{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T14:09:02Z","timestamp":1791295742833,"version":"4.1.0"},"reference-count":104,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["FOC"],"published-print":{"date-parts":[[2013,4]]},"abstract":"\n Object<\/jats:title>\n The authors performed a retrospective study to assess the impact of functional neuronavigation and intraoperative MRI (iMRI) on surgery of extratemporal epileptogenic lesions on postsurgical morbidity and seizure control.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n Twenty-five patients (14 females and 11 males) underwent extratemporal resections for drug-resistant epilepsy close to speech\/motor brain areas or adjacent to white matter tracts. The mean age at surgery was 34 years (range 12\u201367 years). The preoperative mean disease duration was 13.2 years. To avoid awake craniotomy, cortical motor-sensory representation was mapped during preoperative evaluation in 14 patients and speech representation was mapped in 15 patients using functional MRI. In addition, visualization of the pyramidal tract was performed in 11 patients, of the arcuate fascicle in 7 patients, and of the visual tract in 6 patients using diffusion tensor imaging. The mean minimum distance of tailored resection between the eloquent brain areas was 5.6 mm. During surgery, blood oxygen level\u2013dependent imaging and diffusion tensor imaging data were integrated into neuronavigation and displayed through the operating microscope. The postoperative mean follow-up was 44.2 months.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n In 20% of these patients, further intraoperative resection was performed because of intraoperatively documented residual lesions according to iMRI findings. At the end of resection, the final iMRI scans confirmed achievement of total resection of the putative epileptogenic lesion in all patients. Postoperatively, transient complications and permanent complications were observed in 20% and 12% of patients, respectively. Favorable postoperative seizure control (Engel Classes I and II) was achieved in 84% and seizure freedom in 72% of these consecutive surgical patients.<\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n By using functional neuronavigation and iMRI for treatment of epileptogenic brain lesions, the authors achieved a maximum extent of resection despite the lesions' proximity to eloquent brain cortex and fiber tracts in all cases. The authors' results underline possible benefits of this technique leading to a favorable seizure outcome with acceptable neurological deficit rates in difficult-to-treat extratemporal epilepsy.<\/jats:p>\n <\/jats:sec>","DOI":"10.3171\/2013.2.focus12397","type":"journal-article","created":{"date-parts":[[2013,4,1]],"date-time":"2013-04-01T11:24:01Z","timestamp":1364815441000},"page":"E4","source":"Crossref","is-referenced-by-count":54,"title":["Integration of functional neuronavigation and intraoperative MRI in surgery for drug-resistant extratemporal epilepsy close to eloquent brain areas"],"prefix":"10.3171","volume":"34","author":[{"given":"Bj\u00f6rn","family":"Sommer","sequence":"first","affiliation":[{"name":"Departments of Neurosurgery,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"Grummich","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roland","family":"Coras","sequence":"additional","affiliation":[{"name":"Neuropathology, University Hospital Erlangen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Burkhard Sebastian","family":"Kasper","sequence":"additional","affiliation":[{"name":"Neurology\/Epilepsy Center, and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ingmar","family":"Blumcke","sequence":"additional","affiliation":[{"name":"Neuropathology, University Hospital Erlangen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hajo Martinus","family":"Hamer","sequence":"additional","affiliation":[{"name":"Neurology\/Epilepsy Center, and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hermann","family":"Stefan","sequence":"additional","affiliation":[{"name":"Neurology\/Epilepsy Center, and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Buchfelder","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karl","family":"Roessler","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery,"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1-0340004","series-title":"Acta Neurochir (Wien)","first-page":"1071","article-title":"Validity of primary motor area localization with fMRI versus electric cortical stimulation: a comparative study","volume":"151","author":"Bartos","year":"2009"},{"key":"b2-0340004","series-title":"J Neurosurg","first-page":"1170","article-title":"Surgical treatment of parietal lobe epilepsy. 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electrocorticography in epilepsy surgery","volume":"64","author":"Cho","year":"2005"},{"key":"b7-0340004","series-title":"J Neurosurg","first-page":"513","article-title":"Long-term outcome of epilepsy surgery among 399 patients with nonlesional seizure foci including mesial temporal lobe sclerosis","volume":"104","author":"Cohen-Gadol","year":"2006"},{"key":"b8-0340004","series-title":"Epilepsia","first-page":"889","article-title":"Results of surgery in patients with refractory extratemporal epilepsy with normal or nonlocalizing magnetic resonance findings investigated with subdural grids","volume":"42","author":"Cukiert","year":"2001"},{"key":"b9-0340004","series-title":"Neurosurgery","first-page":"516","article-title":"Outcome of extratemporal epilepsy surgery experience of a single center","volume":"63","author":"Elsharkawy","year":"2008"},{"key":"b10-0340004","series-title":"Surgical Treatment of the Epilepsies","first-page":"609","article-title":"Outcome with respect to epileptic 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Neurophysiol","first-page":"1802","article-title":"Interictal, unifocal spikes in refractory extratemporal epilepsy predict ictal origin and postsurgical outcome","volume":"111","author":"Holmes","year":"2000"},{"issue":"3","key":"b20-0340004","series-title":"Neurosurg Focus","first-page":"E7","article-title":"Corpus callosotomy in children with intractable epilepsy using frameless stereotactic neuronavigation: 12-year experience at the Hospital for Sick Children in Toronto","volume":"25","author":"Jea","year":"2008"},{"key":"b21-0340004","series-title":"Epilepsia","first-page":"425","article-title":"Optimizing epilepsy surgery with intraoperative MR imaging","volume":"43","author":"Kaibara","year":"2002"},{"key":"b22-0340004","series-title":"Neurosurg Clin N Am","first-page":"173","article-title":"Epilepsy surgery with intraoperative MRI at 1.5 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Clinical article","volume":"4","author":"Levy","year":"2009"},{"key":"b27-0340004","series-title":"Epilepsia","first-page":"970","article-title":"Long-term seizure outcome and risk factors for recurrence after extratemporal epilepsy surgery","volume":"53","author":"McIntosh","year":"2012"},{"key":"b28-0340004","series-title":"Epilepsy Res","first-page":"126","article-title":"Clinical utility of functional magnetic resonance imaging for brain mapping in epilepsy surgery","volume":"89","author":"Mehta","year":"2010"},{"key":"b29-0340004","series-title":"Neuroimage","first-page":"1219","article-title":"Intraoperative visualization of the pyramidal tract by diffusion-tensor-imaging-based fiber tracking","volume":"30","author":"Nimsky","year":"2006"},{"key":"b30-0340004","series-title":"Zentralbl Neurochir","first-page":"133","article-title":"Visualization of the pyramidal tract in glioma surgery by integrating diffusion tensor imaging in functional neuronavigation","volume":"66","author":"Nimsky","year":"2005"},{"key":"b31-0340004","series-title":"Acta Neurochir Suppl","first-page":"207","article-title":"Multimodal navigation integrated with imaging","volume":"109","author":"Nimsky","year":"2011"},{"key":"b32-0340004","series-title":"Int J Med Robot","first-page":"75","article-title":"Integrated image- and function-guided surgery in eloquent cortex: a technique report","volume":"2","author":"O'Shea","year":"2006"},{"key":"b33-0340004","series-title":"Acta Neurochir (Wien)","first-page":"1215","article-title":"Outcome of fully awake craniotomy for lesions near the eloquent cortex: analysis of a prospective surgical series of 79 supratentorial primary brain tumors with long follow-up","volume":"151","author":"Pereira","year":"2009"},{"key":"b34-0340004","series-title":"Brain","first-page":"3307","article-title":"Epilepsy surgery involving the sensory-motor cortex","volume":"129","author":"Pondal-Sordo","year":"2006"},{"key":"b35-0340004","series-title":"Neurology","first-page":"596","article-title":"MR tractography predicts visual field defects following temporal lobe resection","volume":"65","author":"Powell","year":"2005"},{"key":"b36-0340004","series-title":"Clin Neurophysiol","first-page":"1153","article-title":"Current themes in neuroimaging of epilepsy: brain networks, dynamic phenomena, and clinical relevance","volume":"121","author":"Richardson","year":"2010"},{"key":"b37-0340004","series-title":"J Neurol Neurosurg Psychiatry","first-page":"1152","article-title":"Evaluation of preoperative high magnetic field motor functional MRI (3 Tesla) in glioma patients by navigated electrocortical stimulation and postoperative outcome","volume":"76","author":"Roessler","year":"2005"},{"key":"b38-0340004","series-title":"Surg Neurol","first-page":"282","article-title":"Frameless stereotactic lesion contourguided surgery using a 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tumors","volume":"107","author":"Serletis","year":"2007"},{"key":"b43-0340004","series-title":"Seizure","first-page":"573","article-title":"Successful selection of patients with intractable extratemporal epilepsy using non-invasive investigations","volume":"12","author":"Shukla","year":"2003"},{"key":"b44-0340004","series-title":"Epilepsia","first-page":"883","article-title":"Medically intractable, localization-related epilepsy with normal MRI: presurgical evaluation and surgical outcome in 43 patients","volume":"42","author":"Siegel","year":"2001"},{"key":"b45-0340004","series-title":"Neurol Psych Brain Res","first-page":"109","article-title":"Presurgical evaluation for epilepsy surgery","volume":"7","author":"Stefan","year":"1999"},{"key":"b46-0340004","series-title":"J Clin Neurosci","first-page":"1350","article-title":"Intraoperative MRI with integrated functional neuronavigation-guided resection of supratentorial cavernous malformations in eloquent brain areas","volume":"18","author":"Sun","year":"2011"},{"key":"b47-0340004","series-title":"Brain","first-page":"1188","article-title":"Long-term seizure outcomes following epilepsy surgery: a systematic review and meta-analysis","volume":"128","author":"T\u00e9llez-Zenteno","year":"2005"},{"key":"b48-0340004","series-title":"Epilepsy Res","first-page":"310","article-title":"Surgical outcomes in lesional and non-lesional epilepsy: a systematic review and meta-analysis","volume":"89","author":"T\u00e9llez-Zenteno","year":"2010"},{"key":"b49-0340004","series-title":"Brain","first-page":"1048","article-title":"Insular lesionectomy for refractory epilepsy: management and outcome","volume":"132","author":"von Lehe","year":"2009"},{"key":"b50-0340004","series-title":"N Engl J Med","first-page":"311","article-title":"A randomized, controlled trial of surgery for temporal-lobe epilepsy","volume":"345","author":"Wiebe","year":"2001"},{"key":"b51-0340004","series-title":"Epilepsia","first-page":"1430","article-title":"Diffusion tensor imaging tractography to visualize the relationship of the optic radiation to epileptogenic lesions prior to neurosurgery","volume":"52","author":"Winston","year":"2011"},{"key":"b52-0340004","series-title":"Epilepsia","first-page":"1072","article-title":"Surgical treatment of extratemporal epilepsy: clinical, radiologic, and histopathologic findings in 60 patients","volume":"37","author":"Zentner","year":"1996"},{"key":"b1-0340004","series-title":"Acta Neurochir (Wien)","first-page":"1071","article-title":"Validity of primary motor area localization with fMRI versus electric cortical stimulation: a comparative study","volume":"151","author":"Bartos","year":"2009"},{"key":"b2-0340004","series-title":"J Neurosurg","first-page":"1170","article-title":"Surgical treatment of parietal lobe epilepsy. Clinical article","volume":"110","author":"Binder","year":"2009"},{"key":"b3-0340004","series-title":"Epilepsia","first-page":"158","article-title":"The clinicopathologic spectrum of focal cortical dysplasias: a consensus classification proposed by an ad hoc Task Force of the ILAE Diagnostic Methods Commission","volume":"52","author":"Bl\u00fcmcke","year":"2011"},{"key":"b4-0340004","series-title":"Epileptic Disord","first-page":"38","article-title":"Selection of ideal candidates for extratemporal resective epilepsy surgery in a country with limited resources","volume":"12","author":"Chaudhry","year":"2010"},{"key":"b5-0340004","series-title":"Neuroimage","first-page":"286","article-title":"Prediction of visual field deficits by diffusion tensor imaging in temporal lobe epilepsy surgery","volume":"45","author":"Chen","year":"2009"},{"key":"b6-0340004","series-title":"Surg Neurol","first-page":"411","article-title":"Application of neuronavigator coupled with an operative microscope and electrocorticography in epilepsy surgery","volume":"64","author":"Cho","year":"2005"},{"key":"b7-0340004","series-title":"J Neurosurg","first-page":"513","article-title":"Long-term outcome of epilepsy surgery among 399 patients with nonlesional seizure foci including mesial temporal lobe sclerosis","volume":"104","author":"Cohen-Gadol","year":"2006"},{"key":"b8-0340004","series-title":"Epilepsia","first-page":"889","article-title":"Results of surgery in patients with refractory extratemporal epilepsy with normal or nonlocalizing magnetic resonance findings investigated with subdural grids","volume":"42","author":"Cukiert","year":"2001"},{"key":"b9-0340004","series-title":"Neurosurgery","first-page":"516","article-title":"Outcome of extratemporal epilepsy surgery experience of a single center","volume":"63","author":"Elsharkawy","year":"2008"},{"key":"b10-0340004","series-title":"Surgical Treatment of the Epilepsies","first-page":"609","article-title":"Outcome with respect to epileptic seizures","author":"Engel","year":"1993"},{"key":"b11-0340004","series-title":"Epilepsia","first-page":"741","article-title":"Practice parameter: temporal lobe and localized neocortical resections for epilepsy","volume":"44","author":"Engel","year":"2003"},{"key":"b12-0340004","series-title":"Arch Pathol Lab Med","first-page":"545","article-title":"Surgical pathologic findings of extratemporal-based intractable epilepsy: a study of 133 consecutive resections","volume":"124","author":"Frater","year":"2000"},{"key":"b13-0340004","series-title":"Acta Neurochir Suppl","first-page":"61","article-title":"Intraoperative MRI and functional mapping","volume":"109","author":"Gasser","year":"2011"},{"key":"b14-0340004","series-title":"Neuroimage","first-page":"1793","article-title":"Combining fMRI and MEG increases the reliability of presurgical language localization: a clinical study on the difference between and congruence of both 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cortex","volume":"129","author":"Pondal-Sordo","year":"2006"},{"key":"b35-0340004","series-title":"Neurology","first-page":"596","article-title":"MR tractography predicts visual field defects following temporal lobe resection","volume":"65","author":"Powell","year":"2005"},{"key":"b36-0340004","series-title":"Clin Neurophysiol","first-page":"1153","article-title":"Current themes in neuroimaging of epilepsy: brain networks, dynamic phenomena, and clinical relevance","volume":"121","author":"Richardson","year":"2010"},{"key":"b37-0340004","series-title":"J Neurol Neurosurg Psychiatry","first-page":"1152","article-title":"Evaluation of preoperative high magnetic field motor functional MRI (3 Tesla) in glioma patients by navigated electrocortical stimulation and postoperative outcome","volume":"76","author":"Roessler","year":"2005"},{"key":"b38-0340004","series-title":"Surg Neurol","first-page":"282","article-title":"Frameless stereotactic lesion contourguided surgery using a 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tumors","volume":"107","author":"Serletis","year":"2007"},{"key":"b43-0340004","series-title":"Seizure","first-page":"573","article-title":"Successful selection of patients with intractable extratemporal epilepsy using non-invasive investigations","volume":"12","author":"Shukla","year":"2003"},{"key":"b44-0340004","series-title":"Epilepsia","first-page":"883","article-title":"Medically intractable, localization-related epilepsy with normal MRI: presurgical evaluation and surgical outcome in 43 patients","volume":"42","author":"Siegel","year":"2001"},{"key":"b45-0340004","series-title":"Neurol Psych Brain Res","first-page":"109","article-title":"Presurgical evaluation for epilepsy surgery","volume":"7","author":"Stefan","year":"1999"},{"key":"b46-0340004","series-title":"J Clin Neurosci","first-page":"1350","article-title":"Intraoperative MRI with integrated functional neuronavigation-guided resection of supratentorial cavernous malformations in eloquent brain 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