{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,14]],"date-time":"2026-07-14T01:49:17Z","timestamp":1783993757216,"version":"3.55.0"},"reference-count":176,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["FOC"],"published-print":{"date-parts":[[2016,3]]},"abstract":"<jats:sec>\n                    <jats:title>OBJECTIVE<\/jats:title>\n                    <jats:p>Intraoperative overestimation of resection volume in epilepsy surgery is a well-known problem that can lead to an unfavorable seizure outcome. Intraoperative MRI (iMRI) combined with neuronavigation may help surgeons avoid this pitfall and facilitate visualization and targeting of sometimes ill-defined heterogeneous lesions or epileptogenic zones and may increase the number of complete resections and improve seizure outcome.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>To investigate this hypothesis, the authors conducted a retrospective clinical study of consecutive surgical procedures performed during a 10-year period for epilepsy in which they used neuronavigation combined with iMRI and functional imaging (functional MRI for speech and motor areas; diffusion tensor imaging for pyramidal, speech, and visual tracts; and magnetoencephalography and electrocorticography for spike detection). Altogether, there were 415 patients (192 female and 223 male, mean age 37.2 years; 41% left-sided lesions and 84.9% temporal epileptogenic zones). The mean preoperative duration of epilepsy was 17.5 years. The most common epilepsy-associated pathologies included hippocampal sclerosis (n = 146 [35.2%]), long-term epilepsy-associated tumor (LEAT) (n = 67 [16.1%]), cavernoma (n = 45 [10.8%]), focal cortical dysplasia (n = 31 [7.5%]), and epilepsy caused by scar tissue (n = 23 [5.5%]).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>In 11.8% (n = 49) of the surgeries, an intraoperative second-look surgery (SLS) after incomplete resection verified by iMRI had to be performed. Of those incomplete resections, LEATs were involved most often (40.8% of intraoperative SLSs, 29.9% of patients with LEAT). In addition, 37.5% (6 of 16) of patients in the diffuse glioma group and 12.9% of the patients with focal cortical dysplasia underwent an SLS. Moreover, iMRI provided additional advantages during implantation of grid, strip, and depth electrodes and enabled intraoperative correction of electrode position in 13.0% (3 of 23) of the cases. Altogether, an excellent seizure outcome (Engel Class I) was found in 72.7% of the patients during a mean follow-up of 36 months (range 3 months to 10.8 years). The greatest likelihood of an Engel Class I outcome was found in patients with cavernoma (83.7%), hippocampal sclerosis (78.8%), and LEAT (75.8%). Operative revisions that resulted from infection occurred in 0.3% of the patients, from hematomas in 1.6%, and from hydrocephalus in 0.8%. Severe visual field defects were found in 5.2% of the patients, aphasia in 5.7%, and hemiparesis in 2.7%, and the total mortality rate was 0%.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS<\/jats:title>\n                    <jats:p>Neuronavigation combined with iMRI was beneficial during surgical procedures for epilepsy and led to favorable seizure outcome with few specific complications. A significantly higher resection volume associated with a higher chance of favorable seizure outcome was found, especially in lesional epilepsy involving LEAT or diffuse glioma.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/2015.12.focus15554","type":"journal-article","created":{"date-parts":[[2016,3,1]],"date-time":"2016-03-01T03:37:27Z","timestamp":1456803447000},"page":"E15","source":"Crossref","is-referenced-by-count":46,"title":["Resective surgery for medically refractory epilepsy using intraoperative MRI and functional neuronavigation: the Erlangen experience of 415 patients"],"prefix":"10.3171","volume":"40","author":[{"given":"Karl","family":"Roessler","sequence":"first","affiliation":[{"name":"Departments of Neurosurgery,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea","family":"Hofmann","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bjoern","family":"Sommer","sequence":"additional","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, and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Burkard Sebastian","family":"Kasper","sequence":"additional","affiliation":[{"name":"Neurology, Epilepsy Centre, University Hospital Erlangen; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hajo M.","family":"Hamer","sequence":"additional","affiliation":[{"name":"Neurology, Epilepsy Centre, University Hospital Erlangen; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ingmar","family":"Blumcke","sequence":"additional","affiliation":[{"name":"Neuropathology, and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hermann","family":"Stefan","sequence":"additional","affiliation":[{"name":"Neurology, Epilepsy Centre, University Hospital Erlangen; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher","family":"Nimsky","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University Hospital Marburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Buchfelder","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery,"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1-focus15554","series-title":"Seizure","first-page":"420","article-title":"Seizure outcome after surgery for epilepsy due to focal cortical dysplastic 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freedom in low-grade temporal lobe brain tumors","volume":"70","author":"Englot","year":"2012"},{"key":"b27-focus15554","series-title":"J Neurosurg","first-page":"381","article-title":"Intraoperative magnetic resonance imaging during transsphenoidal surgery","volume":"95","author":"Fahlbusch","year":"2001"},{"key":"b28-focus15554","series-title":"Childs Nerv Syst","first-page":"829","article-title":"Intraoperative imaging with open magnetic resonance imaging and neuronavigation","volume":"16","author":"Fahlbusch","year":"2000"},{"key":"b29-focus15554","series-title":"Seizure","first-page":"785","article-title":"Surgical versus conservative treatment in patients with cerebral cavernomas and non refractory epilepsy","volume":"21","author":"Fern\u00e1ndez","year":"2012"},{"key":"b30-focus15554","series-title":"Neuroimage","first-page":"685","article-title":"Intraoperative functional MRI: implementation and preliminary 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selective amygdalohippocampectomy in patients with temporal lobe epilepsy: one-year follow-up","volume":"45","author":"Gleissner","year":"2004"},{"key":"b35-focus15554","series-title":"Neurosci Lett","first-page":"143","article-title":"Observation of unaveraged giant MEG activity from language areas during speech tasks in patients harboring brain lesions very close to essential language areas: expression of brain plasticity in language processing networks?","volume":"380","author":"Grummich","year":"2005"},{"key":"b36-focus15554","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 modalities","volume":"32","author":"Grummich","year":"2006"},{"key":"b37-focus15554","series-title":"Epilepsia","first-page":"1669","article-title":"Diagnostic methods and treatment options for focal cortical 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patients","volume":"154","author":"Hu","year":"2012"},{"key":"b42-focus15554","series-title":"Brain","first-page":"395","article-title":"Temporal lobe epilepsy with hippocampal sclerosis: predictors for long-term surgical outcome","volume":"128","author":"Janszky","year":"2005"},{"key":"b43-focus15554","series-title":"JAMA","first-page":"285","article-title":"Resective epilepsy surgery for drug-resistant focal epilepsy: a review","volume":"313","author":"Jobst","year":"2015"},{"key":"b44-focus15554","series-title":"Seizure","first-page":"541","article-title":"Resection extent versus postoperative outcomes of seizure and memory in mesial temporal lobe epilepsy","volume":"14","author":"Joo","year":"2005"},{"key":"b45-focus15554","series-title":"Arq Neuropsiquiatr","first-page":"1002","article-title":"Clinical characteristics and surgical outcome of patients with temporal lobe tumors and epilepsy","volume":"58","author":"Jorge","year":"2000"},{"key":"b46-focus15554","series-title":"Seizure","first-page":"540","article-title":"Seizure prognosis of patients with low-grade tumors","volume":"21","author":"Kahlenberg","year":"2012"},{"key":"b47-focus15554","series-title":"Epilepsy Res","first-page":"105","article-title":"Epilepsy surgery in the United States: Analysis of data from the National Association of Epilepsy Centers","volume":"116","author":"Kaiboriboon","year":"2015"},{"key":"b48-focus15554","series-title":"J Neurosurg","first-page":"19","article-title":"Control of temporal lobe epilepsy following en bloc resection of low-grade tumors","volume":"78","author":"Kirkpatrick","year":"1993"},{"key":"b49-focus15554","series-title":"J Neurol Neurosurg Psychiatry","first-page":"853","article-title":"Focal cortical dysplasia: long term seizure outcome after surgical treatment","volume":"78","author":"Kral","year":"2007"},{"key":"b50-focus15554","series-title":"Neurology","first-page":"217","article-title":"Incomplete resection of focal cortical dysplasia is the main predictor of poor postsurgical outcome","volume":"72","author":"Krsek","year":"2009"},{"key":"b51-focus15554","series-title":"Br J Neurosurg","first-page":"380","article-title":"Impact of intraoperative MRI on outcomes in epilepsy surgery: preliminary experience of two years","volume":"29","author":"Kurwale","year":"2015"},{"key":"b52-focus15554","series-title":"Neurology","first-page":"479","article-title":"Temporal lobe developmental malformations and hippocampal sclerosis: epilepsy surgical outcome","volume":"52","author":"Kuzniecky","year":"1999"},{"key":"b53-focus15554","series-title":"Epilepsia","first-page":"822","article-title":"The spectrum of long-term epilepsy-associated tumors: long-term seizure and tumor outcome and neurosurgical aspects","volume":"44","author":"Luyken","year":"2003"},{"key":"b54-focus15554","series-title":"J Neurol Neurosurg Psychiatry","first-page":"80","article-title":"Epilepsy surgery, visual fields, and driving: a study of the visual field criteria for driving in patients after temporal lobe epilepsy surgery with a comparison of Goldmann and Esterman perimetry","volume":"68","author":"Manji","year":"2000"},{"issue":"1 Suppl","key":"b55-focus15554","series-title":"Neurosurgery","first-page":"337","article-title":"Motor evoked potential monitoring with supratentorial surgery","volume":"61","author":"Neuloh","year":"2007"},{"key":"b56-focus15554","series-title":"Acta Neurochir Suppl","first-page":"55","article-title":"Glioma surgery evaluated by intraoperative low-field magnetic resonance imaging","volume":"85","author":"Nimsky","year":"2003"},{"key":"b57-focus15554","series-title":"Radiology","first-page":"67","article-title":"Intraoperative high-field-strength MR imaging: implementation and experience in 200 patients","volume":"233","author":"Nimsky","year":"2004"},{"key":"b58-focus15554","series-title":"J Neurosurg","first-page":"70","article-title":"Seizure and memory outcome following temporal lobe surgery: selective compared with nonselective approaches for hippocampal sclerosis","volume":"104","author":"Paglioli","year":"2006"},{"key":"b59-focus15554","series-title":"Ann Neurol","first-page":"741","article-title":"Focal neuronal migration disorders and intractable partial epilepsy: a study of 30 patients","volume":"30","author":"Palmini","year":"1991"},{"key":"b60-focus15554","series-title":"Seizure","first-page":"201","article-title":"Improved resection in lesional temporal lobe epilepsy surgery using neuronavigation and intraoperative MR imaging: favourable long term surgical and seizure outcome in 88 consecutive cases","volume":"23","author":"Roessler","year":"2014"},{"key":"b61-focus15554","series-title":"Stereotact Funct 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