Epilepsy and paroxysmal conditions

Advanced search

The use of intraoperative ultrasound in patients with focal cortical dysplasia: preliminary observations

Full Text:


Introduction. The cessation of epileptic seizures after surgical treatment of focal epilepsy is the main objective of the surgeon. When a neurosurgeon operates focal cortical dysplasia (FCD), he/she faces difficulties with the radical removal of pathological tissue, which looks similar to healthy one. Using the neuronavigation system may not be helpful because of errors caused by displacement of brain tissues after opening the dura mater and resection of pathological foci. Intraoperative MRI examination requires significant financial expenses. One alternative is the intraoperative ultrasound (US) test, which allows one to visualize areas of pathological tissue in real time.

The aim of this study is to assess the feasibility of using intraoperative US test.

Materials and methods. We conducted a retrospective analysis of 20 cases of pharmacoresistant epilepsy that involved US examination during surgical operation for epilepsy caused by focal cortical dysplasia. In the preoperative period, all patients underwent EEG video monitoring in which at least three seizures were detected. In addition, three patients underwent invasive EEG video monitoring as well as preoperative and postoperative brain MRI. Based on histological verification, the distribution of patients was as follows: Ia type – 1 case (5%); Ib type – 4 cases (20%); Ic type –3 cases (15%); IIa type –3 cases (15%); IIb type – 8 cases (40%); IIIa type – 1 case (5%). Postoperative follow-up continued for 14±10 months (min – 2 months, max – 31 months).

Results. Twenty (100%) patients underwent intraoperative US examination where signs of an altered cortex were found in locations similar to those revealed with preoperative MRI scans. Based on the US images, radical resection of pathological tissues was performed in these patients. In 15 (75%) patients, the seizures stopped (Engel class I). According to the US data, FCD had the following characteristics: hyperechogenicity as compared to the brain parenchyma; uneven, fuzzy, irregularly shaped contours; lack of a clear border between the white and gray matter.

Conclusion. Intraoperative ultrasound is a safe, inexpensive and effective method for intraoperative imaging of FCD.

The authors declare the absence of conflict of interest with respect to this publication. All authors contributed equally to this article.

About the Authors

A. A. Sufianov
Federal Center for Neurosurgery; Sechenov University
Russian Federation

Albert A. Sufianov – MD, Professor, Chief Physician 

Scopus Author ID: 6603558501

S. V. Mirhaydarov
Federal Center for Neurosurgery; Sechenov University
Russian Federation
Salavat V. Mirhaydarov – MD, Neurosurgeon

Yu. A. Yakimov
Federal Center for Neurosurgery; Sechenov University
Russian Federation
Yuri A. Yakimov – MD, Head of the Department of Pediatric Neurosurgery

O. M. Klimenko
Federal Center for Neurosurgery
Russian Federation
Olga M. Klimenko – MD, Neurologist-Epileptologist

A. A. Skripnikov
Federal Center for Neurosurgery
Russian Federation
Alexander A. Skripnikov – MD, Neurophysiologist

S. Z. Stefanov
Federal Center for Neurosurgery; Sechenov University
Russian Federation
Stefan Z. Stefanov – MD, Neurosurgeon

O. N. Sadykova
Federal Center for Neurosurgery
Russian Federation
Olga N. Sadykova – MD, Specialist in Functional Diagnostics

R. S. Talybov
Federal Center for Neurosurgery
Russian Federation
Rustam S. Talybov – MD, Radiologist

R. A. Sufianov
Sechenov University
Russian Federation
Rinat A. Sufianov – MD, Resident-in-Training


1. Palmini A., Holthausen H. Focal malformations of cortical development: A most relevant etiology of epilepsy in children. Handbook of clinical neurology. 2013; 549-565.

2. Sacino M.F., Ho C.Y., Whitehead M.T., Zelleke T., Magge S.N., Myseros J., Keating R.F., Gaillard W.D., Oluigbo C.O. Resective surgery for focal cortical dysplasia in children: a comparative analysis of the utility of intraoperative magnetic resonance imaging (iMRI). Child’s Nervous System. 2016; 32 (6): 1101-1107.

3. Tringali G., Bono B., Dones I., Cordella R., Didato G., Villani F., Prada F. Multimodal Approach for Radical Excision of Focal Cortical Dysplasia by Combining Advanced Magnetic Resonance Imaging Data to Intraoperative Ultrasound, Electrocorticography, and Cortical Stimulation: A Preliminary Experience. World Neurosurgery. 2018; 113: 738-746.

4. Roessler K., Kasper B.S., Heynold E., Coras R, Sommer B., Rampp S., Hamer H.M., Blümcke I., Buchfelder M. Intraoperative MR imaging and neuronavigation during resection of FCD Type II in adult epilepsy surgery offers better seizure outcome. World Neurosurgery. 2018; 109: 43-49.

5. Sacino M.F., Ho C.Y., Murnick J., Tsuchida T., Magge S.N., Keating R.F., Gaillard W.D., Oluigbo C.O. Intraoperative MRI-guided resection of focal cortical dysplasia in pediatric patients: technique and outcomes. Journal of neurosurgery. Pediatrics. 2016; 17 (6): 672-8.

6. Miller D., Knake S., Bauer S., Krakow K., Pagenstecher A., Sure U., Rosenow F. Intraoperative ultrasound to define focal cortical dysplasia in epilepsy surgery. Epilepsia. 2008; 49 (1): 156-158.

7. Miller D., Knake S., Menzler K., Krakow K., Rosenow F., Sure U. Intraoperative ultrasound in malformations of cortical development. Ultraschall in Med. 2011; 32: 69-74.

8. Miller D., Carney P., Archer J.S., Fitt G.J., Jackson G.D., Bulluss K.J. Intraoperative definition of bottom-of-sulcus dysplasia using intraoperative ultrasound and single depth electrode recording – A technical note. Journal of clinical neuroscience. 2017; 48: 191-195.

9. Martinoni M., Marucci G., Meletti S., Volpi L., Michelucci R., Giulioni M. Ultrasound assisted awake epilepsy surgery for type IIB focal cortical dysplasia in eloquent areas. Journal of Neurosurgical Sciences. 2017; 28.

10. Sandrikov V.A., Fisenko E.P., Vetsheva N.N., Fedulova S.V., Vasilev S.A., Zuev A.A. Intraoperacionnoe ultrazvukovoe issledovanie golovnogo i spinnogo mozga. Moscow. 2012. (In Russ).

11. Zayavka na izobretenie №2018123417. Sufianov A.A. Apparatus for suction and irrigation of liquids. Link is active on 01.12.2018.

12. Blümcke I., Thom M., Aronica E., Armstrong D.D., Vinters H.V., Palmini A., Jacques T.S., Avanzini G., Barkovich A.J., Battaglia G., Becker A., Cepeda C., Cendes F., Colombo N., Crino P., Cross J.H., Delalande O., Dubeau F., Duncan J., Guerrini R., Kahane P., Mathern G., Najm I., Ozkara C., Raybaud C., Represa A., Roper S.N., Salamon N., Schulze-Bonhage A., Tassi L., Vezzani A., Spreafico R. The clinicopathologic spectrum of focal cortical dysplasias: A consensus classification proposed by an ad hoc Task Force of the ILAE Diagnostic Methods Commission. Epilepsia. 2011; 52 (1): 158-174.

13. Wieser H.G., Blume W.T., Fish D., Goldensohn E., Hufnagel A., King D., Sperling M.R., Lüders H., Pedley T.A. Proposal for a New Classification of Outcome with Respect to Epileptic Seizures Following Epilepsy Surgery. Epilepsy. 2001; 42 (2); 282-286.

14. Fauser S., Essang C., Altenmüller D.M., Staack A.M., Steinhoff B.J., Strobl K., Bast T., Schubert-Bast S., Stephani U., Wiegand G., Prinz M., Brandt A., Zentner J.,Schulze-Bonhage A. Long-term seizure outcome in 211 patients with focal cortical dysplasia. Epilepsia. 2015; 56 (1): 66-76.

15. Choi S.A., Kim S.Y., Kim H., Kim W.J., Kim H., Hwang H., Choi J.E., Lim B.C., Chae J.H., Chong S., Lee J.Y., Phi J.H., Kim S.K., Wang K.C., Kim K.J. Surgical outcome and predictive factors of epilepsy surgery in pediatric isolated focal cortical dysplasia. Epilepsy Research. 2018; 139: 54-59.

For citation:

Sufianov A.A., Mirhaydarov S.V., Yakimov Yu.A., Klimenko O.M., Skripnikov A.A., Stefanov S.Z., Sadykova O.N., Talybov R.S., Sufianov R.A. The use of intraoperative ultrasound in patients with focal cortical dysplasia: preliminary observations. Epilepsy and paroxysmal conditions. 2019;11(4):335-347. (In Russ.)

Views: 250

ISSN 2077-8333 (Print)
ISSN 2311-4088 (Online)