Authors: Ryan James Jafrani, MD
While resective epilepsy surgery has favorable outcomes overall, 20%40% of patients continue to have uncontrolled seizures due to incomplete resection of lesion, epileptogenic zone, or unrecognized or distant epileptogenesis. Intraoperative magnetic resonance imaging (iMRI) during epilepsy surgery can be a valuable adjunct to maximize extent of safe resection in pediatric epilepsy surgery.Methods: The IMRIS Multicenter iMRI Neurosurgery Database (I-MIND TM) was used to retrospectively identify pediatric patients who underwent iMRI during epilepsy surgery. Demographic data, number of iMRI scans, OR times, complications, and follow-up were recorded.
283 resective epilepsy surgeries were performed in iMRI capable ORs in 243 children at 4 institutions by 7 surgeons from 2007-2021. Median age was 10 years (range 0-18 years). Of these surgeries, 246 (86.9%) underwent iMRI after initial resection, with 102 (36.0%) undergoing additional resection based on the results. 24 cases (8.5%) had a second iMRI scan, leading to additional resection in 10 cases (3.5%), and 5 (1.7%) utilized a 3rd iMRI scan, with one patient undergoing subsequent additional resection. Average operative time was 5.7±1.7 hours. Of the 77 patients with complete 30 day complication data, there were two post-op infections (2.6%) and no post-op seizures. There were no iMRI related complications, although 7 patients were unable to undergo iMRI due to habitus or technical difficulties.
Multicenter experience with iMRI indicates it is a safe and efficacious adjunct in maximizing extent of safe resection in epilepsy surgery, with 102 patients (36%) undergoing additional resection based off information obtained from iMRI. Limited early follow-up data regarding seizure freedom is promising, but long-term seizure outcome data in this cohort is still needed to understand the extent of its clinical impact.