Turkish Neurosurgery 2015 , Vol 25 , Num 6
Presurgical Evaluation and Epilepsy Surgery in MRI Negative Resistant Epilepsy of Childhood with Good Outcome
Dana CRAIU1,2, Andrei BARBORICA3,4, Cristina MOTOESCU1,2, Cristian DONOS3, Jean CIUREA5,3 Ioana MINDRUTA1,3,6
1“Carol Davila” University of Medicine Bucharest, Department of Neurology, Pediatric Neurology, Psychiatry, Neurosurgery Discipline, Bucharest, Romania
2“Alexandru Obregia” Clinical Psychiatric Hospital, Pediatric Neurology Clinic, Ůos. Berceni 10- 12, Sector 4, Bucharest, Romania
3University of Bucharest, Physics Department, Bucharest, Romania
4FHC Inc, Bowdoin ME, USA
5Bagdasar Arseni Emergency Hospital, Functional Neurosurgery Department, Ůos. Berceni 14-16, Sector 4, Bucharest, Romania
6University Emergency Hospital Bucharest, Neurology Clinic, Str. Splaiul Independenţei Nr 169, Sector 5, Bucharest, Romania
DOI : 10.5137/1019-5149.JTN.12093-14.0 Magnetic resonance imaging (MRI)-negative epilepsy may be successfully solved with a multidisciplinary approach using invasive recordings, image and signal analysis. The whole methodology used by the epilepsy surgery team is systematically described based on an resistant epilepsy case with all steps and rationale of choosing different investigation methods from surface electroencephalography (EEG) to invasive recordings. Due to negative MRI and non-concordant ictal surface EEG with clinical semiology, the patient was investigated with stereo- EEG (SEEG), aiming to delimitate epileptogenic and eloquent cerebral areas. Implantation strategy, seizures recordings, stimulation, resection planning using quantitative EEG analysis, and the surgery plan are presented. The patient has been seizure-free for 14 months so far, with improved behavior and daily life quality. Post-operative examination revealed focal cortical dysplasia type II B. Keywords : Epilepsy surgery, Focal cortical dysplasia, MRI-negative postsurgical outcome, Resistant epilepsy, Stereo-EEG
Corresponding author : Dana Crařu, dcraiu@yahoo.com