Intraoperative definition of bottom-of-sulcus dysplasia using intraoperative ultrasound and single depth electrode recording – A technical note. (February 2018)

• Record Type: Journal Article
• Authors: Miller, Dorothea; Carney, Patrick; Archer, John S.; Fitt, Gregory J.; Jackson, Graeme D.; Bulluss, Kristian J.
• Is Part Of: Journal of clinical neuroscience. Volume 48(2018)
• Page Start: 191
• Page End: 195
• Publication Date: 2018-02
• Subjects: Focal cortical dysplasia -- Bottom-of-sulcus dysplasia -- Intraoperative ultrasound -- Electrocorticography -- Depth electrodes; Brain -- Surgery -- Periodicals; Neurosciences -- Periodicals; Nervous system -- Surgery -- Periodicals; Brain -- surgery -- Periodicals; Neurosurgical Procedures -- Periodicals; Neurosciences -- Periodicals; Electronic journals; 616.8
• DOI: 10.1016/j.jocn.2017.10.045
• Languages: English
• ISSNs: 0967-5868

Abstract

Highlights: IUS is beneficial in localizing and delineating small BOSDs intra-operatively. Visualization of depth electrode positioning by iUS ensures optimal EEG sampling. Correlation between pre- and post-resection iUS helps in assessing completeness of resection. Using a multimodal approach including iUS and ECoG in surgery for BOSD may improve seizure outcome. Compared to iMRI, iUS is cheaper, widely available and allows imaging in real-time. Abstract: Bottom of sulcus dysplasias (BOSDs) are localized focal cortical dysplasias (FCDs) centred on the bottom of a sulcus that can be highly epileptogenic, but difficult to delineate intraoperatively. We report on a patient with refractory epilepsy due to a BOSD, successfully resected with the aid of a multimodal surgical approach using neuronavigation based on MRI and PET, intraoperative ultrasound (iUS) and electrocorticography (ECoG) using depth electrodes. The lesion could be visualized on iUS showing an increase in echogenicity at the grey-white matter junction. IUS demonstrated the position of the depth electrode in relation to the lesion. Depth electrode recording showed almost continuous spiking. Thus, intraoperative imaging and electrophysiology helped confirm the exact location of the lesion. Post-resection ultrasound demonstrated the extent of the resection and depth electrode recording did not show any epileptiform activity. Thus, both techniques helped assess completeness of resection. The patient has been seizure free since surgery. Using a multimodal approach including iUS and ECoG is a helpful adjunct in surgery for BOSD and may improve seizure outcome.