201
|
Abstract
Focal epileptic seizures have long been considered to arise from a small susceptible brain area and spread through uninvolved regions. In the past decade, the idea that focal seizures instead arise from coordinated activity across large-scale epileptic networks has become widely accepted. Understanding the network model's applicability is critical, due to its increasing influence on clinical research and surgical treatment paradigms. In this review, we examine the origins of the concept of epileptic networks as the nidus for recurring seizures. We summarize analytical and methodological elements of epileptic network studies and discuss findings from recent detailed electrophysiological investigations. Our review highlights the strengths and limitations of the epileptic network theory as a metaphor for the complex interactions that occur during seizures. We present lines of investigation that may usefully probe these interactions and thus serve to advance our understanding of the long-range effects of epileptiform activity.
Collapse
Affiliation(s)
- Elliot H Smith
- Department of Neurological Surgery, Columbia University Medical Center, New York, NY, 10032, USA
| | - Catherine A Schevon
- Department of Neurology, Columbia University Medical Center, New York, NY, 10032, USA.
- Neurological Institute, 710 West 168th Street, New York, NY, 10032, USA.
| |
Collapse
|
202
|
Ravindra VM, Sweney MT, Bollo RJ. Recent developments in the surgical management of paediatric epilepsy. Arch Dis Child 2017; 102:760-766. [PMID: 28096104 DOI: 10.1136/archdischild-2016-311183] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Revised: 12/12/2016] [Accepted: 12/21/2016] [Indexed: 11/08/2022]
Abstract
Among the 1% of children affected by epilepsy, failure of pharmacological therapy and early age of seizure onset can lead to worse long-term cognitive outcomes, mental health disorders and impaired functional status. Surgical management often improves functional and cognitive outcomes in children with medically refractory epilepsy, especially when seizure remission is achieved. However, surgery remains underused in children with drug-resistant epilepsy, creating a large treatment gap. Several recent innovations have led to considerable improvement in surgical technique, including the recent development of minimally invasive diagnostic and therapeutic techniques such as stereotactic EEG, transcranial magnetic stimulation, MRI-guided laser ablation, as well as novel paradigms of neurostimulation. This article discusses the current landscape of surgical innovation in the management of paediatric epilepsy, leading to a paradigm shift towards minimally invasive therapy and closing the treatment gap in children suffering from drug-resistant seizures.
Collapse
Affiliation(s)
- Vijay M Ravindra
- Division of Pediatric Neurosurgery, Department of Neurosurgery, University of Utah School of Medicine, Primary Children's Hospital, Slat Lake City, Utah, USA
| | - Matthew T Sweney
- Division of Pediatric Neurology, Department of Pediatrics, University of Utah School of Medicine, Primary Children's Hospital, Salt Lake City, Utah, USA
| | - Robert J Bollo
- Division of Pediatric Neurosurgery, Department of Neurosurgery, University of Utah School of Medicine, Primary Children's Hospital, Slat Lake City, Utah, USA
| |
Collapse
|
203
|
Kang JY, Sperling MR. Epileptologist's view: Laser interstitial thermal ablation for treatment of temporal lobe epilepsy. Epilepsy Res 2017; 142:149-152. [PMID: 28774708 DOI: 10.1016/j.eplepsyres.2017.07.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Revised: 06/23/2017] [Accepted: 07/11/2017] [Indexed: 11/29/2022]
Abstract
A procedure called laser interstitial thermal ablation has been utilized to treat drug resistant epilepsy. With this technique, a probe is stereotactically inserted into a target structure responsible for seizures, such as mesial temporal lobe, hypothalamic hamartoma, or a small malformation of cortical development, and the tip is then heated by application of laser energy to ablate structures adjacent to the probe tip. This procedure has the advantage of selectively targeting small lesions responsible for seizures, and is far less invasive than open surgery with shorter hospitalization, less pain, and rapid return to normal activities. Initial results in mesial temporal lobe epilepsy are promising, with perhaps half of patients becoming free of seizures after the procedure. Neuropsychological deficits appear to be reduced because of the smaller volume of ablated cortex in contrast to large resections. More research must be done to establish optimal targeting of structures for ablation and selection of candidates for surgery, and more patients must be studied to better establish efficacy and adverse effect rates.
Collapse
Affiliation(s)
- Joon Y Kang
- Jefferson Comprehensive Epilepsy Center, Department of Neurology, Thomas Jefferson University, Philadelphia, PA, USA
| | | |
Collapse
|
204
|
|
205
|
Silva D, Sharma M, Juthani R, Meola A, Barnett GH. Magnetic Resonance Thermometry and Laser Interstitial Thermal Therapy for Brain Tumors. Neurosurg Clin N Am 2017; 28:525-533. [PMID: 28917281 DOI: 10.1016/j.nec.2017.05.015] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Recent technological advancements in intraoperative imaging are shaping the way for a new era in brain tumor surgery. Magnetic resonance thermometry has provided intraoperative real-time imaging feedback for safe and effective application of laser interstitial thermal therapy (LITT) in neuro-oncology. Thermal ablation has also established itself as a surgical option in epilepsy surgery and is currently used in spine oncology with promising results. This article reviews the principles and rationale as well as the clinical application of LITT for brain tumors. It also discusses the technical nuances of the current commercially available systems.
Collapse
Affiliation(s)
- Danilo Silva
- Rose Ella Burkhardt Brain Tumor and Neuro-oncology Center, Department of Neurosurgery, Neurological Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA
| | - Mayur Sharma
- Rose Ella Burkhardt Brain Tumor and Neuro-oncology Center, Department of Neurosurgery, Neurological Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA
| | - Rupa Juthani
- Rose Ella Burkhardt Brain Tumor and Neuro-oncology Center, Department of Neurosurgery, Neurological Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA
| | - Antonio Meola
- Rose Ella Burkhardt Brain Tumor and Neuro-oncology Center, Department of Neurosurgery, Neurological Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA
| | - Gene H Barnett
- Rose Ella Burkhardt Brain Tumor and Neuro-oncology Center, Department of Neurosurgery, Neurological Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA.
| |
Collapse
|
206
|
Ray S, Tripathi M, Chandra SP, Chakravarty K. Protocols in contemporary epilepsy surgery-a short communication. Int J Surg 2017. [PMID: 28648797 DOI: 10.1016/j.ijsu.2017.06.076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Sucharita Ray
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Manjari Tripathi
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India.
| | - Sarat P Chandra
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | | |
Collapse
|
207
|
Krámská L, Vojtěch Z, Lukavský J, Stará M, Malíková H. Five-Year Neuropsychological Outcome after Stereotactic Radiofrequency Amygdalohippocampectomy for Mesial Temporal Lobe Epilepsy: Longitudinal Study. Stereotact Funct Neurosurg 2017; 95:149-157. [DOI: 10.1159/000468527] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Accepted: 03/02/2017] [Indexed: 11/19/2022]
|
208
|
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
|
209
|
History of surgery for temporal lobe epilepsy. Epilepsy Behav 2017; 70:57-60. [PMID: 28410466 DOI: 10.1016/j.yebeh.2017.02.020] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Revised: 02/07/2017] [Accepted: 02/13/2017] [Indexed: 11/20/2022]
Abstract
The history of epilepsy and its treatment goes back to ancient times when it included medicinal herbs, lifestyle modifications, and even surgery. Trepanation is considered the oldest surgical procedure for the treatment of epilepsy. The first series of temporal lobectomies for the treatment of drug-resistant epilepsy were reported by Penfield and Flanigin (1950). During the years since then, neuroimaging and other technologies have had remarkable and revolutionary progress. This progress has resulted in tremendous advancements in understanding the underlying causes and pathophysiology of epilepsies. With the help of these technologies and advancements, we may now offer surgery as a safer therapeutic option to more patients who are suffering from drug-resistant temporal lobe epilepsy. However, the degree of improvement in surgery outcome has not been proportionate to the technological progress.
Collapse
|
210
|
Geller EB, Skarpaas TL, Gross RE, Goodman RR, Barkley GL, Bazil CW, Berg MJ, Bergey GK, Cash SS, Cole AJ, Duckrow RB, Edwards JC, Eisenschenk S, Fessler J, Fountain NB, Goldman AM, Gwinn RP, Heck C, Herekar A, Hirsch LJ, Jobst BC, King-Stephens D, Labar DR, Leiphart JW, Marsh WR, Meador KJ, Mizrahi EM, Murro AM, Nair DR, Noe KH, Park YD, Rutecki PA, Salanova V, Sheth RD, Shields DC, Skidmore C, Smith MC, Spencer DC, Srinivasan S, Tatum W, Van Ness PC, Vossler DG, Wharen RE, Worrell GA, Yoshor D, Zimmerman RS, Cicora K, Sun FT, Morrell MJ. Brain-responsive neurostimulation in patients with medically intractable mesial temporal lobe epilepsy. Epilepsia 2017; 58:994-1004. [DOI: 10.1111/epi.13740] [Citation(s) in RCA: 184] [Impact Index Per Article: 26.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/03/2017] [Indexed: 11/29/2022]
Affiliation(s)
| | | | | | | | | | - Carl W. Bazil
- Columbia University Medical Center; New York City New York U.S.A
| | - Michael J. Berg
- University of Rochester Medical Center; Rochester New York U.S.A
| | | | - Sydney S. Cash
- Massachusetts General Hospital; Boston Massachusetts U.S.A
| | - Andrew J. Cole
- Massachusetts General Hospital; Boston Massachusetts U.S.A
| | | | | | | | - James Fessler
- University of Rochester Medical Center; Rochester New York U.S.A
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Donald C. Shields
- George Washington University School of Medicine & Health Sciences; Washington Washington DC U.S.A
| | | | | | | | | | - William Tatum
- Mayo Clinic College of Medicine; Jacksonville Florida U.S.A
| | | | | | | | | | | | | | | | | | - Martha J. Morrell
- NeuroPace, Inc.; Mountain View California U.S.A
- Stanford University School of Medicine; Stanford California U.S.A
| |
Collapse
|
211
|
Nagae LM, Honce JM, Nyberg E, Ojemann S, Abosch A, Drees CN. Imaging of Laser Therapy in Epilepsy. J Neuroimaging 2017; 27:292-299. [PMID: 28370739 DOI: 10.1111/jon.12438] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Revised: 02/23/2017] [Accepted: 02/25/2017] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND AND PURPOSE MR-guided laser interstitial thermal therapy (MRgLITT) is an increasingly popular neuroablative method for the surgical treatment of epilepsy patients. This article intends to demonstrate the utility and pitfalls of imaging in the context of patient care with MRgLITT. MATERIAL AND METHODS A retrospective review of the medical records and imaging database with six illustrative cases selected to demonstrate the use of imaging throughout patient management with MRgLITT in diverse clinical situations and pathologies. A review of the knowledge in the literature was applied to the relevant points discussed. RESULTS Imaging findings were described in the setting of laser therapy in nonlesional epilepsy, mesial temporal sclerosis, dual pathology, periventricular nodular heterotopia, and schizencephaly. Discussion of imaging principles, potential pitfalls, as well as its use in the patient work-up and follow-up, is shown. CONCLUSIONS MRgLITT is an alternative minimally invasive therapy for refractory epilepsy, which is becoming widely sought for. Imaging plays a crucial role prior to, during, and after the procedure.
Collapse
Affiliation(s)
- Lidia M Nagae
- Department of Radiology, Neuroradiology, University of Colorado Denver School of Medicine, Aurora, CO
| | - Justin M Honce
- Department of Radiology, Neuroradiology, University of Colorado Denver School of Medicine, Aurora, CO
| | - Eric Nyberg
- Department of Radiology, Neuroradiology, University of Colorado Denver School of Medicine, Aurora, CO
| | - Steven Ojemann
- Department of Neurosurgery, University of Colorado Denver School of Medicine, Aurora, CO
| | - Aviva Abosch
- Department of Neurosurgery, University of Colorado Denver School of Medicine, Aurora, CO
| | - Cornelia N Drees
- Department of Neurology, Epilepsy Section, University of Colorado Denver School of Medicine, Aurora, CO
| |
Collapse
|
212
|
Waseem H, Vivas AC, Vale FL. MRI-guided laser interstitial thermal therapy for treatment of medically refractory non-lesional mesial temporal lobe epilepsy: Outcomes, complications, and current limitations: A review. J Clin Neurosci 2017; 38:1-7. [DOI: 10.1016/j.jocn.2016.12.002] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2016] [Accepted: 12/04/2016] [Indexed: 11/28/2022]
|
213
|
Prevalence and Incidence of Drug-Resistant Mesial Temporal Lobe Epilepsy in the United States. World Neurosurg 2017; 99:662-666. [DOI: 10.1016/j.wneu.2016.12.074] [Citation(s) in RCA: 107] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Revised: 12/15/2016] [Accepted: 12/17/2016] [Indexed: 12/13/2022]
|
214
|
Jermakowicz WJ, Kanner AM, Sur S, Bermudez C, D'Haese PF, Kolcun JPG, Cajigas I, Li R, Millan C, Ribot R, Serrano EA, Velez N, Lowe MR, Rey GJ, Jagid JR. Laser thermal ablation for mesiotemporal epilepsy: Analysis of ablation volumes and trajectories. Epilepsia 2017; 58:801-810. [PMID: 28244590 DOI: 10.1111/epi.13715] [Citation(s) in RCA: 113] [Impact Index Per Article: 16.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/31/2017] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To identify features of ablations and trajectories that correlate with optimal seizure control and minimize the risk of neurocognitive deficits in patients undergoing laser interstitial thermal therapy (LiTT) for mesiotemporal epilepsy (mTLE). METHODS Clinical and radiographic data were reviewed from a prospectively maintained database of all patients undergoing LiTT for the treatment of mTLE at the University of Miami Hospital. Standard preoperative and postoperative evaluations, including contrast-enhanced magnetic resonance imaging (MRI) and neuropsychological testing, were performed in all patients. Laser trajectory and ablation volumes were computed both by manual tracing of mesiotemporal structures and by nonrigid registration of ablation cavities to a common reference system based on 7T MRI data. RESULTS Among 23 patients with at least 1-year follow-up, 15 (65%) were free of disabling seizures since the time of their surgery. Sparing of the mesial hippocampal head was significantly correlated with persistent disabling seizures (p = 0.01). A lateral trajectory through the hippocampus showed a trend for poor seizure outcome (p = 0.08). A comparison of baseline and postoperative neurocognitive testing revealed areas of both improvement and worsening, which were not associated with ablation volume or trajectory. SIGNIFICANCE At 1-year follow-up, LiTT appears to be a safe and effective tool for the treatment of mTLE, although a longer follow-up period is necessary to confirm these observations. Better understanding of the impact of ablation volume and location could potentially fine-tune this technique to improve seizure-freedom rates and associated neurologic and cognitive changes.
Collapse
Affiliation(s)
- Walter J Jermakowicz
- Department of Neurological Surgery, Miller School of Medicine, University of Miami, Miami, Florida, U.S.A
| | - Andres M Kanner
- Epilepsy Division, Department of Neurology, Miller School of Medicine, University of Miami, Miami, Florida, U.S.A
| | - Samir Sur
- Department of Neurological Surgery, Miller School of Medicine, University of Miami, Miami, Florida, U.S.A
| | - Christina Bermudez
- Division of Neuropsychology, Department of Neurology, Miller School of Medicine, University of Miami, Miami, Florida, U.S.A
| | - Pierre-Francois D'Haese
- Department of Electrical Engineering and Computer Science, Vanderbilt University, Nashville, Tennessee, U.S.A
| | - John Paul G Kolcun
- Department of Neurological Surgery, Miller School of Medicine, University of Miami, Miami, Florida, U.S.A
| | - Iahn Cajigas
- Department of Neurological Surgery, Miller School of Medicine, University of Miami, Miami, Florida, U.S.A
| | - Rui Li
- Department of Electrical Engineering and Computer Science, Vanderbilt University, Nashville, Tennessee, U.S.A
| | - Carlos Millan
- Epilepsy Division, Department of Neurology, Miller School of Medicine, University of Miami, Miami, Florida, U.S.A
| | - Ramses Ribot
- Epilepsy Division, Department of Neurology, Miller School of Medicine, University of Miami, Miami, Florida, U.S.A
| | - Enrique A Serrano
- Epilepsy Division, Department of Neurology, Miller School of Medicine, University of Miami, Miami, Florida, U.S.A
| | - Naymee Velez
- Epilepsy Division, Department of Neurology, Miller School of Medicine, University of Miami, Miami, Florida, U.S.A
| | - Merredith R Lowe
- Epilepsy Division, Department of Neurology, Miller School of Medicine, University of Miami, Miami, Florida, U.S.A
| | - Gustavo J Rey
- Division of Neuropsychology, Department of Neurology, Miller School of Medicine, University of Miami, Miami, Florida, U.S.A
| | - Jonathan R Jagid
- Department of Neurological Surgery, Miller School of Medicine, University of Miami, Miami, Florida, U.S.A
| |
Collapse
|
215
|
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.
Collapse
|
216
|
Crepeau AZ, Sirven JI. Management of Adult Onset Seizures. Mayo Clin Proc 2017; 92:306-318. [PMID: 28160877 DOI: 10.1016/j.mayocp.2016.11.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Revised: 11/11/2016] [Accepted: 11/28/2016] [Indexed: 12/12/2022]
Abstract
Epilepsy is a common yet heterogeneous disease. As a result, management often requires complex decision making. The ultimate goal of seizure management is for the patient to have no seizures and no considerable adverse effects from the treatment. Antiepileptic drugs are the mainstay of therapy, with more than 20 medications currently approved in the United States. Antiepileptic drug selection requires an understanding of the patient's epilepsy, along with consideration of comorbidities and potential for adverse events. After a patient has failed at least 2 appropriate antiepileptic drugs, they are determined to be medically refractory. At this time, additional therapy, including dietary, device, or surgical treatments, need to be considered, typically at a certified epilepsy center. All these treatments require consideration of the potential for seizure freedom, balanced against potential adverse effects, and can have a positive effect on seizure control and quality of life. This review article discussed the treatment options available for adults with epilepsy, including medical, surgical, dietary, and device therapies.
Collapse
|
217
|
Büntjen L, Voges J, Heinze HJ, Hinrichs H, Schmitt FC. Stereotaktische Laserablation. ZEITSCHRIFT FÜR EPILEPTOLOGIE 2017. [DOI: 10.1007/s10309-016-0099-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
218
|
JOURNAL CLUB: Longitudinal Qualitative Characterization of MRI Features After Laser Interstitial Thermal Therapy in Drug-Resistant Epilepsy. AJR Am J Roentgenol 2017; 208:48-56. [DOI: 10.2214/ajr.16.16144] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
|
219
|
Shukla ND, Ho AL, Pendharkar AV, Sussman ES, Halpern CH. Laser interstitial thermal therapy for the treatment of epilepsy: evidence to date. Neuropsychiatr Dis Treat 2017; 13:2469-2475. [PMID: 29026310 PMCID: PMC5627747 DOI: 10.2147/ndt.s139544] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Medically intractable epilepsy is associated with increased morbidity and mortality. For those with focal epilepsy and correlated electrophysiological or radiographic features, open surgical resection can achieve high rates of seizure control, but can be associated with neurologic deficits and cognitive effects. Recent innovations have allowed for more minimally invasive methods of surgical seizure control such as magnetic resonance-guided laser interstitial therapy (MRgLITT). MRgLITT achieves the goal of ablating seizure foci while preserving neuropsycho-logical function and offering real-time feedback and monitoring of tissue ablation. This review summarizes the utilization of MRgLITT for mesial temporal lobe epilepsy and other seizure disorders. Overall, the efficacy of MRgLITT is comparable to that of open surgery and offers a less invasive approach in patients with significantly less morbidity.
Collapse
Affiliation(s)
- Navika D Shukla
- Department of Neurosurgery, Stanford University, Stanford, CA, USA
| | - Allen L Ho
- Department of Neurosurgery, Stanford University, Stanford, CA, USA
| | | | - Eric S Sussman
- Department of Neurosurgery, Stanford University, Stanford, CA, USA
| | - Casey H Halpern
- Department of Neurosurgery, Stanford University, Stanford, CA, USA
| |
Collapse
|
220
|
Tao JX, Issa N, Collins JW, Wu S, Rose S, Warnke P. Homonymous hemianopsia after MR-guided stereotactic laser amygdalohippocampectomy. Epilepsy Behav 2017; 66:140-141. [PMID: 27993511 DOI: 10.1016/j.yebeh.2016.09.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Accepted: 09/07/2016] [Indexed: 10/20/2022]
Affiliation(s)
- James X Tao
- Department of Neurology, The University of Chicago, Chicago, IL 60637, United States.
| | - Naoum Issa
- Department of Neurology, The University of Chicago, Chicago, IL 60637, United States
| | - John W Collins
- Department of Radiology, The University of Chicago, Chicago, IL 60637, United States
| | - Shasha Wu
- Department of Neurology, The University of Chicago, Chicago, IL 60637, United States
| | - Sandra Rose
- Department of Neurology, The University of Chicago, Chicago, IL 60637, United States
| | - Peter Warnke
- Department of Neurosurgery, The University of Chicago, Chicago, IL 60637, United States
| |
Collapse
|
221
|
Kang JY, Sperling MR. Magnetic Resonance Imaging-Guided Laser Interstitial Thermal Therapy for Treatment of Drug-Resistant Epilepsy. Neurotherapeutics 2017; 14:176-181. [PMID: 27905093 PMCID: PMC5233636 DOI: 10.1007/s13311-016-0498-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
Surgery is the most effective treatment for drug-resistant epilepsy. Long-term studies demonstrate that about 60% to 80% of patients become seizure-free after anterior temporal lobectomy and a majority of patients (about 95%) report significant seizure reduction after surgery. In the last few years, there has been significant advances in minimally invasive surgical techniques to treat drug-resistant epilepsy. These minimally invasive procedures have significant advantages over open surgery in that they produce less immediate discomfort and disability, while allowing for greater preservation of functional tissue. Laser interstitial thermal therapy (LiTT) is an example of such a procedure. Recent advances in imaging, surgical navigation, and real-time thermal monitoring have made LiTT safer and easier to implement, offering an effective and powerful neurosurgical tool for drug-resistant epilepsy. This article will review the technical considerations, uses, and potential future directions for LiTT in drug-resistant epilepsy.
Collapse
Affiliation(s)
- Joon Y Kang
- Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Meyer 2-147, Baltimore, MD, 21287, USA.
| | - Michael R Sperling
- Thomas Jefferson University Hospital, 900 Walnut Street Suite 200, Philadelphia, PA, 19107, USA
| |
Collapse
|
222
|
LaRiviere MJ, Gross RE. Stereotactic Laser Ablation for Medically Intractable Epilepsy: The Next Generation of Minimally Invasive Epilepsy Surgery. Front Surg 2016; 3:64. [PMID: 27995127 PMCID: PMC5136731 DOI: 10.3389/fsurg.2016.00064] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Accepted: 11/21/2016] [Indexed: 12/02/2022] Open
Abstract
Epilepsy is a common, disabling illness that is refractory to medical treatment in approximately one-third of patients, particularly among those with mesial temporal lobe epilepsy. While standard open mesial temporal resection is effective, achieving seizure freedom in most patients, efforts to develop safer, minimally invasive techniques have been underway for over half a century. Stereotactic ablative techniques, in particular, radiofrequency (RF) ablation, were first developed in the 1960s, with refinements in the 1990s with the advent of modern computed tomography and magnetic resonance-based imaging. In the past 5 years, the most recent techniques have used MRI-guided laser interstitial thermotherapy (LITT), the development of which began in the 1980s, saw refinements in MRI thermal imaging through the 1990s, and was initially used primarily for the treatment of intracranial and extracranial tumors. The present review describes the original stereotactic ablation trials, followed by modern imaging-guided RF ablation series for mesial temporal lobe epilepsy. The developments of LITT and MRI thermometry are then discussed. Finally, the two currently available MRI-guided LITT systems are reviewed for their role in the treatment of mesial temporal lobe and other medically refractory epilepsies.
Collapse
Affiliation(s)
- Michael J. LaRiviere
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, USA
| | - Robert E. Gross
- Departments of Neurosurgery and Neurology, Emory University School of Medicine, Atlanta, GA, USA
| |
Collapse
|
223
|
Wicks RT, Jermakowicz WJ, Jagid JR, Couture DE, Willie JT, Laxton AW, Gross RE. Laser Interstitial Thermal Therapy for Mesial Temporal Lobe Epilepsy. Neurosurgery 2016; 79 Suppl 1:S83-S91. [DOI: 10.1227/neu.0000000000001439] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
Approximately one-third of patients with epilepsy do not achieve adequate seizure control through medical management alone. Mesial temporal lobe epilepsy (MTLE) is one of the most common forms of medically refractory epilepsy referred for surgical management. Stereotactic laser amygdalohippocampotomy using magnetic resonance-guided laser interstitial thermal therapy (MRg-LITT) is an important emerging therapy for MTLE. Initial published reports support MRg-LITT as a less invasive surgical option with a shorter hospital stay and fewer neurocognitive side effects compared with craniotomy for anterior temporal lobectomy with amygdalohippocampectomy and selective amygdalohippocampectomy. We provide a historical overview of laser interstitial thermal therapy development and the technological advancements that led to the currently available commercial systems. Current applications of MRg-LITT for MTLE, reported outcomes, and technical issues of the surgical procedure are reviewed. Although initial reports indicate that stereotactic laser amygdalohippocampotomy may be a safe and effective therapy for medically refractory MTLE, further research is required to establish its long-term effectiveness and its cost/benefit profile.
Collapse
Affiliation(s)
- Robert T. Wicks
- Department of Neurological Surgery, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | | | | | - Daniel E. Couture
- Department of Neurological Surgery, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Jon T. Willie
- Department of Neurosurgery, Emory University, Atlanta, Georgia
| | - Adrian W. Laxton
- Department of Neurological Surgery, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Robert E. Gross
- Department of Neurosurgery, Emory University, Atlanta, Georgia
| |
Collapse
|
224
|
Dadey DYA, Kamath AA, Smyth MD, Chicoine MR, Leuthardt EC, Kim AH. Utilizing personalized stereotactic frames for laser interstitial thermal ablation of posterior fossa and mesiotemporal brain lesions: a single-institution series. Neurosurg Focus 2016; 41:E4. [DOI: 10.3171/2016.7.focus16207] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE
The precision of laser probe insertion for interstitial thermal therapy of deep-seated lesions is limited by the method of stereotactic guidance. The objective of this study was to evaluate the feasibility of customized STarFix 3D-printed stereotactic platforms to guide laser probe insertion into mesiotemporal and posterior fossa targets.
METHODS
The authors conducted a retrospective review of 5 patients (12–55 years of age) treated with laser interstitial thermal therapy (LITT) in which STarFix platforms were used for probe insertion. Bone fiducials were implanted in each patient's skull, and subsequent CT scans were used to guide the design of each platform and incorporate desired treatment trajectories. Once generated, the platforms were mounted on the patients' craniums and used to position the laser probe during surgery. Placement of the laser probe and the LITT procedure were monitored with intraoperative MRI. Perioperative and follow-up MRI were performed to identify and monitor changes in target lesions.
RESULTS
Accurate placement of the laser probe was observed in all cases. For all patients, thermal ablation was accomplished without intraoperative complications. Of the 4 patients with symptomatic lesions, 2 experienced complete resolution of symptoms, and 1 reported improved symptoms compared with baseline.
CONCLUSIONS
Customized stereotactic platforms were seamlessly incorporated into the authors' previously established LITT workflow and allowed for accurate treatment delivery.
Collapse
Affiliation(s)
- David Y. A. Dadey
- 1Department of Neurological Surgery, and
- 2Medical Scientist Training Program, Washington University School of Medicine, St. Louis, Missouri
| | | | | | | | | | | |
Collapse
|
225
|
Ammon's Horns of a Dilemma: A LITTle Less is More. Epilepsy Curr 2016; 16:249-50. [PMID: 27582664 DOI: 10.5698/1535-7511-16.4.249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
|
226
|
Seizure outcomes in nonresective epilepsy surgery: an update. Neurosurg Rev 2016; 40:181-194. [PMID: 27206422 DOI: 10.1007/s10143-016-0725-8] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2015] [Revised: 01/31/2016] [Accepted: 03/06/2016] [Indexed: 12/18/2022]
Abstract
In approximately 30 % of patients with epilepsy, seizures are refractory to medical therapy, leading to significant morbidity and increased mortality. Substantial evidence has demonstrated the benefit of surgical resection in patients with drug-resistant focal epilepsy, and in the present journal, we recently reviewed seizure outcomes in resective epilepsy surgery. However, not all patients are candidates for or amenable to open surgical resection for epilepsy. Fortunately, several nonresective surgical options are now available at various epilepsy centers, including novel therapies which have been pioneered in recent years. Ablative procedures such as stereotactic laser ablation and stereotactic radiosurgery offer minimally invasive alternatives to open surgery with relatively favorable seizure outcomes, particularly in patients with mesial temporal lobe epilepsy. For certain individuals who are not candidates for ablation or resection, palliative neuromodulation procedures such as vagus nerve stimulation, deep brain stimulation, or responsive neurostimulation may result in a significant decrease in seizure frequency and improved quality of life. Finally, disconnection procedures such as multiple subpial transections and corpus callosotomy continue to play a role in select patients with an eloquent epileptogenic zone or intractable atonic seizures, respectively. Overall, open surgical resection remains the gold standard treatment for drug-resistant epilepsy, although it is significantly underutilized. While nonresective epilepsy procedures have not replaced the need for resection, there is hope that these additional surgical options will increase the number of patients who receive treatment for this devastating disorder-particularly individuals who are not candidates for or who have failed resection.
Collapse
|
227
|
Abstract
In the approximately 1% of children affected by epilepsy, pharmacoresistance and early age of seizure onset are strongly correlated with poor cognitive outcomes, depression, anxiety, developmental delay, and impaired activities of daily living. These children often require multiple surgical procedures, including invasive diagnostic procedures with intracranial electrodes to identify the seizure-onset zone. The recent development of minimally invasive surgical techniques, including stereotactic electroencephalography (SEEG) and MRI-guided laser interstitial thermal therapy (MRgLITT), and new applications of neurostimulation, such as responsive neurostimulation (RNS), are quickly changing the landscape of the surgical management of pediatric epilepsy. In this review, the authors discuss these various technologies, their current applications, and limitations in the treatment of pediatric drug-resistant epilepsy, as well as areas for future research. The development of minimally invasive diagnostic and ablative surgical techniques together with new paradigms in neurostimulation hold vast potential to improve the efficacy and reduce the morbidity of the surgical management of children with drug-resistant epilepsy.
Collapse
Affiliation(s)
- Michael Karsy
- 1 Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, USA ; 2 Division of Neurosurgery, University of Vermont, Burlington, USA ; 3 Division of Pediatric Neurosurgery, Primary Children's Hospital, Salt Lake City, USA
| | - Jian Guan
- 1 Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, USA ; 2 Division of Neurosurgery, University of Vermont, Burlington, USA ; 3 Division of Pediatric Neurosurgery, Primary Children's Hospital, Salt Lake City, USA
| | - Katrina Ducis
- 1 Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, USA ; 2 Division of Neurosurgery, University of Vermont, Burlington, USA ; 3 Division of Pediatric Neurosurgery, Primary Children's Hospital, Salt Lake City, USA
| | - Robert J Bollo
- 1 Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, USA ; 2 Division of Neurosurgery, University of Vermont, Burlington, USA ; 3 Division of Pediatric Neurosurgery, Primary Children's Hospital, Salt Lake City, USA
| |
Collapse
|
228
|
Barba C, Rheims S, Minotti L, Guénot M, Hoffmann D, Chabardès S, Isnard J, Kahane P, Ryvlin P. Reply: Temporal plus epilepsy is a major determinant of temporal lobe surgery failures. Brain 2016; 139:e36. [PMID: 26966138 DOI: 10.1093/brain/aww047] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Carmen Barba
- Paediatric Neurology Unit, Children's Hospital meyer-University of Florence, 50139, Florence, Italy
| | - Sylvain Rheims
- Department of Functional Neurology and Epileptology, Hospices Civils de Lyon, 69500, Lyon and Lyon 1 University, France Lyon's Research Neuroscience Centre, INSERM U1028/CNRS UMR5292, Lyon, France Institute of Epilepsies (IDEE), Lyon, France
| | - Lorella Minotti
- Epilepsy Unit, Neurology Department, 38043, Michallon Hospital, Grenoble, France
| | - Marc Guénot
- Department of Functional Neurosurgery, Hospices Civils de Lyon, 69003 Lyon, and Lyon 1 University, France
| | | | - Stephan Chabardès
- Neurosurgery Department, Michallon Hospital, 38043, Grenoble, France
| | - Jean Isnard
- Department of Functional Neurology and Epileptology, Hospices Civils de Lyon, 69500, Lyon and Lyon 1 University, France
| | - Philippe Kahane
- Epilepsy Unit, Neurology Department, 38043, Michallon Hospital, Grenoble, France GIN, Inserm U836, University Grenoble-Alpes, Grenoble, France
| | - Philippe Ryvlin
- Lyon's Research Neuroscience Centre, INSERM U1028/CNRS UMR5292, Lyon, France Institute of Epilepsies (IDEE), Lyon, France Department of Clinical Neurosciences, Centre Hospitalo-Universitaire Vaudois, 1011, Lausanne, Switzerland
| |
Collapse
|