesota: 1940- 1980. Epilepsia, 32(4), 429-445.
Olafsson, E., Ludvigsson, P., Gudmundsson, G., Hesdorffer, D., Kjartansson, O. and Hauser, W.A. (2005) Incidence of unprovoked seizures and epilepsy in Iceland and assessment of the epilepsy syndrome classification: A prospective study. The Lancet Neurology, 4(10), 627- 634.
Semah, F., Picot, M.C., Adam, C., Broglin, D., Arzimanoglou, A., Bazin, B., Cavalcanti, D. and Baulac, M. (1998) Is the underlying cause of epilepsy a major prognostic factor for recurrence? Neurology, 51(5), 1256- 1262.
Kloster, R. and Engelskjon, T. (1999) Sudden unexpected death in epilepsy (SUDEP): A clinical perspective and a search for risk factors. Journal of Neurology, Neurosurgery & Psychiatry, 67(4), 439-444.
Sillanpaa, M. and Schmidt, D. (2006) Natural history of treated childhood-onset epilepsy: Prospective, long-term population-based study. Brain, 129(Pt3), 617-624.
Tonini, C., Beghi, E., Berg, A.T., Bogliun, G., Giordano, L., Newton, R.W., Tetto, A., Vitelli, E., Vitezic, D. and Wiebe, S. (2004) Predictors of epilepsy surgery outcome: A meta-analysis. Epilepsy Research, 62(1), 75-87.
Berg, A.T., Vickrey, B.G., Langfitt, J.T., Sperling, M.R., Walczak, T.S., Shinnar, S., Bazil, C.W., Pacia, S.V. and Spencer, S.S. (2003) The multicenter study of epilepsy surgery: Recruitment and selection for surgery. Epilepsia, 44(11), 1425-1433.
Zernov, D. (1890) L’encephalometre. revue générale de clinique et de thérapeutique, 19, 320.
Horsley, V. R.C. (1908) The structure and functions of the cerebellum examined by a new method. Brain, 31(1), 45-124.
Kirschner, M. (1933) Die Punktionstechnik und die Elek- trokoagulation des Ganglion Gasseri. über gezielte Operationen. Langenbecks Archiv für klinische Chirurgie, 176, 581-620.
Grunert, P., Darabi, K., Espinosa, J. and Filippi, R. (2003) Computer-aided navigation in neurosurgery. Neurosurgical Review, 26(2), 73-99.
Enchev, Y. (2009) Neuronavigation: Geneology, reality, and prospects. Neurosurgical Focus, 27(3), E11.
Ganslandt, O., Behari, S., Gralla, J., Fahlbusch, R. and Nimsky, C. (2002) Neuronavigation: Concept, techniques and applications. Neurol India, 50(3), 244-255.
Wagner, W., Gaab, M.R., Schroeder, H.W. and Tschiltschke, W. (2000) Cranial neuronavigation in neurosurgery: Assessment of usefulness in relation to type and site of pathology in 284 patients. Minim Invasive Neurosurg 43(3), 124-131.
Spetzger, U., Laborde, G. and Gilsbach, J.M. (1995) Frameless neuronavigation in modern neurosurgery. Minim Invasive Neurosurg, 38(4), 163-166.
Winkler, D., Lindner, D., Strauss, G., Richter, A., Schober, R. and Meixensberger, J. (2006) Surgery of cavernous malformations with and without navigational support-a comparative study. Minimally Invasive Neurosurgery, 49(1), 15-19.
Stone, S.S. and Rutka, J.T. (2008) Utility of neuronavigation and neuromonitoring in epilepsy surgery. Neurosurgical Focus, 25(3), E17.
Nimsky, C., Ganslandt, O., Hastreiter, P., Wang, R., Benner, T., Sorensen, A.G. and Fahlbusch, R. (2005) Preoperative and intraoperative diffusion tensor imaging- based fiber tracking in glioma surgery. Neurosurgery 56(1), 130-137.
Reisch, R., Stadie, A., Kockro, R., Gawish, I., Schwandt, E. and Hopf, N. (2009) The minimally invasive supraorbital subfrontal key-hole approach for surgical treatment of temporomesial lesions of the dominant hemisphere. Minim Invasive Neurosurg, 52(4), 163-169.
Engel, J.V.N.P. Jr., Rasmussen, T.B. and Ojemann, L.M. (Ed.), (1993) Outcome with respect to epileptic seizures. Raven Press, New York.
Miyagi, Y., Shima, F., Ishido, K., Araki, T., Taniwaki, Y., Okamoto, I. and Kamikaseda, K. (2003) Inferior temporal sulcus approach for amygdalohippocampectomy gui- ded by a laser beam of stereotactic navigator. Neurosurgery 52(5), 1117-1123.
Oertel, J., Gaab, M.R., Runge, U., Schroeder, H.W., Wagner, W. and Piek, J. (2004) Neuronavigation and complication rate in epilepsy surgery. Neurosurgical Review, 27(3), 214-217.
Wurm, G., Wies, W., Schnizer, M., Trenkler, J. and Holl, K. (2000) Advanced surgical approach for selective amy- gdalohippocampectomy through neuronavigation. Neurosurgery, 46(2), 1377-1382.
Wurm, G., Ringler, H., Knogler, F., Schnizer, M. (2003) Evaluation of neuronavigation in lesional and non-lesional epilepsy surgery. Computer Aided Surgery, 8(4), 204-214.
Hirabayashi, H., Chitoku, S., Hoshida, T. and Sakaki, T. (1999) Accuracy and availability of the computed assisted neurosurgery navigation system during epilepsy surgery. Stereotact Funct Neurosurg, 72(2-4), 117-124.
Acar, G., Acar, F., Miller, J., Spencer, D.C. and Burchiel, K.J. (2008) Seizure outcome following transcortical selective amygdalohippocampectomy in mesial temporal lobe epilepsy. Stereotact Funct Neurosurg, 86(5), 314- 319.
Fahlbusch, R., Ganslandt, O. and Nimsky, C. (2000) In- traoperative imaging with open magnetic resonance imaging and neuronavigation. Child’s Nervous System, 16(10-11), 829-831.
Sindou, M.G.M., Isnard, J., Ryvlin, P., Fischer, C. and Mauguière, F. (2006) Temporo-mesial epilepsy surgery: outcome and complications in 100 consecutive adult patients. Acta Neurochir (Wien), 148(1), 39-45
Willems, P.W.A., Taphoorn, M.J.B., Burger, H., van der Sprenkel, J.W.B. and Tulleken, C.A.F. (2006) Effectiveness of neuronavigation in resecting solitary intracerebral contrast-enhancing tumors: A randomized controlled trial. Journal of Neurosurgery 104(3), 360-368.