J Korean Neurol Assoc > Volume 20(2); 2002 > Article

Journal of the Korean Neurological Association 2002;20(2): 169-178.

"난치성 신피질 간질환자에 대한 수술시 자기공명 3차원 입체영상의 유용성"

고은정 , 최하영 곽용근 김영현 고대하 김근수

전북대학교 의과대학 신경외과학교실, 약리학교실, 신경과학교실†, 예방의학교실

"The Usefulness of 3D-Surface Rendering of the MRI in Surgical Treatment of Patients with Intractable Neocortical Epilepsy"

Eun-Jeong Koh

"Department of Neurosurgery, Pharmacology, Neurology, and Preventive Medicine Chonbuk National University Medical School and Hospital"

Abstract

"Background : This study is designed to indicate the role of 3D-surface rendering of the MRI in defining and resecting the epileptogenic zone. Methods : 25 healthy volunteers and 55 patients were studied. Conventional MRI and 3Dsurface rendering were performed. Sulcal and gyral patterns were assesed by a neuroradiologist and a neurologist without the clinical informations. Chronic video-EEG monitoring with surface and subdural grid electrodes, and PET were done. Resection was performed based on data of the EEG recordings and 3D-surface rendering. Results : Conventional MRI identified structural abnormality ( MRI-identifiable lesion ) in 20 patients. 20 of 35 patients without structural abnormality in conventional MRI revealed abnormal sulcal and gyral patterns in 3D-surface rendering of MRI ( 3Didentifiable lesion ). Subdural grid EEGs recorded focal or diffuse ictal EEG onset from the region of 3D-identifiable lesion . Histopathologic findings revealed cortical dysplasia in 48 and neocortical gliosis in seven. Overall surgical outcome, at the average follow up period of 32.5 months, showed class I in 63.6%, class II in 25.5%, and class III in 10.9%. Among 20 patients with “MRI-identifiable lesion , 80% were in class I and 20% were in class II. Among 35 patients without MRI-identifiable lesion , 54.3% were in class I, 28.6% were class II, and 17.1% were in class III. 80% of 20 patients with 3D-identifiable lesion showed class I and 20% of 15 patients without 3D-identifiable lesion showed class I. Conclusions : Identification of MRI-identifiable lesion or 3D-identifiable lesion was of value in defining the epileptogenic zone. Resection of MRI-identifiable lesion or 3D-identifiable lesion , which were epileptogenic in EEGs, promised a good surgical outcome.Key Words : Neocortical epilepsy, MRI-identifiable lesion, 3D-identifiable lesion"