Abstract
Summary Epilepsy is one of the most frequent chronic neurological pathologies, with high incidence and prevalence worldwide. A third of these patients are resistant to treatment, which is known as refractory epilepsy. Most of these patients suffer epilepsy secondary to epileptogenic lesions, where the surgery is the only treatment that could cure epilepsy. The goal of epilepsy surgery is to remove the epileptogenic area with preservation of eloquent areas, and here the surgical experience, the neuroimaging technology and the availability of image-guided surgery systems known as a neuronavigator plays a key role. Objectives: To demonstrate the usefulness of neuronavigation in pre-surgical planning and in the surgery of refractory epilepsy. Method: A cross-sectional and analytical descriptive study was conducted based on 47 surgeries performed (12 resective, 32 palliative and 3 diagnostic) in patients with refractory epilepsy and mean age of 9.93 years (SD 4.1). In 27 patients (57.44%) the neuronavigator was used. In the group of patients operated with neuronavigation, the surgical time decreased by 47.17 minutes (p = 0.022), the amount of bleeding by 111.41 milliliters (p = 0.011) and the days of hospitalization by 6.68 days (p = 0.005), compared with the group operated without neuronavigation. Complications in the neuronavigation group were 29.63% compared to 65% in the group operated without neuronavigation (p = 0.034). Conclusions: In our series, the use of the neuronavigator in the planning and development of the surgery had a significant impact by reducing the amount of bleeding lost, the surgical time, the days of hospitalization, and the post-surgical complications.
Highlights
Epilepsy is one of the most frequent chronic neurological pathologies, with an incidence of 50 / 100,000 / year and a prevalence between 0.5 and 2% worldwide [1,2]
The goal of epilepsy surgery is to remove the epileptogenic area with preservation of eloquent areas, and here the surgical experience, the neuroimaging technology and the availability of image-guided surgery systems known as a neuronavigator plays a key role
During the years 2013 – 2016, 55 cases of patients with refractory epilepsy were presented in the “Multidisciplinary Committee of Epilepsy”
Summary
Epilepsy is one of the most frequent chronic neurological pathologies, with an incidence of 50 / 100,000 / year and a prevalence between 0.5 and 2% worldwide [1,2]. ILAE defines refractory epilepsy as “one in which there has been a failure to 2 trials of antiepileptic drugs (FAE), in monotherapy or in combination, tolerated, appropriately chosen and appropriately used, to achieve the sustained absence of crisis” [4,5]. Most of these patients suffer from focal epilepsy secondary to epileptogenic lesions, increasingly evidenced in direct correlation with the new brain neuroimaging techniques [6]. The aim of epilepsy surgery is to remove the epileptogenic area with preservation of eloquent areas, and it is here that surgical experience and neuroimaging technology play a key role [9]
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