Abstract
Previous studies reported interest in intraoperative shear-wave elastography (SWE) guidance for brain-tumor and epilepsy surgeries. Focal cortical dysplasia (FCD) surgery is one of the most appropriate indications for using SWE guidance. The aim of this study was to evaluate the efficacy of ultrasound SWE techniques for the intraoperative detection of FCDs. We retrospectively analyzed data from 18 adult patients with drug-resistant epilepsy associated with FCD who had undergone SWE-guided surgery. Conventional B-mode images detected FCD in 2 patients (11.1%), while SWE detected FCD in 14 patients (77.8%). The stiffness ratios between MRI-positive and -negative cases were significantly different (3.6 ± 0.4 vs. 2.2 ± 0.6, respectively; p < 0.001). FCDs were significantly more frequently detected by interoperative SWE in women (OR 4.7, 95% CI (1.7–12.7); p = 0.004) and in patients in whom FCD was visible on magnetic resonance imaging (MRI; OR 2.3, 95% CI (1.3–4.3); p = 0.04). At 1 year after surgery and at last follow-up (mean = 21 months), seizure outcome was good (International League Against Epilepsy (ILAE) Class 1 or 2) in 72.2% and 55.6% of patients, respectively. Despite some limitations, our study highlighted the potential of SWE as an intraoperative tool to detect FCD. Future technical developments should allow for optimizing intraoperative surgical-cavity evaluation from the perspective of complete FCD resection. Interobserver reliability of SWE measurements should also be assessed by further studies.
Highlights
Epilepsy globally affects at least 50 million people [1]
Future technical developments should allow for optimizing intraoperative surgical-cavity evaluation from the perspective of complete Focal cortical dysplasia (FCD) resection
FCDs cannot be seen by the naked eye or through a surgical microscope, and are mostly not detected by 3.0 T magnetic resonance imaging (MRI)
Summary
Epilepsy globally affects at least 50 million people [1]. Focal cortical dysplasia (FCD)is responsible for 30% to 50% of drug-resistant epilepsies [2]. Epilepsy globally affects at least 50 million people [1]. Is responsible for 30% to 50% of drug-resistant epilepsies [2]. FCDs are characterized by deranged neurons in white matter, dyslamination, and abnormal balloon cells, and thereby have stiffer consistence than that of the surrounding healthy parenchyma [3]. A complete surgical resection of FCD leads to postsurgical seizure control in up to 80% of patients [4]. FCDs cannot be seen by the naked eye or through a surgical microscope, and are mostly not detected by 3.0 T magnetic resonance imaging (MRI). The accurate intraoperative detection of FCD is extremely challenging for neurosurgeons
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