Authors :
Presenting Author: Daan Pijs, BSc – Boston Children's Hospital & Harvard Medical School
Ellen Broekhuizen, BSc. – Boston Children's Hospital & Harvard Medical School
Ivan Sanchez Fernandez, MD – Boston Children's Hospital & Harvard Medical School
Gillian Miller, BSc – Boston Children's Hospital & Harvard Medical School
Matheus Soldatelli, MD, PhD – Boston Children's Hospital & Harvard Medical School
Ismail Mohamed, MD – University of Alabama at Birmingham
Rohini Coorg, MD – Texas Children's Hospital & Baylor College of Medicine
Anne Anderson, MD – Baylor College of Medicine/Texas Children's Hospital
Stephanie Randle, MD – Seattle Children's Hospital
Murat Oztek, MD – University of Washington
Catherine Chu, MD, MSC – Massachusetts General Hospital, Harvard Medical School, Kennedy Krieger Institute, Johns Hopkins University
Katherine Taub, MD – Children's Hospital of Philadelphia
Benjamin Kennedy, MD – Children's Hospital of Philadelphia
Sarah Weatherspoon, MD – University of Tennessee Health Science Center
Nir Shimony, MD – University of Tennessee Health Science Center
Rajsekar Rajaraman, MD – David Geffen School of Medicine; UCLA Mattel Children’s Hospital
Simon Warfield, PhD – Boston Children’s Hospital & Harvard Medical School
Mustafa Sahin, MD, PhD – Boston Children's Hospital, Harvard
Darcy Krueger, MD,PhD – Cincinnati Children's Hospital
Martina Bebin, MD, MPA – The University of Alabama at Birmingham
Hope Northrup, MD – Division of Medical Genetics, Department of Pediatrics, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA
Joyce Wu, MD – Ann and Robert H Lurie Children's Hospital of Chicago
Jeffrey Blount, MD – University of Alabama at Birmingham
Aria Fallah, MD, MSc, MBA – Department of Neurosurgery, UCLA Medical Center, David Geffen School of Medicine
Scellig Stone, MD, PhD – Boston Childrens Hospital & Harvard Medical School
Howard Weiner, MD – Texas Children's Hospital & Baylor College of Medicine
Jurriaan Peters, MD PhD – Boston Children's Hospital
Rationale:
In tuberous sclerosis complex (TSC), resection of an epileptogenic tuber may result in seizure freedom, but the surgical technique varies between patients, surgeons, and centers, potentially resulting in variable outcomes. We evaluated how specific neuroimaging-based resection metrics affect seizure outcomes.Methods:
This retrospective, multicenter neuroimaging study included pediatric TSC patients who underwent resective epilepsy surgery. We collected demographic and clinical data, pre- and postoperative neuroimaging, and Engel Class surgical outcomes. We manually segmented tubers and adjacent tissue types on preoperative MRI. Next, we projected the post-operative resection cavity onto the pre-operative scan and manually adjusted for non-uniform tissue shift. We corrected for differences in total brain volume by warping images to a common atlas space. Qualitative data collected included sex, genotype, surgical lobe and laterality, complete resection of tuber and of radial migration line; quantitative data included age at surgery, shortest distance to nearest neighboring tuber and from tuber to resection margin, total tuber burden, volumes of resected tissue (total cavity, tuber, gray- and white matter), the tuber/cavity volume ratio. We applied a multivariable logistic-regression model including all candidate variables with p < 0.20 in univariate analysis to identify predictors of 12-month Engel Class I seizure freedom.