Abstract #0234

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

Joseph Yuan-Mou Yang^1,2,3,4, Ramshekhar Menon^5,6, Sarah Barton^2,3,4,5, Simone Mandelstam^7,8,9, Rachel Kerr¹⁰, Jacquie Wrennall^11,12, Catherine Bailey⁵, Jeremy Freeman^2,5, Wirginia Maixner^1,2, and A Simon Harvey^2,3,5

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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