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Abstract #0234

One-stage, language-dominant, opercular-insular epilepsy surgery with multimodal structural and functional neuroimaging evaluation

Joseph Yuan-Mou Yang1,2,3,4, Ramshekhar Menon5,6, Sarah Barton2,3,4,5, Simone Mandelstam7,8,9, Rachel Kerr10, Jacquie Wrennall11,12, Catherine Bailey5, Jeremy Freeman2,5, Wirginia Maixner1,2, and A Simon Harvey2,3,5
1Neurosurgery, Royal Children's Hospital, Melbourne, Australia, 2Neuroscience Research group, Murdoch Children's Research Institution, Melbourne, Australia, 3Paediatrics, University of Melbourne, Melbourne, Australia, 4Developmental Imaging group, Murdoch Children's Research Institution, Melbourne, Australia, 5Neurology, Royal Children's Hospital, Melbourne, Australia, 6Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, India, 7Medical Imaging, Royal Children's Hospital, Melbourne, Australia, 8Medicine and Radiology, University of Melbourne, Melbourne, Australia, 9The Florey Institute of Neuroscience and Mental Health, Melbourne, Australia, 10Speech pathology, Royal Children's Hospital, Melbourne, Australia, 11Clinical neuropsychology, Royal Children's Hospital, Melbourne, Australia, 12Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Australia

Language dominant, insular-opercular epilepsies are challenging to manage due complex seizure presentations and proximity to language cortex and associated white matter tracts. Most centres elected for extensive invasive stereo-electroencephalogram recordings and ablative procedures. We demonstrated in our retrospective cohort of 11 patients that focal resections can be undertaken safely and effectively using neuroimaging of seizures, lesions, language fMRI and high order tractography reconstructions based on a multi-fibre white matter modelling technique, and careful microsurgical techniques. This avoids risks associated with invasive procedures. Surgery performed under direct vision is more precise, likely safer, allows tailoring with intraoperative electrocorticography, and provides histopathology.

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