E2113. Imaging Appearance of Common Epilepsy Surgeries: What the Radiologist Needs to Know
  1. Priyanka Garg; University of Rochester Medical Center
  2. Maria Lorca; University of Rochester Medical Center
  3. Kevin Carocci; University of Rochester Medical Center
  4. Shehanaz Ellika; University of Rochester Medical Center
  5. Jeevak Almast; University of Rochester Medical Center
  6. Edward Lin; University of Rochester Medical Center
Primary goal of epilepsy surgery is to render patients seizure-free without complications. Epilepsy surgery can be divided based on the goals of the operation into palliative and curative surgeries. Curative surgeries include lesionectomy, lobectomy, corticectomy, and multiple subpial transections. The main goal of curative surgery is for the patient to preferably be off of all antiepileptic medications and lead a normal life. Palliative surgeries include hemispherectomy, multiple subpial transections, corpus callosotomy, and vagal nerve stimulation. The main goal of palliative surgery is to prevent morbid type of seizures, lessen the frequency or lessen the severity of seizures.

Educational Goals / Teaching Points
Gain familiarity with the types of commonly performed epilepsy surgeries and their indications. Recognize the expected postoperative appearances of epilepsy procedures and identify postoperative complications or incomplete operations, if present. Recognize the role of advanced MRI including DTI in identifying patients with residual connectivity between the affected and unaffected hemispheres which may help in planning targeted disconnection of the regions of residual connectivity.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
Pertinent anatomy and preoperative imaging appearance of patients with epilepsy. Postoperative imaging appearance of epilepsy surgeries. Imaging appearance of post-surgical complications and incomplete surgery. Role of Diffusion-tensor imaging (DTI) in epilepsy imaging.

There are multiple surgical techniques for the treatment of intractable seizures. It is crucial, as a radiologist, to recognize the pre- and postoperative imaging appearance of common epilepsy surgeries to diagnose postoperative complications and/or incomplete surgeries to guide appropriate intervention/therapy.