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Bourdillon P, Ferrand-Sorbet S, Apra C, Chipaux M, Raffo E, Rosenberg S, Bulteau C, Dorison N, Bekaert O, Dinkelacker V, Le Guérinel C, Fohlen M, Dorfmüller G. Surgical treatment of hypothalamic hamartomas. Neurosurg Rev 2020; 44:753-762. [PMID: 32318922 DOI: 10.1007/s10143-020-01298-z] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 03/29/2020] [Accepted: 03/31/2020] [Indexed: 12/15/2022]
Abstract
Hypothalamic hamartomas are aberrant masses, composed of abnormally distributed neurons and glia. Along endocrine and cognitive symptoms, they may cause epileptic seizures, including the specific gelastic and dacrystic seizures. Surgery is the treatment of drug-resistant hamartoma epilepsy, with associated positive results on endocrine, psychiatric, and cognitive symptoms. Recently, alternatives to open microsurgical treatment have been proposed. We review these techniques and compare their efficacy and safety. Open resection or disconnection of the hamartoma, either through pterional, transcallosal, or transventricular approach, leads to good epileptological control, but its high complication rate, up to 30%, limits its indications. The purely cisternal peduncular forms remain the only indication of open, pterional approach, while other strategies have been developed to overcome the neurological, endocrine, behavioral, or cognitive complications. Laser and radiofrequency thermocoagulation-based disconnection through robot-guided stereo-endoscopy has been proposed as an alternative to open microsurgical resection and stereotactic destruction. The goal is to allow safe and complete disconnection of a possibly complex attachment zone, through a single intraparenchymal trajectory which allows multiple laser or radiofrequency probe trajectory inside the ventricle. The efficacy was high, with 78% of favorable outcome, and the overall complication rate was 8%. It was especially effective in patients with isolated gelastic seizures and pure intraventricular hamartomas. Stereotactic radiosurgery has proved as efficacious and safer than open microsurgery, with around 60% of seizure control and a very low complication rate. Multiple stereotactic thermocoagulation showed very interesting results with 71% of seizure freedom and 2% of permanent complications. Stereotactic laser interstitial thermotherapy (LiTT) seems as effective as open microsurgery (from 76 to 81% of seizure freedom) but causes up to 20% of permanent complications. This technique has however been highly improved by targeting only the epileptogenic onset zone in the hamartoma, as shown on preoperative functional MRI, leading to an improvement of epilepsy control by 45% (92% of seizure freedom) with no postoperative morbidity. All these results suggest that the impact of the surgical procedure does not depend on purely technical matters (laser vs radiofrequency thermocoagulation or stereotactic vs robot-guided stereo-endoscopy) but relies on the understanding of the epileptic network, including inside the hamartoma, the aim being to plan an effective disconnection or lesion of the epileptogenic part while sparing the adjacent functional structures.
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Affiliation(s)
- Pierre Bourdillon
- Department of Neurosurgery, Rothschild Foundation Hospital, 29 Rue Manin, 75019, Paris, France. .,Department of Pediatric Neurosurgery, Rothschild Foundation Hospital, Paris, France. .,Sorbonne Université, Paris, France. .,INSERM U1127, CNRS, UMR7225, Brain and Spine Institute, Paris, France.
| | - S Ferrand-Sorbet
- Department of Pediatric Neurosurgery, Rothschild Foundation Hospital, Paris, France
| | - C Apra
- Sorbonne Université, Paris, France.,INSERM U1127, CNRS, UMR7225, Brain and Spine Institute, Paris, France.,Department of Neurosurgery, Pitié-Salpêtrière Hospital, Paris, France
| | - M Chipaux
- Department of Pediatric Neurosurgery, Rothschild Foundation Hospital, Paris, France
| | - E Raffo
- Department of Pediatric Neurosurgery, Rothschild Foundation Hospital, Paris, France.,Université de Lorraine, Nancy, France
| | - S Rosenberg
- Department of Pediatric Neurosurgery, Rothschild Foundation Hospital, Paris, France
| | - C Bulteau
- Department of Pediatric Neurosurgery, Rothschild Foundation Hospital, Paris, France.,Université de Paris, Paris, France
| | - N Dorison
- Department of Pediatric Neurosurgery, Rothschild Foundation Hospital, Paris, France
| | - O Bekaert
- Department of Pediatric Neurosurgery, Rothschild Foundation Hospital, Paris, France
| | - V Dinkelacker
- Department of Neurology, Rothschild Foundation Hospital, Paris, France
| | - C Le Guérinel
- Department of Neurosurgery, Rothschild Foundation Hospital, 29 Rue Manin, 75019, Paris, France
| | - M Fohlen
- Department of Pediatric Neurosurgery, Rothschild Foundation Hospital, Paris, France
| | - G Dorfmüller
- Department of Pediatric Neurosurgery, Rothschild Foundation Hospital, Paris, France
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Bai J, Zhou W, Wang H, Zhang B, Lin J, Song X, Li J, Ruan J, Liu Y, Shi J, He J, Feng Q. Value of stereoelectroencephalography (SEEG)-guided radiofrequency thermocoagulation in treating drug-resistant focal epilepsy. BRAIN SCIENCE ADVANCES 2020. [DOI: 10.26599/bsa.2019.9050015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Stereoelectroencephalography (SEEG) has been widely used in the presurgical evaluation of patients with medically intractable epilepsy. In the past, SEEG was commonly used as a method for mapping and localizing the epileptogenic zone (EZ). Since 2004, several studies have been conducted to examine the effectiveness of SEEG-guided radiofrequency thermocoagulation (RF-TC) in treating refractory epilepsy. However, the seizure-free and responder rates varied greatly across studies. We aimed to analyze the outcome of 56 patients who were treated with SEEG-guided RF-TC to evaluate the effectiveness of this treatment. SEEG-guided RF-TC can be considered as a treatment for refractory epilepsy. However, due to its limited efficacy, SEEG-guided RF-TC might be regarded as a temporary treatment performed under SEEG rather than a promising treatment for refractory epilepsy.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | - Qian Feng
- Epilepsy Center, Yuquan Hospital, Tsinghua University, Beijing 100049, China
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53
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Practice of stereoelectroencephalography (sEEG) in drug-resistant epilepsy: Retrospective series with surgery and thermocoagulation outcomes. Neurochirurgie 2020; 66:139-143. [PMID: 32278000 DOI: 10.1016/j.neuchi.2019.12.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2019] [Revised: 11/13/2019] [Accepted: 12/01/2019] [Indexed: 11/23/2022]
Abstract
OBJECTIVE The aim of this study was to determine the success rate of sEEG in locating the epileptogenic zone (EZ) in patients with pharmaco-resistant epilepsy. Secondary objectives were to analyze sEEG-related morbidity and outcomes for post-sEEG thermocoagulation and cortical resection. METHODS Data were collected on 49 sEEGs from 46 consecutive patients between 2010 and 2018. Following sEEG, either resective or palliative surgery with vagus nerve stimulation was performed. In 8 patients, EZ thermocoagulation was performed before EEG leads were withdrawn. Outcomes were collected based on the Engel and ILAE outcome scales. RESULTS sEEG was contributive in 45 of 49 recordings, with a success rate of 92% in locating the EZ. Minor complications, such as transient neurologic deficit and electrode implantation failures, occurred in 6%. One major complication occurred, with death due to atypical late hematoma. Thermocoagulation was performed in 8 patients and stopped or significantly reduced seizure frequency in 7 (88%). Outcome of surgical resection (n=33) was good, with 20 (61%) seizure-free patients and 32 (97%) with definite improvement. CONCLUSIONS Our findings suggest that sEEG is an effective technique for EZ location in patients with drug-resistant epilepsy. sEEG was contributive in up to 92% of patients, allowing thermocoagulation and/or surgical resection that resulted in seizure-freedom in two-thirds and seizure-reduction in one-third of cases. This study highlights the need for strict selection of implantation candidates, with strong initial hypothesis as to EZ location.
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54
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Gillinder L, Papacostas J, Devlin M, Campbell R, Dionisio S. Minimally invasive epilepsy surgery using radiofrequency ablation is now available in Australia. Intern Med J 2020; 50:503-505. [PMID: 32270613 DOI: 10.1111/imj.14801] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2019] [Revised: 06/28/2019] [Accepted: 06/29/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Lisa Gillinder
- Mater Centre for Neurosciences, Mater Hospital, Brisbane, Queensland, Australia
| | - Jason Papacostas
- Mater Centre for Neurosciences, Mater Hospital, Brisbane, Queensland, Australia
| | - Michael Devlin
- Mater Centre for Neurosciences, Mater Hospital, Brisbane, Queensland, Australia
| | - Robert Campbell
- Mater Centre for Neurosciences, Mater Hospital, Brisbane, Queensland, Australia
| | - Sasha Dionisio
- Mater Centre for Neurosciences, Mater Hospital, Brisbane, Queensland, Australia
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55
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Surgical techniques: Stereoelectroencephalography-guided radiofrequency-thermocoagulation (SEEG-guided RF-TC). Seizure 2020; 77:64-68. [DOI: 10.1016/j.seizure.2019.01.021] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Revised: 01/19/2019] [Accepted: 01/22/2019] [Indexed: 01/24/2023] Open
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56
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Taussig D, Chipaux M, Fohlen M, Dorison N, Bekaert O, Ferrand-Sorbets S, Dorfmüller G. Invasive evaluation in children (SEEG vs subdural grids). Seizure 2020; 77:43-51. [DOI: 10.1016/j.seizure.2018.11.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Revised: 11/09/2018] [Accepted: 11/14/2018] [Indexed: 10/27/2022] Open
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Franco AC, Peralta AR, Morgado C, Gonçalves Ferreira A, Rainha Campos A, Bentes C. Stereo-EEG recording and minimally invasive treatment of a periventricular nodular heterotopy: Two-in-one strategy. Clin Neurophysiol 2020; 131:1099-1101. [PMID: 32200091 DOI: 10.1016/j.clinph.2020.02.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Accepted: 02/29/2020] [Indexed: 11/16/2022]
Affiliation(s)
- Ana Catarina Franco
- EEG/Sleep Lab and Neurophysiology Monitoring Unit, Department of Neurosciences and Mental Health (Neurology), Hospital de Santa Maria, Centro Hospitalar Universitário de Lisboa Norte, Lisboa, Portugal; Department of Neurosciences and Mental Health, Department of Neurology, Hospital de Santa Maria, Centro Hospitalar Universitário de Lisboa Norte, Lisboa, Portugal; Faculdade de Medicina da Universidade de Lisboa, Lisboa, Portugal; Centro de Referência Para Epilepsias Refractárias from EpiCare Network (European Reference Network for Rare and Complex Epilepsies), Hospital de Santa Maria, CHLUN, Lisboa, Portugal.
| | - Ana Rita Peralta
- EEG/Sleep Lab and Neurophysiology Monitoring Unit, Department of Neurosciences and Mental Health (Neurology), Hospital de Santa Maria, Centro Hospitalar Universitário de Lisboa Norte, Lisboa, Portugal; Department of Neurosciences and Mental Health, Department of Neurology, Hospital de Santa Maria, Centro Hospitalar Universitário de Lisboa Norte, Lisboa, Portugal; Faculdade de Medicina da Universidade de Lisboa, Lisboa, Portugal; Centro de Referência Para Epilepsias Refractárias from EpiCare Network (European Reference Network for Rare and Complex Epilepsies), Hospital de Santa Maria, CHLUN, Lisboa, Portugal
| | - Carlos Morgado
- Department of Neuroradiology, Hospital de Santa Maria, Centro Hospitalar Universitário de Lisboa Norte, Lisboa, Portugal; Centro de Referência para Epilepsias Refractárias from EpiCare Network (European Reference Network for rare and complex Epilepsies), Hospital de Santa Maria, CHLUN, Lisboa, Portugal
| | - António Gonçalves Ferreira
- Department of Neurosciences and Mental Health, Department of Neurosurgery, Hospital de Santa Maria, Centro Hospitalar Universitário de Lisboa Norte, Lisboa, Portugal; Faculdade de Medicina da Universidade de Lisboa, Lisboa, Portugal; Centro de Referência para Epilepsias Refractárias from EpiCare Network (European Reference Network for rare and complex Epilepsies), Hospital de Santa Maria, CHLUN, Lisboa, Portugal
| | - Alexandre Rainha Campos
- Department of Neurosciences and Mental Health, Department of Neurosurgery, Hospital de Santa Maria, Centro Hospitalar Universitário de Lisboa Norte, Lisboa, Portugal; Faculdade de Medicina da Universidade de Lisboa, Lisboa, Portugal; Centro de Referência para Epilepsias Refractárias from EpiCare Network (European Reference Network for rare and complex Epilepsies), Hospital de Santa Maria, CHLUN, Lisboa, Portugal
| | - Carla Bentes
- EEG/Sleep Lab and Neurophysiology Monitoring Unit, Department of Neurosciences and Mental Health (Neurology), Hospital de Santa Maria, Centro Hospitalar Universitário de Lisboa Norte, Lisboa, Portugal; Department of Neurosciences and Mental Health, Department of Neurology, Hospital de Santa Maria, Centro Hospitalar Universitário de Lisboa Norte, Lisboa, Portugal; Faculdade de Medicina da Universidade de Lisboa, Lisboa, Portugal; Centro de Referência para Epilepsias Refractárias from EpiCare Network (European Reference Network for rare and complex Epilepsies), Hospital de Santa Maria, CHLUN, Lisboa, Portugal
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58
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Gao R, Yu T, Xu C, Zhang X, Yan X, Ni D, Zhang X, Ma K, Qiao L, Zhu J, Wang X, Ren Z, Zhang X, Zhang G, Li Y. The value of magnetoencephalography for stereo-EEG-guided radiofrequency thermocoagulation in MRI-negative epilepsy. Epilepsy Res 2020; 163:106322. [PMID: 32278277 DOI: 10.1016/j.eplepsyres.2020.106322] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2019] [Revised: 02/24/2020] [Accepted: 03/19/2020] [Indexed: 12/31/2022]
Abstract
OBJECTIVE Magnetoencephalography (MEG) is valuable for guiding resective surgery in patients with epilepsy. However, its value for minimally invasive treatment is still unknown. This study aims to evaluate the value of MEG for stereo-electroencephalogram (EEG)-guided radiofrequency thermocoagulation (SEEG-guided RF-TC) in magnetic resonance imaging (MRI)-negative epilepsies. METHODS An observational cohort study was performed and 19 MRI-negative patients who underwent SEEG-guided RF-TC in our epilepsy center were included. In addition, 16 MRI-positive patients were included as a reference group. Semiology, electrophysiology, and imaging information were collected. To evaluate the value of locating the MEG cluster, the proportion of the RF-TC contacts located in the MEG cluster out of all contacts used to perform RF-TC in each patient was calculated. All patients underwent the standard SEEG-guided RF-TC procedure and were followed up after the treatment. RESULTS Nineteen MRI-negative patients were divided into two groups based on the existence of MEG clusters; 10 patients with MEG clusters were in group I and nine patients without any MEG cluster were in group II. No significant difference was observed in terms of age, sex, type of seizures, or number of SEEG electrodes implanted. The median of the proportion of contacts in the MEG cluster was 77.0 % (IQR 57.7-100.0 %). The follow-up results showed that the probability of being seizure-free at one year after RFTC in MRI-negative patients with an MEG cluster was 30.0 % (95 % CI 11.6-77.3 %), significantly (p = 0.014) higher than that in patients without an MEG cluster; there was no significant difference when compared with MRI-positive patients. CONCLUSION This is the first study to evaluate the value of MEG in SEEG-guided RF-TC in MRI-negative epilepsies. MEG is a useful supplement for patients with MRI-negative epilepsy. MEG can be applied in minimally invasive treatment. MEG clusters can help identify better candidates and provide a valuable target for SEEG-guided RF-TC, which leads to better outcomes.
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Affiliation(s)
- Runshi Gao
- Beijing Institute of Functional Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Tao Yu
- Beijing Institute of Functional Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Cuiping Xu
- Beijing Institute of Functional Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Xiating Zhang
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Xiaoming Yan
- Beijing Institute of Functional Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Duanyu Ni
- Beijing Institute of Functional Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Xiaohua Zhang
- Beijing Institute of Functional Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Kai Ma
- Beijing Institute of Functional Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Liang Qiao
- Beijing Institute of Functional Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Jin Zhu
- Beijing Institute of Functional Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Xueyuan Wang
- Beijing Institute of Functional Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Zhiwei Ren
- Beijing Institute of Functional Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Xi Zhang
- Beijing Institute of Functional Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Guojun Zhang
- Beijing Institute of Functional Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Yongjie Li
- Beijing Institute of Functional Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China.
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59
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Andrews JP, Gummadavelli A, Farooque P, Bonito J, Arencibia C, Blumenfeld H, Spencer DD. Association of Seizure Spread With Surgical Failure in Epilepsy. JAMA Neurol 2020; 76:462-469. [PMID: 30508033 DOI: 10.1001/jamaneurol.2018.4316] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Seizures recur in as many as half of patients who undergo surgery for drug-resistant temporal lobe epilepsy (TLE). Understanding why TLE is resistant to surgery in some patients may reveal insights into epileptogenic networks and direct new therapies to improve outcomes. Objective To characterize features of surgically refractory TLE. Design, Setting, and Participants Medical records from a comprehensive epilepsy center were retrospectively reviewed for 131 patients who received a standard anteromedial temporal resection by a single surgeon from January 1, 2000, to December 31, 2015. Thirteen patients were excluded for having less than 1 year of follow-up. Patients at the highest risk for seizure recurrence were identified. Intracranial electroencephalogram (iEEG) analyses generated 3-dimensional seizure spread representations and quantified rapid seizure spread. The final analyses of seizure outcome and follow-up data were performed in June 2017. Main Outcomes and Measures The Engel class seizure outcome following surgery was evaluated for all patients, defining seizure recurrence as Engel class II or greater. Intracranial recordings of neocortical grids/strips and depth electrodes were analyzed visually for seizure spread. Fast β power was projected onto reconstructions of patients' brain magnetic resonance imaging scans to visualize spread patterns and was quantified to compare power within vs outside resective margins. Results Of 118 patients with 1 year of follow-up or more (mean [SD], 6.5 [4.6] years), 66 (55.9%) were women and 52 (44.1%) were men (median age, 39 years [range, 4-66 years]). The cumulative probability of continuous Engel class I seizure freedom since surgery at postoperative year 10 and afterward was 65.6%, with 92% of recurrences in years 1 to 3. Multivariable statistical analyses found that the selection for iEEG study was the most reliable predictor of seizure recurrence, with a mixed-effects model estimating that the Engel score in the iEEG cohort was higher by a mean (SD) of 1.1 (0.33) (P = .001). In patients with iEEG results, rapid seizure spread in less than 10 seconds was associated with recurrence (hazard ratio, 5.99; 95% CI, 1.7-21.1; P < .01). In the first 10 seconds of seizures, fast β power activity outside the resective margins in the lateral temporal cortex was significantly greater in patients whose seizures recurred compared with patients who were seizure-free (mean [SEM], 137.5% [16.8%] vs 93.4% [4.6%]; P < .05). Conclusions and significance Rapid seizure spread outside anteromedial temporal resection resective margins plays a significant role in the surgical failure of drug-resistant TLE. Seizure control after epilepsy surgery might be improved by investigating areas of early spread as candidates for resection or neuromodulation.
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Affiliation(s)
- John P Andrews
- Department of Neurosurgery, Yale University School of Medicine, New Haven, Connecticut.,Department of Neurology, Yale University School of Medicine, New Haven, Connecticut
| | - Abhijeet Gummadavelli
- Department of Neurosurgery, Yale University School of Medicine, New Haven, Connecticut
| | - Pue Farooque
- Department of Neurology, Yale University School of Medicine, New Haven, Connecticut
| | - Jennifer Bonito
- Department of Neurosurgery, Yale University School of Medicine, New Haven, Connecticut
| | | | - Hal Blumenfeld
- Department of Neurosurgery, Yale University School of Medicine, New Haven, Connecticut.,Department of Neurology, Yale University School of Medicine, New Haven, Connecticut.,Department of Neuroscience, Yale University School of Medicine, New Haven, Connecticut
| | - Dennis D Spencer
- Department of Neurosurgery, Yale University School of Medicine, New Haven, Connecticut.,Department of Neurology, Yale University School of Medicine, New Haven, Connecticut
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Wang D, Wei P, Shan Y, Ren L, Wang Y, Zhao G. Optimized stereoelectroencephalography-guided radiofrequency thermocoagulation in the treatment of patients with focal epilepsy. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:15. [PMID: 32055606 DOI: 10.21037/atm.2019.10.112] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Epilepsy is a severe health disorder affecting people of all ages with high prevalence worldwide. The introduction of new antiepileptic drugs has yielded notable effects in recent decades, yet there are still approximately 30% of patients with seizures refractory to medical therapy. Open surgical resection is widely accepted as a highly effective approach for the treatment of drug-resistant focal epilepsy if the epileptogenic zone can be precisely delineated. However, concerns about the impact of open surgery on brain function have driven considerable interest in less invasive techniques. Clinically, stereoelectroencephalography (SEEG) offers a unique means of exploring the pathophysiologic process and accurately mapping the epileptogenic network in presurgical evaluations for patients with epilepsy because of insufficient information from other noninvasive investigations. Moreover, SEEG-guided radiofrequency thermocoagulation (SEEG-guided RF-TC), which ablates lesions directly through the recording electrodes according to electroclinical evidence, has emerged as a promising, minimally invasive modality with notable preservation of neurocognitive functions. This critical review summarizes the technical details of the parameters and the selection of patients for SEEG-guided RF-TC based on the literature as well as our experiences. With respect to the parameters, the power and duration of RF-TC are discussed. In particular, an optimized SEEG-guided RF-TC modality that integrates more contacts from multiple different electrodes to create a confluent lesioning field is proposed for a more curative effect in comparison to the current protocol of palliative treatment in which RF-TC selectively disrupts critical hubs in the epileptic network through contiguous contacts within the range of a single electrode. Currently, SEEG-guided RF-TC is indicated for a variety of small, deeply seeded and well-demarcated epileptogenic foci, such as deep heterotopic nodules and hypothalamic hamartoma. The efficacy of treating patients with focal cortical dysplasias in the eloquent cortex and with mesial temporal lobe epilepsy associated with hippocampal sclerosis needs to be further determined. Given the small number of patients reported, randomized controlled trials are necessary to compare the efficacy of SEEG-guided RF-TC with conventional methods in the future.
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Affiliation(s)
- Di Wang
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China.,The Beijing Key Laboratory of Neuromodulation, Beijing 100053, China
| | - Penghu Wei
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
| | - Yongzhi Shan
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
| | - Liankun Ren
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China.,The Beijing Key Laboratory of Neuromodulation, Beijing 100053, China
| | - Yuping Wang
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China.,The Beijing Key Laboratory of Neuromodulation, Beijing 100053, China
| | - Guoguang Zhao
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
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61
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Vila-Vidal M, Pérez Enríquez C, Principe A, Rocamora R, Deco G, Tauste Campo A. Low entropy map of brain oscillatory activity identifies spatially localized events: A new method for automated epilepsy focus prediction. Neuroimage 2019; 208:116410. [PMID: 31785422 DOI: 10.1016/j.neuroimage.2019.116410] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Revised: 11/07/2019] [Accepted: 11/26/2019] [Indexed: 10/25/2022] Open
Abstract
The spatial mapping of localized events in brain activity critically depends on the correct identification of the pattern signatures associated with those events. For instance, in the context of epilepsy research, a number of different electrophysiological patterns have been associated with epileptogenic activity. Motivated by the need to define automated seizure focus detectors, we propose a novel data-driven algorithm for the spatial identification of localized events that is based on the following rationale: the distribution of emerging oscillations during confined events across all recording sites is highly non-uniform and can be mapped using a spatial entropy function. By applying this principle to EEG recording obtained from 67 distinct seizure epochs, our method successfully identified the seizure focus on a group of ten drug-resistant temporal lobe epilepsy patients (average sensitivity: 0.94, average specificity: 0.90) together with its characteristic electrophysiological pattern signature. Cross-validation of the method outputs with postresective information revealed the consistency of our findings in long follow-up seizure-free patients. Overall, our methodology provides a reliable computational procedure that might be used as in both experimental and clinical domains to identify the neural populations undergoing an emerging functional or pathological transition.
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Affiliation(s)
- Manel Vila-Vidal
- Center for Brain and Cognition, Department of Information and Communication Technologies, Universitat Pompeu Fabra, 08005, Barcelona, Spain.
| | | | - Alessandro Principe
- Hospital del Mar Medical Research Institute, 08003, Barcelona, Spain; Epilepsy Monitoring Unit, Department of Neurology, Hospital del Mar, 08003, Barcelona, Spain; Faculty of Health and Life Sciences, Universitat Pompeu Fabra, 08003, Barcelona, Spain
| | - Rodrigo Rocamora
- Hospital del Mar Medical Research Institute, 08003, Barcelona, Spain; Epilepsy Monitoring Unit, Department of Neurology, Hospital del Mar, 08003, Barcelona, Spain; Faculty of Health and Life Sciences, Universitat Pompeu Fabra, 08003, Barcelona, Spain.
| | - Gustavo Deco
- Center for Brain and Cognition, Department of Information and Communication Technologies, Universitat Pompeu Fabra, 08005, Barcelona, Spain; Institució Catalana de Recerca i Estudis Avançats, 08010, Barcelona, Spain
| | - Adrià Tauste Campo
- Center for Brain and Cognition, Department of Information and Communication Technologies, Universitat Pompeu Fabra, 08005, Barcelona, Spain.
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62
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Bourdillon P, Châtillon CE, Moles A, Rheims S, Catenoix H, Montavont A, Ostrowsky-Coste K, Boulogne S, Isnard J, Guénot M. Effective accuracy of stereoelectroencephalography: robotic 3D versus Talairach orthogonal approaches. J Neurosurg 2019; 131:1938-1946. [PMID: 30544338 DOI: 10.3171/2018.7.jns181164] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Accepted: 07/16/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Stereoelectroencephalography (SEEG) was first developed in the 1950s by Jean Talairach using 2D angiography and a frame-based, orthogonal approach through a metallic grid. Since then, various other frame-based and frameless techniques have been described. In this study the authors sought to compare the traditional orthogonal Talairach 2D angiographic approach with a frame-based 3D robotic procedure that included 3D angiographic interoperative imaging guidance. MRI was used for both procedures during surgery, but MRI preplanning was done only in the robotic 3D technique. METHODS All study patients suffered from drug-resistant focal epilepsy and were treated at the same center by the same neurosurgical team. Fifty patients who underwent the 3D robotic procedure were compared to the same number of historical controls who had previously been successfully treated with the Talairach orthogonal procedure. The effectiveness and absolute accuracy, as well as safety, of the two procedures were compared. Moreover, in the 3D robotic group, the reliability of the preoperative MRI to avoid vascular structures was evaluated by studying the rate of trajectory modification following the coregistration of the intraoperative 3D angiographic data onto the preoperative MRI-based trajectory plans. RESULTS Effective accuracy (96.5% vs 13.7%) and absolute accuracy (1.15 mm vs 4.00 mm) were significantly higher in the 3D robotic group than in the Talairach orthogonal group. Both procedures showed excellent safety results (no major complications). The rate of electrode modification after 3D angiography was 43.8%, and it was highest for frontal and insular locations. CONCLUSIONS The frame-based, 3D angiographic, robotic procedure described here provided better accuracy for SEEG implantations than the traditional Talairach approach. This study also highlights the potential safety advantage of trajectory planning using intraoperative frame-based 3D angiography over preoperative MRI alone.
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Affiliation(s)
- Pierre Bourdillon
- 1Department of Neurosurgery, Neurology & Neurosurgery Hospital Pierre Wertheimer, Hospices Civils de Lyon, Lyon, France
- 2Faculty of Medicine Claude Bernard, University of Lyon, Lyon, France
- 3Faculty of Science & Engineering, Sorbonne University, Paris, France
- 4Brain and Spine Institute, INSERM U1127, CNRS 7225, Paris, France
| | - Claude-Edouard Châtillon
- 5Department of Surgery, Service of Neurosurgery, Centre Hospitalier Affilié Universitaire Régional, Trois-Rivières Hospital, Trois-Rivières, Quebec, Canada
- 6Faculty of Medicine, Division of Neurosurgery, Université de Montréal, Montreal, Quebec, Canada
| | - Alexis Moles
- 1Department of Neurosurgery, Neurology & Neurosurgery Hospital Pierre Wertheimer, Hospices Civils de Lyon, Lyon, France
| | - Sylvain Rheims
- 2Faculty of Medicine Claude Bernard, University of Lyon, Lyon, France
- 7Department of Functional Neurology and Epileptology, Neurology & Neurosurgery Hospital Pierre Wertheimer, Hospices Civils de Lyon, Lyon, France
- 8TIGER, Neuroscience Research Center of Lyon, INSERM U1028, CNRS 5292, Université de Lyon, Lyon, France; and
| | - Hélène Catenoix
- 7Department of Functional Neurology and Epileptology, Neurology & Neurosurgery Hospital Pierre Wertheimer, Hospices Civils de Lyon, Lyon, France
| | - Alexandra Montavont
- 7Department of Functional Neurology and Epileptology, Neurology & Neurosurgery Hospital Pierre Wertheimer, Hospices Civils de Lyon, Lyon, France
| | - Karine Ostrowsky-Coste
- 7Department of Functional Neurology and Epileptology, Neurology & Neurosurgery Hospital Pierre Wertheimer, Hospices Civils de Lyon, Lyon, France
| | - Sebastien Boulogne
- 2Faculty of Medicine Claude Bernard, University of Lyon, Lyon, France
- 7Department of Functional Neurology and Epileptology, Neurology & Neurosurgery Hospital Pierre Wertheimer, Hospices Civils de Lyon, Lyon, France
| | - Jean Isnard
- 7Department of Functional Neurology and Epileptology, Neurology & Neurosurgery Hospital Pierre Wertheimer, Hospices Civils de Lyon, Lyon, France
| | - Marc Guénot
- 1Department of Neurosurgery, Neurology & Neurosurgery Hospital Pierre Wertheimer, Hospices Civils de Lyon, Lyon, France
- 2Faculty of Medicine Claude Bernard, University of Lyon, Lyon, France
- 9NEUROPAIN Team, Lyon Neuroscience Research Center, INSERM U1028, CNRS 5292, Université de Lyon, Lyon, France
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Staudt MD, Maturu S, Miller JP. Radiofrequency Energy and Electrode Proximity Influences Stereoelectroencephalography-Guided Radiofrequency Thermocoagulation Lesion Size: An In Vitro Study with Clinical Correlation. Oper Neurosurg (Hagerstown) 2019; 15:461-469. [PMID: 29462411 DOI: 10.1093/ons/opx291] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Accepted: 12/21/2017] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Radiofrequency thermocoagulation of epileptogenic foci via stereoelectroencephalography (SEEG) electrodes has been suggested as a treatment for medically intractable epilepsy, but reported outcomes have been suboptimal, possibly because lesions generated using conventional high-energy radiofrequency parameters are relatively small. OBJECTIVE To describe a technique of delivering low energy across separate SEEG electrodes in order to create large confluent radiofrequency lesions. METHODS The size and configuration of radiofrequency lesions using different radiofrequency intensity and interelectrode distance was assessed in egg whites. Magnetic resonance images (MRI) from 3 patients who had undergone radiofrequency lesion creation were evaluated to determine the contribution of lesion intensity and electrode separation on lesion size. Electroencephalography, MRI, and clinical data were assessed before and after lesion creation. RESULTS Both in Vitro and in Vivo analysis revealed that less energy paradoxically produced larger lesions, with the largest possible lesions produced when radiofrequency power was applied for long duration at less than 3 W. Linear separation of electrodes also contributed to lesion size, with largest lesions produced when electrodes were separated by a linear distance of between 5 and 12 mm. Clinical lesions produced using these parameters were large and resulted in improvement in interictal and ictal activity. CONCLUSION Radiofrequency lesions produced using low-energy delivery between SEEG electrodes in close proximity can produce a large lesion. These findings might have advantages for treatment of focal epilepsy.
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Affiliation(s)
- Michael D Staudt
- Department of Neurosurgery, University Hospital Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Sarita Maturu
- Department of Neurosurgery, University Hospital Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Jonathan P Miller
- Department of Neurosurgery, University Hospital Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio
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Baumgartner C, Koren JP, Britto-Arias M, Zoche L, Pirker S. Presurgical epilepsy evaluation and epilepsy surgery. F1000Res 2019; 8. [PMID: 31700611 PMCID: PMC6820825 DOI: 10.12688/f1000research.17714.1] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/14/2019] [Indexed: 12/21/2022] Open
Abstract
With a prevalence of 0.8 to 1.2%, epilepsy represents one of the most frequent chronic neurological disorders; 30 to 40% of patients suffer from drug-resistant epilepsy (that is, seizures cannot be controlled adequately with antiepileptic drugs). Epilepsy surgery represents a valuable treatment option for 10 to 50% of these patients. Epilepsy surgery aims to control seizures by resection of the epileptogenic tissue while avoiding neuropsychological and other neurological deficits by sparing essential brain areas. The most common histopathological findings in epilepsy surgery specimens are hippocampal sclerosis in adults and focal cortical dysplasia in children. Whereas presurgical evaluations and surgeries in patients with mesial temporal sclerosis and benign tumors recently decreased in most centers, non-lesional patients, patients requiring intracranial recordings, and neocortical resections increased. Recent developments in neurophysiological techniques (high-density electroencephalography [EEG], magnetoencephalography, electrical and magnetic source imaging, EEG-functional magnetic resonance imaging [EEG-fMRI], and recording of pathological high-frequency oscillations), structural magnetic resonance imaging (MRI) (ultra-high-field imaging at 7 Tesla, novel imaging acquisition protocols, and advanced image analysis [post-processing] techniques), functional imaging (positron emission tomography and single-photon emission computed tomography co-registered to MRI), and fMRI significantly improved non-invasive presurgical evaluation and have opened the option of epilepsy surgery to patients previously not considered surgical candidates. Technical improvements of resective surgery techniques facilitate successful and safe operations in highly delicate brain areas like the perisylvian area in operculoinsular epilepsy. Novel less-invasive surgical techniques include stereotactic radiosurgery, MR-guided laser interstitial thermal therapy, and stereotactic intracerebral EEG-guided radiofrequency thermocoagulation.
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Affiliation(s)
- Christoph Baumgartner
- Department of Neurology, General Hospital Hietzing with Neurological Center Rosenhügel, Vienna, Austria.,Karl Landsteiner Institute for Clinical Epilepsy Research and Cognitive Neurology, Vienna, Austria.,Medical Faculty, Sigmund Freud University, Vienna, Austria
| | - Johannes P Koren
- Department of Neurology, General Hospital Hietzing with Neurological Center Rosenhügel, Vienna, Austria.,Karl Landsteiner Institute for Clinical Epilepsy Research and Cognitive Neurology, Vienna, Austria
| | - Martha Britto-Arias
- Department of Neurology, General Hospital Hietzing with Neurological Center Rosenhügel, Vienna, Austria.,Karl Landsteiner Institute for Clinical Epilepsy Research and Cognitive Neurology, Vienna, Austria
| | - Lea Zoche
- Department of Neurology, General Hospital Hietzing with Neurological Center Rosenhügel, Vienna, Austria.,Karl Landsteiner Institute for Clinical Epilepsy Research and Cognitive Neurology, Vienna, Austria
| | - Susanne Pirker
- Department of Neurology, General Hospital Hietzing with Neurological Center Rosenhügel, Vienna, Austria.,Karl Landsteiner Institute for Clinical Epilepsy Research and Cognitive Neurology, Vienna, Austria
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Liu Y, Zhou W, Hong B, Zhao T, Xu C, Ruan J, Bai J, Wang S. Multiple Stereoelectroencephalography-Guided Radiofrequency Thermocoagulations for Polymicrogyria With Startle Seizures: A Case Report. Front Neurol 2019; 10:1095. [PMID: 31681156 PMCID: PMC6813566 DOI: 10.3389/fneur.2019.01095] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Accepted: 09/30/2019] [Indexed: 01/01/2023] Open
Abstract
The best results of stereoelectroencephalography (SEEG)-guided radiofrequency thermocoagulation (RF-TC) were observed in epilepsies with more limited lesions, but this procedure is rarely used in a wide range of brain malformation. We report a rare case of polymicrogyria (PMG) combined with drug-resistant startle seizures. Presurgical monitoring was performed using SEEG owing to the large lesion and complexity of PMG. According to the intracranial electrode results, the seizure onset was extensive, with the onset starting earlier in the cingulate sulcus and insular pole than in other sites of the other electrodes. Multi-point and multi-step SEEG-guided RF-TC was used for diffuse lesion and functional protection. RF-TC was first applied to the cingulate sulcus and insular pole, and our patient was rendered free from startle seizures after 2 weeks. Two weeks of observation helped us to observe the efficacy of RF-TC and the changes of SEEG, so as to make the next TC scheme. The patient still had spontaneous seizures after the first treatment. RF-TC was then applied to other sites involved earlier. Finally, the patient reached Engel class IIa for a follow-up period of 1 year. There were no additional startle seizures, and important functional areas were protected.
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Affiliation(s)
- Yi'Ou Liu
- Tsinghua University Yuquan Hospital, Beijing, China
| | - Wenjing Zhou
- Tsinghua University Yuquan Hospital, Beijing, China
| | - Bo Hong
- Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing, China
| | - Tong Zhao
- Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing, China
| | - Chengwei Xu
- Inner Mongolia People's Hospital, Inner Mongolia Autonomous Region, Hohhot, China
| | - Jing Ruan
- Tsinghua University Yuquan Hospital, Beijing, China
| | - Jianjun Bai
- Tsinghua University Yuquan Hospital, Beijing, China
| | - Siyu Wang
- Tsinghua University Yuquan Hospital, Beijing, China
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Optimized SEEG-guided radiofrequency thermocoagulation for mesial temporal lobe epilepsy with hippocampal sclerosis. Seizure 2019; 71:304-311. [DOI: 10.1016/j.seizure.2019.08.011] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2019] [Revised: 08/17/2019] [Accepted: 08/23/2019] [Indexed: 02/03/2023] Open
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Lee CY, Li HT, Wu T, Cheng MY, Lim SN, Lee ST. Efficacy of limited hippocampal radiofrequency thermocoagulation for mesial temporal lobe epilepsy. J Neurosurg 2019; 131:781-789. [PMID: 30497199 DOI: 10.3171/2018.4.jns184] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Accepted: 04/26/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Radiofrequency thermocoagulation (RFTC), which has been developed for drug-resistant epilepsy patients, involves less brain tissue loss due to surgery, fewer surgical adverse effects, and generally good seizure control. This study demonstrates the effectiveness of RFTC performed at limited hippocampal locations. METHODS Daily seizure diaries were prospectively maintained for at least 6 months by 9 patients (ages 30-59 years) with drug-resistant mesial temporal lobe epilepsy (MTLE) before treatment with RFTC. The limited target for stereotactic RFTC was chosen based on intraoperative electroencephalography (EEG) recording and was initially tested with a Radionics electrode at a low temperature, 45°C, for 60 seconds. The therapeutic RFTC heating parameters were 78°C-80°C for 90 seconds. All patients who received the RFTC treatment underwent both MRI and EEG recording immediately postoperatively and at the 3-month follow-up. Monthly outpatient clinic visits were arranged over 6 months to document seizure frequency and severity to clarify the changes noted in imaging studies and EEG patterns. RESULTS Two patients were excluded from our analysis because one had undergone multiple seizure surgeries and the other had a poor recording of seizure frequency, before the RFTC surgery. Five and two patients underwent left-sided and right-sided RFTC, respectively. None of the patients had generalized tonic-clonic attacks postoperatively, and no adverse effects or complications occurred. According to MRI data, the effect of coagulation was limited to less than 1.0 cm in diameter and perifocal edema was also in limited range. The seizure frequency within 6 months decreased postoperatively with a mean reduction in seizures of 78% (range 36%-100%). Only two patients had a temporary increase in seizure frequency within 2 weeks of the surgery, and over 50% of all patients showed a decrease in average seizure frequency. CONCLUSIONS The study results confirm that limited RFTC provides a more effective surgery with similar seizure control but fewer complications than resective surgery for drug-resistant MTLE patients.
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Affiliation(s)
| | - Han-Tao Li
- 2Section of Epilepsy, Department of Neurology, Chang Gung Memorial Hospital Linkou Medical Center and Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Tony Wu
- 2Section of Epilepsy, Department of Neurology, Chang Gung Memorial Hospital Linkou Medical Center and Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Mei-Yun Cheng
- 2Section of Epilepsy, Department of Neurology, Chang Gung Memorial Hospital Linkou Medical Center and Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Siew-Na Lim
- 2Section of Epilepsy, Department of Neurology, Chang Gung Memorial Hospital Linkou Medical Center and Chang Gung University College of Medicine, Taoyuan, Taiwan
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Bourdillon P, Rheims S, Isnard J, Guénot M. Letter to the Editor. Temporal lobe epilepsy: open or stereotactic surgery? J Neurosurg 2019; 131:989. [PMID: 30797194 DOI: 10.3171/2018.11.jns183107] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Pierre Bourdillon
- 1Hospital Pierre Wertheimer, Hospices Civils de Lyon, Lyon, France
- 2University of Lyon, Faculty of Medicine Claude Bernard, Lyon, France
- 3Sorbonne University, Paris, France
- 4Brain and Spine Institute, INSERM U1127, CNRS, UMR7225, Paris, France
| | - Sylvain Rheims
- 1Hospital Pierre Wertheimer, Hospices Civils de Lyon, Lyon, France
- 2University of Lyon, Faculty of Medicine Claude Bernard, Lyon, France
- 5TIGER, Neuroscience Research Center of Lyon, INSERM U1028, CNRS 5292 Lyon, France; and
| | - Jean Isnard
- 1Hospital Pierre Wertheimer, Hospices Civils de Lyon, Lyon, France
| | - Marc Guénot
- 1Hospital Pierre Wertheimer, Hospices Civils de Lyon, Lyon, France
- 2University of Lyon, Faculty of Medicine Claude Bernard, Lyon, France
- 6NEUROPAIN Team, Lyon Neuroscience Research Center, INSERM U1028, CNRS 5292, Lyon, France
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SEEG-guided radiofrequency thermocoagulation of epileptic foci in the paediatric population: Feasibility, safety and efficacy. Seizure 2019; 70:63-70. [DOI: 10.1016/j.seizure.2019.07.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 05/28/2019] [Accepted: 07/02/2019] [Indexed: 11/18/2022] Open
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Iordanou JC, Camara D, Ghatan S, Panov F. Approach Angle Affects Accuracy in Robotic Stereoelectroencephalography Lead Placement. World Neurosurg 2019; 128:e322-e328. [DOI: 10.1016/j.wneu.2019.04.143] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Revised: 04/15/2019] [Accepted: 04/16/2019] [Indexed: 11/30/2022]
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Cardinale F, Rizzi M, Vignati E, Cossu M, Castana L, d’Orio P, Revay M, Costanza MD, Tassi L, Mai R, Sartori I, Nobili L, Gozzo F, Pelliccia V, Mariani V, Lo Russo G, Francione S. Stereoelectroencephalography: retrospective analysis of 742 procedures in a single centre. Brain 2019; 142:2688-2704. [DOI: 10.1093/brain/awz196] [Citation(s) in RCA: 88] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2018] [Revised: 04/24/2019] [Accepted: 05/06/2019] [Indexed: 11/13/2022] Open
Abstract
AbstractThis retrospective description of a surgical series is aimed at reporting on indications, methodology, results on seizures, outcome predictors and complications from a 20-year stereoelectroencephalography (SEEG) activity performed at a single epilepsy surgery centre. Prospectively collected data from a consecutive series of 742 SEEG procedures carried out on 713 patients were reviewed and described. Long-term seizure outcome of SEEG-guided resections was defined as a binomial variable: absence (ILAE classes 1–2) or recurrence (ILAE classes 3–6) of disabling seizures. Predictors of seizure outcome were analysed by preliminary uni/bivariate analyses followed by multivariate logistic regression. Furthermore, results on seizures of these subjects were compared with those obtained in 1128 patients operated on after only non-invasive evaluation. Survival analyses were also carried out, limited to patients with a minimum follow-up of 10 years. Resective surgery has been indicated for 570 patients (79.9%). Two-hundred and seventy-nine of 470 patients operated on (59.4%) were free of disabling seizures at least 2 years after resective surgery. Negative magnetic resonance and post-surgical lesion remnant were significant risk factors for seizure recurrence, while type II focal cortical dysplasia, balloon cells, glioneuronal tumours, hippocampal sclerosis, older age at epilepsy onset and periventricular nodular heterotopy were significantly associated with seizure freedom. Twenty-five of 153 patients who underwent radio-frequency thermal coagulation (16.3%) were optimal responders. Thirteen of 742 (1.8%) procedures were complicated by unexpected events, including three (0.4%) major complications and one fatality (0.1%). In conclusion, SEEG is a safe and efficient methodology for invasive definition of the epileptogenic zone in the most challenging patients. Despite the progressive increase of MRI-negative cases, the proportion of seizure-free patients did not decrease throughout the years.
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Affiliation(s)
- Francesco Cardinale
- ‘Claudio Munari’ Centre for Epilepsy Surgery, ASST GOM Niguarda, Milan, Italy
| | - Michele Rizzi
- ‘Claudio Munari’ Centre for Epilepsy Surgery, ASST GOM Niguarda, Milan, Italy
| | - Elena Vignati
- ‘Claudio Munari’ Centre for Epilepsy Surgery, ASST GOM Niguarda, Milan, Italy
| | - Massimo Cossu
- ‘Claudio Munari’ Centre for Epilepsy Surgery, ASST GOM Niguarda, Milan, Italy
| | - Laura Castana
- ‘Claudio Munari’ Centre for Epilepsy Surgery, ASST GOM Niguarda, Milan, Italy
| | - Piergiorgio d’Orio
- ‘Claudio Munari’ Centre for Epilepsy Surgery, ASST GOM Niguarda, Milan, Italy
- Neuroscience Institute, CNR, Parma, Italy
| | - Martina Revay
- ‘Claudio Munari’ Centre for Epilepsy Surgery, ASST GOM Niguarda, Milan, Italy
- Neurosurgery Residency Program, University of Milan, Milan, Italy
| | - Martina Della Costanza
- ‘Claudio Munari’ Centre for Epilepsy Surgery, ASST GOM Niguarda, Milan, Italy
- Neurosurgery Unit, Polytechnic, University of Marche, Ancona, Italy
| | - Laura Tassi
- ‘Claudio Munari’ Centre for Epilepsy Surgery, ASST GOM Niguarda, Milan, Italy
| | - Roberto Mai
- ‘Claudio Munari’ Centre for Epilepsy Surgery, ASST GOM Niguarda, Milan, Italy
| | - Ivana Sartori
- ‘Claudio Munari’ Centre for Epilepsy Surgery, ASST GOM Niguarda, Milan, Italy
| | - Lino Nobili
- Child Neuropsychiatry Unit, IRCCS ‘G. Gaslini’ Institute, DINOGMI, University of Genoa, Genoa, Italy
| | - Francesca Gozzo
- ‘Claudio Munari’ Centre for Epilepsy Surgery, ASST GOM Niguarda, Milan, Italy
| | - Veronica Pelliccia
- ‘Claudio Munari’ Centre for Epilepsy Surgery, ASST GOM Niguarda, Milan, Italy
- Department of Neuroscience, University of Parma, Parma, Italy
| | - Valeria Mariani
- ‘Claudio Munari’ Centre for Epilepsy Surgery, ASST GOM Niguarda, Milan, Italy
- Department of Neuroradiology, IRCCS Mondino Foundation, Pavia, Italy
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Giorgio Lo Russo
- ‘Claudio Munari’ Centre for Epilepsy Surgery, ASST GOM Niguarda, Milan, Italy
| | - Stefano Francione
- ‘Claudio Munari’ Centre for Epilepsy Surgery, ASST GOM Niguarda, Milan, Italy
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Malmgren K, Krýsl D. Epilepsy: Long-term outcomes in MRI-negative patients with epilepsy. Nat Rev Neurol 2019; 13:132-133. [PMID: 28252006 DOI: 10.1038/nrneurol.2017.24] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Kristina Malmgren
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy at Gothenburg University and Sahlgrenska University Hospital, Blå Stråket 7, 413 45 Gothenburg, Sweden
| | - David Krýsl
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy at Gothenburg University and Sahlgrenska University Hospital, Blå Stråket 7, 413 45 Gothenburg, Sweden
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Liu W, Tian S, Zhang J, Huang P, Wang T, Deng Y, Liu X, Miao F, Sun B, Zhan S. Utility of stereo-electroencephalography recording guided by magnetoencephalography in the surgical treatment of epilepsy patients with negative magnetic resonance imaging results. Int J Neurosci 2019; 129:1045-1052. [PMID: 31215295 DOI: 10.1080/00207454.2019.1634066] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Objective: It is challenging for neurosurgeons to perform surgeries on patients without detectable structural lesions. Therefore, this retrospective study aimed to explore the outcome of stereo-electroencephalography (SEEG) in suspicious areas guided by magnetoencephalography (MEG)-magnetic resonance imaging (MRI) reconstruction in MRI-negative epilepsy patients. Methods: This study included 47 patients with negative-MRI epilepsy. Seizure outcome at 24 months was assessed using a modified Engel's classification. Accordingly, class I and II were considered favorable outcomes, whereas classes III and IV were unfavorable. Furthermore, patients were classified into a consistent group if the results of MEG and SEEG indicated the same area of the brain. The relationship between surgical outcome and the concordance of MEG and SEEG was analyzed. Results: A complete seizure-free condition was achieved in 22 (47%) patients. Sex, handedness, age and duration of illness were not significantly associated with seizure-free outcome (p = .187 [Pearson chi-squared test]). The number of patients with favorable outcome (Engle I and II) was as high as 68% at the time of follow-up. Furthermore, more seizure-free patients were found in the SEEG and MEG consistent group. Conclusions: SEEG is a valuable tool in the pre-evaluation for resective epilepsy surgery, particularly in negative-MRI epilepsy patients; MEG greatly facilitates localization for SEEG electrode implantation. However, none of these tools are absolutely sensitive and reliable; therefore, collecting as much information as possible is necessary to achieve satisfactory results in epilepsy surgery.
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Affiliation(s)
- Wei Liu
- Department of Stereotactic and Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine , Shanghai , China
| | - Shuaiwei Tian
- Department of Neurosurgery, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine , Shanghai , China
| | - Jing Zhang
- Department of Stereotactic and Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine , Shanghai , China
| | - Peng Huang
- Department of Stereotactic and Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine , Shanghai , China
| | - Tao Wang
- Department of Stereotactic and Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine , Shanghai , China
| | - Yulei Deng
- Department of Neurology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine , Shanghai , China
| | - Xiaoying Liu
- Department of Neurology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine , Shanghai , China
| | - Fei Miao
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine , Shanghai , China
| | - Bomin Sun
- Department of Stereotactic and Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine , Shanghai , China
| | - Shikun Zhan
- Department of Stereotactic and Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine , Shanghai , China
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Mullatti N, Landre E, Mellerio C, Oliveira AJ, Laurent A, Turak B, Devaux B, Chassoux F. Stereotactic thermocoagulation for insular epilepsy: Lessons from successes and failures. Epilepsia 2019; 60:1565-1579. [DOI: 10.1111/epi.16092] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Revised: 05/14/2019] [Accepted: 05/28/2019] [Indexed: 11/27/2022]
Affiliation(s)
- Nandini Mullatti
- Department of Clinical Neurophysiology King's College Hospital London UK
| | - Elisabeth Landre
- Department of Neurosurgery Sainte‐Anne Hospital Paris‐Descartes University Paris France
| | - Charles Mellerio
- Department of Neuroradiology Sainte‐Anne Hospital Paris‐Descartes University Paris France
| | - Andrea J. Oliveira
- Department of Neurosurgery Sainte‐Anne Hospital Paris‐Descartes University Paris France
| | - Agathe Laurent
- Department of Neurosurgery Sainte‐Anne Hospital Paris‐Descartes University Paris France
| | - Baris Turak
- Department of Neurosurgery Sainte‐Anne Hospital Paris‐Descartes University Paris France
| | - Bertrand Devaux
- Department of Neurosurgery Sainte‐Anne Hospital Paris‐Descartes University Paris France
| | - Francine Chassoux
- Department of Neurosurgery Sainte‐Anne Hospital Paris‐Descartes University Paris France
- Nuclear Medicine Department Frederic Joliot Hospital Department, Commission of Nuclear Energy Orsay Orsay France
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Tomlinson SB, Buch VP, Armstrong D, Kennedy BC. Stereoelectroencephalography in Pediatric Epilepsy Surgery. J Korean Neurosurg Soc 2019; 62:302-312. [PMID: 31085956 PMCID: PMC6514312 DOI: 10.3340/jkns.2019.0015] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Accepted: 02/05/2019] [Indexed: 12/25/2022] Open
Abstract
Stereoelectroencephalography (SEEG) is an invasive technique used during the surgical management of medically refractory epilepsy. The utility of SEEG rests in its ability to survey the three-dimensional organization of the epileptogenic zone as well as nearby eloquent cortices. Once concentrated to specialized centers in Europe and Canada, the SEEG methodology has gained worldwide popularity due to its favorable morbidity profile, superior coverage of deep structures, and ability to perform multilobar explorations without the need for craniotomy. This rapid shift in practice represents both a challenge and an opportunity for pediatric neurosurgeons familiar with the subdural grid approach. The purpose of this review is to discuss the indications, technique, and safety of long-term SEEG monitoring in children. In addition to reviewing the conceptual and technical points of the diagnostic evaluation, attention will also be given to SEEG-based interventions (e.g., radiofrequency thermo-coagulation).
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Affiliation(s)
- Samuel B Tomlinson
- Division of Neurosurgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA.,School of Medicine and Dentistry, University of Rochester Medical Center, Rochester, NY, USA
| | - Vivek P Buch
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Dallas Armstrong
- Division of Child Neurology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Benjamin C Kennedy
- Division of Neurosurgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
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76
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77
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Malformations of cortical development: New surgical advances. Rev Neurol (Paris) 2019; 175:183-188. [DOI: 10.1016/j.neurol.2019.01.392] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Revised: 10/23/2018] [Accepted: 01/04/2019] [Indexed: 11/18/2022]
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78
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Bourdillon P, Cucherat M, Isnard J, Ostrowsky-Coste K, Catenoix H, Guénot M, Rheims S. Stereo-electroencephalography-guided radiofrequency thermocoagulation in patients with focal epilepsy: A systematic review and meta-analysis. Epilepsia 2018; 59:2296-2304. [DOI: 10.1111/epi.14584] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Revised: 09/24/2018] [Accepted: 09/24/2018] [Indexed: 01/16/2023]
Affiliation(s)
- Pierre Bourdillon
- Department of Functional Neurosurgery; Hospices Civils de Lyon; Lyon France
- Faculty of Medicine Claude Bernard; University of Lyon; Lyon France
| | - Michel Cucherat
- Faculty of Medicine Claude Bernard; University of Lyon; Lyon France
- Department of Clinical Pharmacology; Hospices Civils de Lyon; Lyon France
- Laboratory of Biometry and Evolutive Biology - UMR CNRS 5558; Lyon France
| | - Jean Isnard
- Lyon’s Neuroscience Research Center; INSERM U1028; CNRS 5292; Lyon France
- Department of Functional Neurology and Epileptology; Hospices Civils de Lyon; Lyon France
| | - Karine Ostrowsky-Coste
- Lyon’s Neuroscience Research Center; INSERM U1028; CNRS 5292; Lyon France
- Epilepsy, Sleep and Pediatric Neurophysiology Department; Hospices Civils de Lyon; Lyon France
| | - Hélène Catenoix
- Lyon’s Neuroscience Research Center; INSERM U1028; CNRS 5292; Lyon France
- Department of Functional Neurology and Epileptology; Hospices Civils de Lyon; Lyon France
| | - Marc Guénot
- Department of Functional Neurosurgery; Hospices Civils de Lyon; Lyon France
- Faculty of Medicine Claude Bernard; University of Lyon; Lyon France
- Lyon’s Neuroscience Research Center; INSERM U1028; CNRS 5292; Lyon France
| | - Sylvain Rheims
- Faculty of Medicine Claude Bernard; University of Lyon; Lyon France
- Lyon’s Neuroscience Research Center; INSERM U1028; CNRS 5292; Lyon France
- Department of Functional Neurology and Epileptology; Hospices Civils de Lyon; Lyon France
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79
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Mo JJ, Hu WH, Zhang C, Wang X, Liu C, Zhao BT, Zhou JJ, Zhang K. Value of stereo-electroencephalogram in reoperation of patients with pharmacoresistant epilepsy: a single center, retrospective study. Br J Neurosurg 2018; 32:663-670. [PMID: 30317876 DOI: 10.1080/02688697.2018.1506095] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Jia-Jie Mo
- Department of Functional Neurosurgery, Beijing Tian Tan Hospital, Capital Medical University, Beijing, China
| | - Wen-Han Hu
- Department of Functional Neurosurgery, Beijing Tian Tan Hospital, Capital Medical University, Beijing, China
- Epilepsy Center, Beijing Fengtai Hospital, Peking University, Beijing, China
| | - Chao Zhang
- Department of Functional Neurosurgery, Beijing Tian Tan Hospital, Capital Medical University, Beijing, China
| | - Xiu Wang
- Department of Functional Neurosurgery, Beijing Tian Tan Hospital, Capital Medical University, Beijing, China
| | - Chang Liu
- Epilepsy Center, Beijing Fengtai Hospital, Peking University, Beijing, China
| | - Bao-Tian Zhao
- Department of Functional Neurosurgery, Beijing Tian Tan Hospital, Capital Medical University, Beijing, China
| | - Jun-Jian Zhou
- Department of Functional Neurosurgery, Beijing Tian Tan Hospital, Capital Medical University, Beijing, China
| | - Kai Zhang
- Department of Functional Neurosurgery, Beijing Tian Tan Hospital, Capital Medical University, Beijing, China
- Epilepsy Center, Beijing Fengtai Hospital, Peking University, Beijing, China
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80
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Kuo CH, Feroze AH, Poliachik SL, Hauptman JS, Novotny EJ, Ojemann JG. Laser Ablation Therapy for Pediatric Patients with Intracranial Lesions in Eloquent Areas. World Neurosurg 2018; 121:e191-e199. [PMID: 30261370 DOI: 10.1016/j.wneu.2018.09.074] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2018] [Revised: 09/09/2018] [Accepted: 09/11/2018] [Indexed: 01/07/2023]
Abstract
BACKGROUND Laser interstitial thermal therapy (LITT) is an alternative, less-invasive, and, in some circumstances, effective treatment for patients with intracranial pathology including epilepsy and some tumors. For intracranial lesions in eloquent areas, resection by conventional craniotomy proves often to be a challenge, including in the care of pediatric patients. Herein, we reviewed our experience with magnetic resonance imaging (MRI)-guided LITT as treatment for pediatric patients with intracranial lesions in eloquent areas and evaluate neurologic function and clinical outcomes. METHODS We retrospectively reviewed consecutive patients with intracranial lesions in eloquent speech and motor areas who underwent MRI-guided LITT. Clinical evaluation, including neurologic function and neuropsychological testing, was conducted according to clinical considerations. MRI pre- and postoperative imaging was reviewed to compare the change of lesion size. RESULTS Five pediatric patients received MRI-guided LITT of intracranial lesions in eloquent cortex. One patient experienced complications secondary to MRI-guided LITT, but neither was discharged with a neurologic deficit. CONCLUSIONS For intracranial lesions in the eloquent cortex, conventional craniotomy with surgical resection is a challenge for neurosurgeons, especially pediatric patients. MRI-guided LITT provides a less-invasive and potentially effective option for treatment in the management of pediatric epilepsy and tumors.
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Affiliation(s)
- Chao-Hung Kuo
- Department of Neurological Surgery, University of Washington, Seattle, Washington, USA; Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan.
| | - Abdullah H Feroze
- Department of Neurological Surgery, University of Washington, Seattle, Washington, USA
| | - Sandra L Poliachik
- Department of Radiology, Seattle Children's Hospital, Seattle, Washington, USA; Department of Neurology, Seattle Children's Hospital, Seattle, Washington, USA
| | - Jason S Hauptman
- Department of Neurological Surgery, University of Washington, Seattle, Washington, USA; Division of Neurosurgery, Seattle Children's Hospital, Seattle, Washington, USA
| | - Edward J Novotny
- Department of Neurology, University of Washington, Seattle, Washington, USA; Department of Neurology, Seattle Children's Hospital, Seattle, Washington, USA
| | - Jeffrey G Ojemann
- Department of Neurological Surgery, University of Washington, Seattle, Washington, USA; Division of Neurosurgery, Seattle Children's Hospital, Seattle, Washington, USA
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81
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Challenges in managing epilepsy associated with focal cortical dysplasia in children. Epilepsy Res 2018; 145:1-17. [DOI: 10.1016/j.eplepsyres.2018.05.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2017] [Revised: 04/30/2018] [Accepted: 05/12/2018] [Indexed: 12/15/2022]
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Abstract
Focal epilepsy originating from the insular cortex is rare. One reason is the small amount of cortical tissue compared with other lobes of the brain. However, the incidence of insular epilepsy might be underestimated because of diagnostic difficulties. The semiology and the surface EEG are often not meaningful or even misleading, and elaborated imaging might be necessary. The close connections of the insular cortex with other potentially epileptogenic areas, such as the temporal lobe or frontal/central cortex, is increasingly recognized as possible reason for failure of epilepsy surgery for temporal or extratemporal seizures. Therefore, some centers consider invasive EEG recording of the insular cortex not only in case of insular epilepsy but also in other focal epilepsies with nonconclusive results from the presurgical work-up. The surgical approach to and resection of insular cortex is challenging because of its deep location and proximity to highly eloquent brain structures. Over the last decades, technical adjuncts like navigation tools, electrophysiological monitoring and intraoperative imaging have improved the outcome after surgery. Nevertheless, there is still a considerable rate of postoperative transient or permanent deficits, in some cases as unavoidable and calculated deficits. In most of the recent series, seizure outcome was favorable and comparable with extratemporal epilepsy surgery or even better. Up to now, the data volume concerning long-term follow-up is limited. This review focusses on the surgical challenges of resections to treat insular epilepsy, on prognostic factors concerning seizure outcome, on postoperative deficits and complications. Moreover, less invasive surgical techniques to treat epilepsy in this highly eloquent area are summarized.
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Garcia-Lorenzo B, del Pino-Sedeño T, Rocamora R, López JE, Serrano-Aguilar P, Trujillo-Martín MM. Stereoelectroencephalography for Refractory Epileptic Patients Considered for Surgery: Systematic Review, Meta-Analysis, and Economic Evaluation. Neurosurgery 2018; 84:326-338. [DOI: 10.1093/neuros/nyy261] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Accepted: 05/16/2018] [Indexed: 11/13/2022] Open
Affiliation(s)
- Borja Garcia-Lorenzo
- Bordeaux Population Health, Team EMOS, Université de Bordeaux, Inserm U1219, Bordeaux, France
- Fundación Canaria de Investigación Sanitaria (FUNCANIS), Santa Cruz de Tenerife, Spain
- Universitat Internacional de Catalunya (UIC), Barcelona, Spain
| | - Tasmania del Pino-Sedeño
- Fundación Canaria de Investigación Sanitaria (FUNCANIS), Santa Cruz de Tenerife, Spain
- Departamento de Psicología Clínica, Psicobiología y Metodología, Universidad de La Laguna, Santa Cruz de Tenerife, Spain
| | - Rodrigo Rocamora
- Epilepsy Unit, Department of Neurology, Hospital del Mar, Parc de Salut Mar, Barcelona, Spain
- Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
- Department of Experimental and Health Sciences, Pompeu Fabra University (UPF), Barcelona, Spain
| | - Juan Erviti López
- Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Madrid, Spain
- Servicio de Prestaciones Farmacéuticas, Dirección Atención Primaria, Servicio Navarro de Salud, Pamplona, Spain
| | - Pedro Serrano-Aguilar
- Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Madrid, Spain
- Servicio de Evaluación y Planificación (SESCS), Servicio Canario de la Salud, Santa Cruz de Tenerife, Spain
| | - María M Trujillo-Martín
- Fundación Canaria de Investigación Sanitaria (FUNCANIS), Santa Cruz de Tenerife, Spain
- Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Madrid, Spain
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84
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Moles A, Guénot M, Rheims S, Berthiller J, Catenoix H, Montavont A, Ostrowsky-Coste K, Boulogne S, Isnard J, Bourdillon P. SEEG-guided radiofrequency coagulation (SEEG-guided RF-TC) versus anterior temporal lobectomy (ATL) in temporal lobe epilepsy. J Neurol 2018; 265:1998-2004. [DOI: 10.1007/s00415-018-8958-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Revised: 06/20/2018] [Accepted: 06/21/2018] [Indexed: 10/28/2022]
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85
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Catenoix H, Bourdillon P, Guénot M, Isnard J. The combination of stereo-EEG and radiofrequency ablation. Epilepsy Res 2018; 142:117-120. [DOI: 10.1016/j.eplepsyres.2018.01.012] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Revised: 11/07/2017] [Accepted: 01/09/2018] [Indexed: 11/28/2022]
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86
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Vaugier L, Lagarde S, McGonigal A, Trébuchon A, Milh M, Lépine A, Scavarda D, Carron R, Bartolomei F. The role of stereoelectroencephalography (SEEG) in reevaluation of epilepsy surgery failures. Epilepsy Behav 2018. [PMID: 29526579 DOI: 10.1016/j.yebeh.2018.02.005] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Management of patients after initial epilepsy surgical failure is challenging. In this study, we report our experience in using the stereoelectroencephalography (SEEG) method in the reevaluation of patients after initial epilepsy surgical failure. We selected 28 patients examined through SEEG in our department for drug-resistant focal epilepsy following initial epilepsy surgical failure. For each patient, the residual seizure onset zone (rSOZ) as defined by SEEG was classified as either contiguous if the seizure onset zone (SOZ) was focal and close to the surgical cavity (same lobe) or noncontiguous in cases where the SOZ included site(s) distant from the surgical cavity. The rSOZ was defined according to visual analysis of SEEG traces completed by an estimation of the epileptogenicity index (EI). A second surgical procedure was performed in 12 patients (45%). A favorable outcome (Engel class I or II) was obtained in 9/12 patients (6 in Engel class I, 50%). The proportion of patients that had reoperation was higher in the contiguous group (80%) than in the noncontiguous group (22%) (p=0.02). A rSOZ localized in close relation to the initial surgical resection zone (contiguous group) was found in 10 patients (35%). Among them, 8 have since undergone reoperation, and a good outcome (Engel class I) was achieved in 5/8 (63%). A rSOZ involving a distant region from the first surgery was observed in 18 patients (65%) (noncontiguous group). Among them, only 4 have undergone reoperation, leading to a failure in 2 (Engel class III or IV) and a good outcome in 2 (IA). Ten patients had a first standard temporal lobectomy, and in 50% of these cases, the insula was involved in the rSOZ. Stereoelectroencephalography offers a unique way to evaluate the rSOZ at the individual level and thus guide further surgical decision-making. The best results are observed in patients having a focal rSOZ close to the site of the surgical resection in the first surgery.
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Affiliation(s)
- Lisa Vaugier
- APHM, Timone Hospital, Clinical Neurophysiology and Epileptology Department, Marseille, France
| | - Stanislas Lagarde
- APHM, Timone Hospital, Clinical Neurophysiology and Epileptology Department, Marseille, France; Aix Marseille Univ, Inserm, INS, Institut de Neurosciences des Systèmes, Marseille, France
| | - Aileen McGonigal
- APHM, Timone Hospital, Clinical Neurophysiology and Epileptology Department, Marseille, France; Aix Marseille Univ, Inserm, INS, Institut de Neurosciences des Systèmes, Marseille, France
| | - Agnès Trébuchon
- APHM, Timone Hospital, Clinical Neurophysiology and Epileptology Department, Marseille, France; Aix Marseille Univ, Inserm, INS, Institut de Neurosciences des Systèmes, Marseille, France
| | - Mathieu Milh
- APHM, Timone Hospital, Clinical Neurophysiology and Epileptology Department, Marseille, France; Aix Marseille Univ, Inserm, INS, Institut de Neurosciences des Systèmes, Marseille, France
| | - Anne Lépine
- APHM, Timone Hospital, Clinical Neurophysiology and Epileptology Department, Marseille, France; Aix Marseille Univ, Inserm, INS, Institut de Neurosciences des Systèmes, Marseille, France
| | - Didier Scavarda
- APHM, Timone Hospital, Clinical Neurophysiology and Epileptology Department, Marseille, France; Aix Marseille Univ, Inserm, INS, Institut de Neurosciences des Systèmes, Marseille, France; APHM, Timone Hospital, Paediatric Neurosurgery Department, Marseille, France
| | - Romain Carron
- APHM, Timone Hospital, Clinical Neurophysiology and Epileptology Department, Marseille, France; Aix Marseille Univ, Inserm, INS, Institut de Neurosciences des Systèmes, Marseille, France; APHM, Timone Hospital, Functional and Stereotactical Neurosurgery Department, Marseille, France
| | - Fabrice Bartolomei
- APHM, Timone Hospital, Clinical Neurophysiology and Epileptology Department, Marseille, France; Aix Marseille Univ, Inserm, INS, Institut de Neurosciences des Systèmes, Marseille, France.
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87
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Bourdillon P, Devaux B, Job-Chapron AS, Isnard J. SEEG-guided radiofrequency thermocoagulation. Neurophysiol Clin 2018; 48:59-64. [DOI: 10.1016/j.neucli.2017.11.011] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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88
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Abstract
A "concept" refers to what exists in the mind as a representation (as in something comprehended) or as a formulation (as in a plan). It is generally understood as "any idea of what a thing ought to be" (Merriam-Webster). From that premise, an "idea" cannot be compartmentalized or rigidly defined as exclusively belonging to any single individual or school of thought. The utility of a concept is inherently linked to its adaptability to the needs and conditions of the time. I state this upfront because over the past several decades, the concept of the epileptogenic zone (EZ) has become so crucial to the foundation of major schools of surgical epilepsy that discussions and opinions on the topic have essentially sought to legitimize one view while criticizing the other. This review is not a referendum on any specific definition of the EZ but rather a chronological analysis of the historical evolution of this concept and the invasive EEG tools used to study it. The goal is to highlight common ground necessary to tackle the ever-present challenge of defining the ideal resection for a patient with drug-resistant focal epilepsy.
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89
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Bourdillon P, Apra C, Guénot M, Duffau H. Similarities and differences in neuroplasticity mechanisms between brain gliomas and nonlesional epilepsy. Epilepsia 2017; 58:2038-2047. [PMID: 29105067 DOI: 10.1111/epi.13935] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/04/2017] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To analyze the conceptual and practical implications of a hodotopic approach in neurosurgery, and to compare the similarities and the differences in neuroplasticity mechanisms between low-grade gliomas and nonlesional epilepsy. METHODS We review the recent data about the hodotopic organization of the brain connectome, alongside the organization of epileptic networks, and analyze how these two structures interact, suggesting therapeutic prospects. Then we focus on the mechanisms of neuroplasticity involved in glioma natural course and after glioma surgery. Comparing these mechanisms with those in action in an epileptic brain highlights their differences, but more importantly, gives an original perspective to the consequences of surgery on an epileptic brain and what could be expected after pathologic white matter removal. RESULTS The organization of the brain connectome and the neuroplasticity is the same in all humans, but different pathologic mechanisms are involved, and specific therapeutic approaches have been developed in epilepsy and glioma surgery. We demonstrate that the "connectome" point of view can enrich epilepsy care. We also underscore how theoretical and practical tools commonly used in epilepsy investigations, such as invasive electroencephalography, can be of great help in awake surgery in general. SIGNIFICANCE Putting together advances in understanding of connectomics and neuroplasticity, leads to significant conceptual improvements in epilepsy surgery.
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Affiliation(s)
- Pierre Bourdillon
- Department of Neurosurgery, Hospital for Neurology and Neurosurgery Pierre Wertheimer, Hospices Civils de Lyon, Lyon, France.,Brain and Spine Institute, INSERM U1127, CNRS 7225, Paris, France.,Claude Bernard University, University of Lyon, Lyon, France.,Pierre and Marie Curie University, Sorbonne University, Paris, France
| | - Caroline Apra
- Pierre and Marie Curie University, Sorbonne University, Paris, France
| | - Marc Guénot
- Department of Neurosurgery, Hospital for Neurology and Neurosurgery Pierre Wertheimer, Hospices Civils de Lyon, Lyon, France.,Brain and Spine Institute, INSERM U1127, CNRS 7225, Paris, France.,Neuroscience Research Center of Lyon, INSERM U1028, CNRS 5292, Lyon, France
| | - Hugues Duffau
- Department of Neurosurgery, Gui de Chauliac Hospital, Montpellier, France.,University of Montpellier, Montpellier, France.,Institute for Neurosciences of Montpellier, INSERM U1051, Montpellier, France
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90
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Mirandola L, Mai RF, Francione S, Pelliccia V, Gozzo F, Sartori I, Nobili L, Cardinale F, Cossu M, Meletti S, Tassi L. Stereo-EEG: Diagnostic and therapeutic tool for periventricular nodular heterotopia epilepsies. Epilepsia 2017; 58:1962-1971. [DOI: 10.1111/epi.13895] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/16/2017] [Indexed: 11/27/2022]
Affiliation(s)
- Laura Mirandola
- Department of Biomedical, Metabolic, and Neural Sciences; University of Modena and Reggio Emilia; Modena Italy
| | - Roberto F. Mai
- “Claudio Munari” Epilepsy Surgery Center; Niguarda Hospital; Milano Italy
| | - Stefano Francione
- “Claudio Munari” Epilepsy Surgery Center; Niguarda Hospital; Milano Italy
| | - Veronica Pelliccia
- “Claudio Munari” Epilepsy Surgery Center; Niguarda Hospital; Milano Italy
- Department of Neuroscience; University of Parma; Parma Italy
| | - Francesca Gozzo
- “Claudio Munari” Epilepsy Surgery Center; Niguarda Hospital; Milano Italy
| | - Ivana Sartori
- “Claudio Munari” Epilepsy Surgery Center; Niguarda Hospital; Milano Italy
| | - Lino Nobili
- “Claudio Munari” Epilepsy Surgery Center; Niguarda Hospital; Milano Italy
| | | | - Massimo Cossu
- “Claudio Munari” Epilepsy Surgery Center; Niguarda Hospital; Milano Italy
| | - Stefano Meletti
- Department of Biomedical, Metabolic, and Neural Sciences; University of Modena and Reggio Emilia; Modena Italy
| | - Laura Tassi
- “Claudio Munari” Epilepsy Surgery Center; Niguarda Hospital; Milano Italy
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91
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Cossu M, Mirandola L, Tassi L. RF-ablation in periventricular heterotopia-related epilepsy. Epilepsy Res 2017; 142:121-125. [PMID: 28705474 DOI: 10.1016/j.eplepsyres.2017.07.001] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2017] [Revised: 06/24/2017] [Accepted: 07/01/2017] [Indexed: 11/27/2022]
Abstract
Drug-resistant focal epilepsy is a common occurrence in patients with gray matter nodular heterotopia (NH), and surgical treatment is often considered in these cases. NH-related epileptogenicity is sustained by complex networks, which may involve the nodules and extralesional cortex in various combinations. Therefore, invasive EEG is usually required to identify the structures involved in seizure generation. It has been reported that surgery may be effective in cases with unilateral lesions, whereas bilateral cases are not optimal candidates for surgical success. Furthermore, violation of cortical and subcortical structures for approaching deep-seated nodules may result in neurological deficits. For these reasons, selective stereotactic ablation with radiofrequency thermocoagulation (RFTC) has been proposed as an alternative option in these patients. In particular, RFTC may be performed by using the same recording intracerebral electrodes implanted for stereo-electro-encephalo-graphy (SEEG) monitoring, with the advantage of a reliable electro-clinical guide. Excellent results on seizures have been initially reported following coagulation of single, unilateral NH. Subsequent experience has indicated that, basing on the evidence of SEEG recording, promising results may be obtained also in more extended unilateral and bilateral cases. In more complex cases, coagulation of both the nodules and of the involved extralesional cortical structures is often required. In a recently reported series, 67% of patients experienced sustained seizure freedom after the procedure. However, post RFTC seizure outcome in complex cases (NH plus other malformations of cortical development) is not as good as in other patterns of NH. RFTC, especially if guided by SEEG evaluation, should be considered as a first-line treatment option in NH-related epilepsy. Satisfactory results may be obtained also in cases not amenable to traditional surgery. The procedure is safe and does not prevent eventual resective surgery in case of failure in seizure control. For these reasons, in patients undergoing SEEG evaluation, electrode arrangement should be planned with the aim to cover as extensively as possible the heterotopic and extralesional areas, which will presumably be the targets of RFTC.
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Affiliation(s)
- Massimo Cossu
- Epilepsy Surgery Center, Department of Neuroscience, Niguarda Hospital, Piazza Ospedale Maggiore 3, 20162 Milan, Italy.
| | - Laura Mirandola
- Epilepsy Surgery Center, Department of Neuroscience, Niguarda Hospital, Piazza Ospedale Maggiore 3, 20162 Milan, Italy.
| | - Laura Tassi
- Epilepsy Surgery Center, Department of Neuroscience, Niguarda Hospital, Piazza Ospedale Maggiore 3, 20162 Milan, Italy.
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92
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Zhang G, Meng D, Liu Y, Yang K, Chen J, Su L, Zhang Z, Chen G. Epileptic Zone Resection for Magnetic Resonance Imaging–Negative Refractory Epilepsy Originating from the Primary Motor Cortex. World Neurosurg 2017; 102:434-441. [DOI: 10.1016/j.wneu.2017.02.090] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2016] [Revised: 02/17/2017] [Accepted: 02/18/2017] [Indexed: 10/20/2022]
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93
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Detection of recurrent activation patterns across focal seizures: Application to seizure onset zone identification. Clin Neurophysiol 2017; 128:977-985. [DOI: 10.1016/j.clinph.2017.03.040] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Revised: 03/20/2017] [Accepted: 03/23/2017] [Indexed: 11/23/2022]
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94
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Laser interstitial thermotherapy (LiTT) in epilepsy surgery. Seizure 2017; 48:45-52. [DOI: 10.1016/j.seizure.2017.04.002] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Revised: 04/02/2017] [Accepted: 04/04/2017] [Indexed: 01/15/2023] Open
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95
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Abstract
In common with other stereotactic procedures, stereotactic laser thermocoagulation (SLT) promises gentle destruction of pathological tissue, which might become especially relevant for epilepsy surgery in the future. Compared to standard resection, no large craniotomy is necessary, cortical damage during access to deep-seated lesions can be avoided and interventions close to eloquent brain areas become possible. We describe the history and rationale of laser neurosurgery as well as the two available SLT systems (Visualase® and NeuroBlate®; CE marks pending). Both systems are coupled with magnetic resonance imaging (MRI) and MR thermometry, thereby increasing patient safety. We report the published clinical experiences with SLT in epilepsy surgery (altogether approximately 200 cases) with respect to complications, brain structural alterations, seizure outcome, neuropsychological findings and treatment costs. The rate of seizure-free patients seems to be slightly lower than for resection surgery. Due to the inadequate quality of studies, the neuropsychological superiority of SLT has not yet been unambiguously demonstrated.
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96
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Polster T, Schulz R, Woermann FG, Bernhard MK, Schmitt FC, Büntjen L, Voges J. Thermoablation bei nodulären Heterotopien. ZEITSCHRIFT FUR EPILEPTOLOGIE 2017. [DOI: 10.1007/s10309-017-0107-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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97
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Dimova P, de Palma L, Job-Chapron AS, Minotti L, Hoffmann D, Kahane P. Radiofrequency thermocoagulation of the seizure-onset zone during stereoelectroencephalography. Epilepsia 2017; 58:381-392. [DOI: 10.1111/epi.13663] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/13/2016] [Indexed: 11/27/2022]
Affiliation(s)
- Petia Dimova
- Epilepsy Surgery Unit; Department of Neurosurgery; St. Ivan Rilski University Hospital; Sofia Bulgaria
| | - Luca de Palma
- Epilepsy Unit; Neurology Department and GIN; INSERM U836; University Grenoble Alpes and Michallon Hospital; Grenoble France
- Neurology Unit; Bambino Gesù Children's Hospital; IRCCS; Rome Italy
| | - Anne-Sophie Job-Chapron
- Epilepsy Unit; Neurology Department and GIN; INSERM U836; University Grenoble Alpes and Michallon Hospital; Grenoble France
| | - Lorella Minotti
- Epilepsy Unit; Neurology Department and GIN; INSERM U836; University Grenoble Alpes and Michallon Hospital; Grenoble France
| | | | - Philippe Kahane
- Epilepsy Unit; Neurology Department and GIN; INSERM U836; University Grenoble Alpes and Michallon Hospital; Grenoble France
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