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Alsallom F, Simon MV. Pediatric Intraoperative Neurophysiologic Mapping and Monitoring in Brain Surgery. J Clin Neurophysiol 2024; 41:96-107. [PMID: 38306217 DOI: 10.1097/wnp.0000000000001054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2024] Open
Abstract
SUMMARY Similar to adults, children undergoing brain surgery can significantly benefit from intraoperative neurophysiologic mapping and monitoring. Although young brains present the advantage of increased plasticity, during procedures in close proximity to eloquent regions, the risk of irreversible neurological compromise remains and can be lowered further by these techniques. More so, pathologies specific to the pediatric population, such as neurodevelopmental lesions, often result in medically refractory epilepsy. Thus, their successful surgical treatment also relies on accurate demarcation and resection of the epileptogenic zone, processes in which intraoperative electrocorticography is often employed. However, stemming from the development and maturation of the central and peripheral nervous systems as the child grows, intraoperative neurophysiologic testing in this population poses methodologic and interpretative challenges even to experienced clinical neurophysiologists. For example, it is difficult to perform awake craniotomies and language testing in the majority of pediatric patients. In addition, children may be more prone to intraoperative seizures and exhibit afterdischarges more frequently during functional mapping using electrical cortical stimulation because of high stimulation thresholds needed to depolarize immature cortex. Moreover, choice of anesthetic regimen and doses may be different in pediatric patients, as is the effect of these drugs on immature brain; these factors add additional complexity in terms of interpretation and analysis of neurophysiologic recordings. Below, we are describing the modalities commonly used during intraoperative neurophysiologic testing in pediatric brain surgery, with emphasis on age-specific clinical indications, methodology, and challenges.
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Affiliation(s)
- Faisal Alsallom
- King Fahad Medical City, KFMC Neurosciences Center, Riyadh, Saudi Arabia; and
| | - Mirela V Simon
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, U.S.A
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Patel SK, Gibson JL, Lovha M, Leach JL, Arya R, Tenney JR, Holland KD, Aungaroon G, Greiner HM, Skoch J, Mangano FT. Posterior Quadrant Disconnection Procedure for Intractable Epilepsy: A Case Series of 5 Young Pediatric Patients. Oper Neurosurg (Hagerstown) 2022; 23:449-456. [PMID: 36227204 PMCID: PMC10586857 DOI: 10.1227/ons.0000000000000410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 07/04/2022] [Indexed: 10/21/2023] Open
Abstract
BACKGROUND Posterior quadrant disconnection (PQD) has been described as a treatment for patients with refractory posterior quadrant subhemispheric epilepsy. Surgical outcomes are difficult to interpret because of limited literature. OBJECTIVE To provide insight regarding the operative technique and postsurgical seizure freedom in young pediatric patients who underwent surgical disconnection for the treatment of posterior quadrant subhemispheric epilepsy at our institution. METHODS The authors retrospectively analyzed a series of 5 patients who underwent PQD between 2019 and 2021. Charts were reviewed for preoperative workup including noninvasive/invasive testing, operative reports, and postoperative follow-up data which included degree of seizure freedom, completion of disconnection, and complications. RESULTS Five patients were included in this series. The median age at seizure onset was 12 months (range 3-24 months), and the median age at surgery was 36 months (range 22-72 months). Histopathology confirmed focal cortical dysplasia in 3 of 5 patients (2 patients with type IB; 1 with type IIID). The average length of follow-up after surgery was 16.8 months (range 12-24 months). All patients underwent complete disconnection of the posterior quadrant without complications. Four of 5 patients (80%) had Engel score of I, while the remaining patient had an Engel score of IIB. CONCLUSION Our early results demonstrate that complete PQD can be successful at providing excellent seizure freedom and functional outcomes in carefully selected young pediatric patients who have concordant seizure semiology, noninvasive/invasive testing, and imaging findings with primary seizure onset zone within the ipsilateral posterior quadrant. Meticulous surgical planning and thorough understanding of the surgical anatomy and technique are critical to achieving complete disconnection.
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Affiliation(s)
- Smruti K. Patel
- Division of Pediatric Neurosurgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Justin L. Gibson
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Mykhailo Lovha
- Division of Pediatric Neurosurgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - James L. Leach
- Division of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Ravindra Arya
- Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Jeffrey R. Tenney
- Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Katherine D. Holland
- Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Gewalin Aungaroon
- Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Hansel M. Greiner
- Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Jesse Skoch
- Division of Pediatric Neurosurgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
- Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Francesco T. Mangano
- Division of Pediatric Neurosurgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
- Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
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Yang Y, Wang W, Wang J, Wang M, Li X, Yan Z, Deng Q, Feng X, Luan G, Yang X, Li T. Scalp-HFO indexes are biomarkers for the lateralization and localization of the epileptogenic zone in preoperative assessment. J Neurophysiol 2021; 126:1148-1158. [PMID: 34495792 DOI: 10.1152/jn.00212.2021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
During the noninvasive evaluation phase for refractory epilepsy, the localization of the epileptogenic zone (EZ) is essential for the surgical protocols. Confirmation of laterality is required when the preoperative evaluation limits the EZ to bilateral anterior temporal lobes or bilateral frontal lobes. High-frequency oscillations (HFOs) are considered to be promising biological markers for the EZ. However, a large number of studies on HFOs stem from intracranial research. There were few quantitative measures for scalp HFOs, so we proposed a new method to quantify and analyze scalp HFOs. This method was called the "scalp-HFO index" (HI) and calculated in both the EZ and non-EZ. The calculation was based on the numbers and spectral power of scalp HFOs automatically detected. We labeled the brain lobes involved in the EZ as regions of interest (ROIs). The HIs based on the ripple numbers (n-HI) and spectral power (s-HI) were significantly higher in the ROI than in the contra-ROI (P = 0.012, P = 0.003), indicating that HIs contributed to the lateralization of EZ. The sensitivity and specificity of n-HI for the localization of the EZ were 90% and 79.58%, respectively, suggesting that n-HI was valuable in localizing the EZ. HI may contribute to the implantation strategy of invasive electrodes. However, few scalp HFOs were recorded when the EZ was located in the medial cortex region.NEW & NOTEWORTHY We proposed the scalp-high-frequency oscillation (HFO) index (HI) as a quantitative assessment method for scalp HFOs to locate the epileptogenic zone (EZ). Our results showed that the HI in regions of interest (ROIs) was significantly higher than in contra-ROIs. Sensitivity and specificity of HI based on ripple rates (n-HI) for EZ localization were 90% and 79.58%, respectively. If the n-HI of the brain region was >1.35, it was more likely to be an epileptogenic region. Clinical application of HIs as an indicator may facilitate localization of the EZ.
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Affiliation(s)
- Yujiao Yang
- Department of Neurology, Sanbo Brain Hospital, Capital Medical University, Beijing, China
| | - Wei Wang
- Beijing Institute of Brain Disorders, Laboratory of Brain Disorders, Ministry of Science and Technology, Collaborative Innovation Center for Brain Disorders, Capital Medical University, Beijing, China.,Bioland Laboratory, Guangzhou Regenerative Medicine and Health, Guangdong Laboratory, Guangzhou, China
| | - Jing Wang
- Department of Neurology, Sanbo Brain Hospital, Capital Medical University, Beijing, China
| | - Mengyang Wang
- Department of Neurology, Sanbo Brain Hospital, Capital Medical University, Beijing, China
| | - Xiaonan Li
- Beijing Institute of Brain Disorders, Laboratory of Brain Disorders, Ministry of Science and Technology, Collaborative Innovation Center for Brain Disorders, Capital Medical University, Beijing, China.,Bioland Laboratory, Guangzhou Regenerative Medicine and Health, Guangdong Laboratory, Guangzhou, China
| | - Zhaofen Yan
- Department of Neurology, Sanbo Brain Hospital, Capital Medical University, Beijing, China
| | - Qinqin Deng
- Department of Neurology, Sanbo Brain Hospital, Capital Medical University, Beijing, China
| | - Xing Feng
- Department of Neurology, Sanbo Brain Hospital, Capital Medical University, Beijing, China
| | - Guoming Luan
- Department of Functional Neurosurgery, Sanbo Brain Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Epilepsy, Sanbo Brain Hospital, Capital Medical University, Beijing, China.,Beijing Institute for Brain Disorders, Capital Medical University, Beijing, China
| | - Xiaofeng Yang
- Bioland Laboratory, Guangzhou Regenerative Medicine and Health, Guangdong Laboratory, Guangzhou, China
| | - Tianfu Li
- Department of Neurology, Sanbo Brain Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Epilepsy, Sanbo Brain Hospital, Capital Medical University, Beijing, China.,Beijing Institute for Brain Disorders, Capital Medical University, Beijing, China
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Fernández-Concepción O, López Jiménez M, Valencia-Calderón C, Calderón-Valdivieso A, Recasén-Linares A, Reyes-Haro L, Vásquez-Ham C. Safety and effectiveness of surgery for epilepsy in children. Experience of a tertiary hospital in Ecuador. NEUROLOGÍA (ENGLISH EDITION) 2021. [DOI: 10.1016/j.nrleng.2017.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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5
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Kadam R, Arimappamagan A, Bhaskara Rao M, Sadashiva N, Mundlamuri RC, Raghavendra K, Asranna A, Viswanathan LG, Mariyappa N, Kulanthaivelu K, Mangalore S, Nagaraj C, Saini J, Bharath RD, Rajeswaran J, Mahadevan A, Satishchandra P, Sinha S. Posterior Quadrant Disconnection for Childhood Onset Sub-Hemispheric Posterior Head Region Epilepsy: Indications in an Indian Cohort and Outcome. Pediatr Neurosurg 2021; 56:538-548. [PMID: 34649244 DOI: 10.1159/000519202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Accepted: 08/20/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Posterior quadrant disconnection (PQD) is an under-utilized surgical technique in the management of refractory epilepsy. There is a dearth of data pertinent to post-PQD seizure outcomes. METHODS This retrospective study analyzed patients with drug-resistant childhood-onset epilepsy who underwent PQD at our center from 2009 to 2018. The clinical, imaging, and electrophysiological data were reviewed. The seizure outcome was noted from the latest follow-up in all patients. RESULTS Fifteen patients underwent PQD, with a mean age at onset of epilepsy of 3.3 ± 4.6 years. All patients had seizure onset in childhood with focal onset of seizures, and in addition, 5 had multiple seizure types. All cases underwent presurgical workup with MRI, video-EEG, psychometry, while PET/MEG was done if required. Engel Ia and ILAE I outcomes were considered to be favorable. The histology of the specimen showed 9 patients (60%) had gliosis, 4 (26.7%) had focal cortical dysplasia (FCD), while 1 patient had nodular heterotopia and another had polymicrogyria-pachygyria complex. Postoperative follow-up was available in 14 cases. One patient was lost to follow-up. Mean follow-up duration for the cohort was 45 + 24 months. At last, follow-up (n = 14), 66.7% (10 cases) had favorable outcome (Engel Ia). At the end of 1-year follow-up, up to 73% (n = 11) of the patients were seizure-free. Four patients developed transient hemiparesis after surgery which improved completely by 3-6 months. CONCLUSIONS Gliosis was more common etiology requiring PQD in our series than Western series, where FCD was more common. PQD is a safe and effective surgical modality in childhood-onset epilepsy with posterior head region epileptogenic focus.
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Affiliation(s)
- Raju Kadam
- Departments of Neurosurgery, NIMHANS, Bangalore, India
| | | | | | | | | | | | - Ajay Asranna
- Department of Neurology, NIMHANS, Bangalore, India
| | | | | | | | | | | | | | | | | | | | | | - Sanjib Sinha
- Department of Neurology, NIMHANS, Bangalore, India
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Ueda R, Iwasaki M, Kita Y, Takeichi H, Saito T, Nakagawa E, Sugai K, Okada T, Sasaki M. Improvement of brain function after surgery in infants with posterior quadrant cortical dysplasia. Clin Neurophysiol 2020; 132:332-337. [PMID: 33450555 DOI: 10.1016/j.clinph.2020.11.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 10/02/2020] [Accepted: 11/10/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To reveal whether neurodevelopmental outcome of infants after epilepsy surgery can be quantitatively assessed by electroencephalography (EEG) functional connectivity analysis. METHODS We enrolled 13 infants with posterior quadrant dysplasia aged <2 years who were treated using posterior quadrantectomy and 21 age-matched infants. EEG was performed both before and one year after surgery. Developmental quotient (DQ) was assessed both before and 3 years after surgery. The phase lag index (PLI) of three different pairs of electrodes in the nonsurgical hemisphere, i.e., the anterior short distance (ASD), posterior short distance (PSD), and long distance (LD) pairs, were calculated as indices of brain connectivity. The relationship between the PLI and DQ was evaluated. RESULTS Overall, 77% infants experienced seizure freedom after surgery. The beta- and gamma- range PLI of PSD pairs increased preoperatively. All these pairs normalized postoperatively. Simple linear regression analysis revealed a significant relationship between the postoperative DQ and the postoperative beta-band PLI of ASD pairs. CONCLUSION Preoperative abnormal hyper-connectivity was normalized to the control level after surgery. The postoperative hyperconnectivity was associated with long-term neurodevelopmental improvement. SIGNIFICANCE PLI quantifies neurodevelopmental improvements after posterior quadrantectomy.
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Affiliation(s)
- Riyo Ueda
- Department of Child Neurology, National Center Hospital, National Center of Neurology and Psychiatry, 4-1-1 Ogawahigashi-cho, Kodaira, Tokyo 187-8551, Japan; Department of Developmental Disorders, National Institute of Mental Health, National Center of Neurology and Psychiatry, 4-1-1 Ogawahigashi-cho, Kodaira, Tokyo 187-8553, Japan.
| | - Masaki Iwasaki
- Department of Neurosurgery, National Center Hospital, National Center of Neurology and Psychiatry, 4-1-1 Ogawahigashi-cho, Kodaira, Tokyo 187-8551, Japan.
| | - Yosuke Kita
- Department of Developmental Disorders, National Institute of Mental Health, National Center of Neurology and Psychiatry, 4-1-1 Ogawahigashi-cho, Kodaira, Tokyo 187-8553, Japan; Cognitive Brain Research Unit (CBRU), Faculty of Medicine, University of Helsinki, Haartmaninkatu 3, FI-00290 Helsinki, Finland; Mori Arinori Center for Higher Education and Global Mobility, Hitotsubashi University, 2-1, Kunitachi, Tokyo 186-8601, Japan.
| | - Hiroshige Takeichi
- Department of Developmental Disorders, National Institute of Mental Health, National Center of Neurology and Psychiatry, 4-1-1 Ogawahigashi-cho, Kodaira, Tokyo 187-8553, Japan.
| | - Takashi Saito
- Department of Child Neurology, National Center Hospital, National Center of Neurology and Psychiatry, 4-1-1 Ogawahigashi-cho, Kodaira, Tokyo 187-8551, Japan.
| | - Eiji Nakagawa
- Department of Child Neurology, National Center Hospital, National Center of Neurology and Psychiatry, 4-1-1 Ogawahigashi-cho, Kodaira, Tokyo 187-8551, Japan.
| | - Kenji Sugai
- Department of Child Neurology, National Center Hospital, National Center of Neurology and Psychiatry, 4-1-1 Ogawahigashi-cho, Kodaira, Tokyo 187-8551, Japan.
| | - Takashi Okada
- Department of Developmental Disorders, National Institute of Mental Health, National Center of Neurology and Psychiatry, 4-1-1 Ogawahigashi-cho, Kodaira, Tokyo 187-8553, Japan.
| | - Masayuki Sasaki
- Department of Child Neurology, National Center Hospital, National Center of Neurology and Psychiatry, 4-1-1 Ogawahigashi-cho, Kodaira, Tokyo 187-8551, Japan.
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Abstract
History A 36-year-old left-handed woman with a history of developmental delay and medical refractory seizures since birth most recently presented with continuous simple partial seizures and occasional breakthrough complex partial seizures with postictal migraines. These were described as the patient "becoming pale with sinking to the floor and staring for approximately 1 minute with confusion thereafter." The patient had years of reported seizure freedom until 2010 when she was evaluated for intractable headaches, and electroencephalography revealed her focal subclinical status. At that time, ambulatory electroencephalography findings showed asymmetric left parietal-occipital high-amplitude spike-and-wave discharges in her best awake and alert state. Since that time, the patient developed and continues to have complex partial seizures every 2-3 months that are persistent despite the implementation of several medical regimens. At the time of recent presentation, the patient initially underwent unenhanced head CT in the emergency department followed by unenhanced MRI of the brain due to increased seizure activity at the patient's group home despite continued compliance with her antiepileptic regimen. Contrast material-enhanced imaging was not available at the time of recent presentation, so comparison was made with gadolinium-enhanced brain MRI performed approximately 9 years earlier.
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Affiliation(s)
- Matthew Klumpp
- From the Department of Diagnostic Radiology, SUNY Upstate Medical University, 750 E Adams St, Syracuse, NY 13210-2306
| | - Rajiv Mangla
- From the Department of Diagnostic Radiology, SUNY Upstate Medical University, 750 E Adams St, Syracuse, NY 13210-2306
| | - Atin Goel
- From the Department of Diagnostic Radiology, SUNY Upstate Medical University, 750 E Adams St, Syracuse, NY 13210-2306
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Wang Y, Zhang C, Wang X, Sang L, Zhou F, Zhang JG, Hu WH, Zhang K. Seizure and cognitive outcomes of posterior quadrantic disconnection: a series of 12 pediatric patients. Br J Neurosurg 2019; 34:677-682. [PMID: 31747787 DOI: 10.1080/02688697.2019.1692785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Purpose: To evaluate surgical outcomes and cognitive improvements after posterior quadrantic disconnection (PQD) in children who had medically intractable epilepsy and to compare the various characteristics between the acquired group and the developmental group.Method: Between 2015 and 2017, we retrospectively enrolled all pediatric patients who underwent PQD. We used image post-processing techniques for preoperative evaluation. Seizure outcomes and postoperative cognitive improvements were analysed. The patients were divided into the acquired group and the developmental group depending on the pathology; we then compared groups regarding age at onset, surgery, history, and seizure and cognitive outcomes.Results: A total of 12 pediatric patients were enrolled, including 7 acquired patients and 5 developmental patients. After a median 28.9-month follow-up, 11 (91.7%) of 12 patients were seizure free. The image post-processing facilitated a better visualization on preoperative evaluation and helped with detection of the epileptogenic zone. There were significant linear relationships between improvements in IQ and operative age (R2=0.527, p = 0.007) and IQ and epileptic history (R2=0.696, p = 0.001). The median age at seizure onset was 4.86 ± 2.12 years in the acquired group and 2.40 ± 1.14 years in the developmental group (t = 2.344, p = 0.028). Epileptic histories, seizure outcomes and cognitive outcomes were not significantly different between groups.Conclusion: Posterior quadrantic disconnection is an effective epilepsy surgery in selected patients. The use of image post-processing is important for preoperative evaluation. The age at seizure onset and surgery in malformation of cortical development (MCD) patients was earlier; however, the seizure outcome was no better than in acquired pathology patients. Early surgery did not change seizure outcomes but improved cognition.
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Affiliation(s)
- Yao Wang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Chao Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xiu Wang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Lin Sang
- Epilepsy Center, Peking University First Hospital Fengtai Hospital, Beijing, China
| | - Feng Zhou
- Epilepsy Center, Peking University First Hospital Fengtai Hospital, Beijing, China
| | - Jian-Guo Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Neurostimulation, China, Beijing.,Stereotactic and Functional Neurosurgery Laboratory, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Wen-Han Hu
- Beijing Key Laboratory of Neurostimulation, China, Beijing.,Stereotactic and Functional Neurosurgery Laboratory, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Kai Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Neurostimulation, China, Beijing
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Kalbhenn T, Cloppenborg T, Wörmann FG, Blümcke I, Coras R, May TW, Polster T, Simon M, Bien CG. Operative posterior disconnection in epilepsy surgery: Experience with 29 patients. Epilepsia 2019; 60:1973-1983. [PMID: 31468520 DOI: 10.1111/epi.16318] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Revised: 07/29/2019] [Accepted: 07/29/2019] [Indexed: 12/31/2022]
Abstract
OBJECTIVE It has been suggested that multilobar epilepsies caused by lesions restricted to the posterior cerebral quadrant (ie, the parietal, temporal, and occipital lobes) can be treated successfully by a procedure termed posterior disconnection. The objective of the present paper was to identify determinants of the epileptological outcome following posterior disconnection surgery. METHODS The authors retrospectively analyzed a series of 29 consecutive patients undergoing posterior disconnection surgery between 2005 and 2017 for the treatment of refractory posterior quadrantic epilepsy. Specifically, all presurgical and postoperative magnetic resonance (MR) studies were reviewed to identify cases with an incomplete disconnection, or the presence of a more widespread pathology involving the whole hemisphere rather than only its posterior quadrant. In addition, we reevaluated all presurgical video-electroencephalography (EEG) reports. RESULTS Seizure-free (International League Against Epilepsy [ILAE] 1) after surgery were 3/3 patients with EEG findings restricted to the posterior quadrant, 0/7 patients who had propagation of epileptic activity to the contralateral frontal lobe, and 11/19 (57.9%) who showed propagation to ipsilateral frontal and/or contralateral posterior. Eleven of 13 (84.6%) patients with purely posterior quadrantic magnetic resonance imaging (MRI) findings (as retrospectively diagnosed by neuroimaging) vs 3/16 (18.8%) cases with additional subtle abnormalities outside the posterior quadrant became seizure-free (P = .001). Eleven of 16 (68.8%) patients with complete disconnections were seizure-free vs only 3/13 (23.0%) cases with leftover temporal lobe tissue with contact to the insula (P = .025, both Fisher's exact test). SIGNIFICANCE A posterior disconnection is a technically demanding but very effective operation for posterior quadrantic epilepsy. Good epileptologic outcomes require not only that the epileptogenic lesion does not extend beyond the confines of the disconnected cerebral volume but also the absence of subtle MRI abnormalities, more widespread than the clear-cut lesion of the posterior quadrant. Hemispheric or contralateral (particularly frontal) propagation of the epileptic activity may also indicate the presence of a hemispheric rather than posterior quadrantic pathology.
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Affiliation(s)
- Thilo Kalbhenn
- Department of Neurosurgery - Epilepsy surgery, Evangelisches Klinikum Bethel, Bielefeld, Germany
| | | | | | - Ingmar Blümcke
- Department of Neuropathology, University Hospital Erlangen, Erlangen, Germany
| | - Roland Coras
- Department of Neuropathology, University Hospital Erlangen, Erlangen, Germany
| | | | | | - Matthias Simon
- Department of Neurosurgery - Epilepsy surgery, Evangelisches Klinikum Bethel, Bielefeld, Germany.,Society for Epilepsy Research, Bielefeld, Germany
| | - Christian G Bien
- Epilepsy Center Bethel, Bielefeld, Germany.,Society for Epilepsy Research, Bielefeld, Germany
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Reghunath A, Ghasi RG, Bhargava A, Bhambri NK. Posterior Quadrantic Dysplasia: MRI Diagnosis of a Lesser Known Cause of Pediatric Intractable Epilepsy. J Pediatr Neurosci 2018; 13:112-115. [PMID: 29899786 PMCID: PMC5982479 DOI: 10.4103/jpn.jpn_88_17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Posterior quadrantic dysplasia (PQD) is a rare cause of pediatric intractable epilepsy. It is a sporadic cortical development malformation that involves the posterior three lobes of a single hemisphere and spares the frontal cortex. Very few cases have been reported in the literature, mostly as anecdotal reports or as a part of large series of refractory epilepsy. It is essential to know about this lesser known entity and differentiate it from other more common similar anomalies such as multilobar cortical dysplasia and hemimegalencephaly as new motor-sparing neurosurgical disconnective procedures have led to dramatically reduced mortality and morbidity rates, apart from gifting the affected children a better quality of life. Magnetic resonance imaging (MRI) is pivotal in astute diagnosis of the condition and accurate delineation of boundaries of the lesion to aid in neurosurgical management. We report one such case of PQD presenting with refractory epilepsy, which was diagnosed on MRI.
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Affiliation(s)
- Anjuna Reghunath
- Department of Radiodiagnosis, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Rohini Gupta Ghasi
- Department of Radiodiagnosis, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Abhimanyu Bhargava
- Department of Radiodiagnosis, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Narinder Kumar Bhambri
- Department of Radiodiagnosis, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
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Fernández-Concepción O, López Jiménez M, Valencia-Calderón C, Calderón-Valdivieso A, Recasén-Linares A, Reyes-Haro L, Vásquez-Ham C. Safety and effectiveness of surgery for epilepsy in children. Experience of a tertiary hospital in Ecuador. Neurologia 2018. [PMID: 29525400 DOI: 10.1016/j.nrl.2017.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
Abstract
INTRODUCTION There is sufficient evidence on the usefulness of surgery as a therapeutic alternative for patients with drug-resistant epilepsy; however this treatment is underutilized, especially in developing countries. METHODS We describe the outcomes of epilepsy surgery in 27 paediatric patients at Hospital Baca Ortiz in Quito, Ecuador. Our analysis considered the following variables: reduction in seizure frequency, surgery outcome according to the Engel classification, improvement in quality of life, and serious complications due to surgery. RESULTS 21 corpus callosotomies and 6 resective surgeries were performed. The mean seizure frequency decreased from 465 per month before surgery to 37.2 per month thereafter (p<.001); quality of life scale scores increased from 12.6 to 37.2 (p<.001), and quality of life improved in 72.7% of patients. Regarding resective surgery, 2 patients with temporal lobe epilepsy and one with posterior quadrant epilepsy achieved Engel class IA, and one patient undergoing hemispherotomy due to Rasmussen encephalitis achieved Engel class IIA. Two patients underwent surgery for hypothalamic hamartoma: one achieved Engel III and the other, Engel IA; however, the latter patient died in the medium term due to a postoperative complication. The other major complication was a case of hydrocephalus, which led to the death of a patient with refractory infantile spasms who underwent corpus callosotomy. CONCLUSIONS Favourable outcomes were observed in 92.5% of patients.
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Affiliation(s)
| | - M López Jiménez
- Servicio de Neurofisiología, Hospital Baca Ortiz, Quito, Ecuador
| | | | | | | | - L Reyes-Haro
- Servicio de Neurofisiología, Hospital Baca Ortiz, Quito, Ecuador
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Cuello-Oderiz C, von Ellenrieder N, Dubeau F, Gotman J. Influence of the location and type of epileptogenic lesion on scalp interictal epileptiform discharges and high-frequency oscillations. Epilepsia 2017; 58:2153-2163. [DOI: 10.1111/epi.13922] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/18/2017] [Indexed: 01/30/2023]
Affiliation(s)
- Carolina Cuello-Oderiz
- Montreal Neurological Institute and Hospital; McGill University; Montreal Quebec, Canada
| | | | - François Dubeau
- Montreal Neurological Institute and Hospital; McGill University; Montreal Quebec, Canada
| | - Jean Gotman
- Montreal Neurological Institute and Hospital; McGill University; Montreal Quebec, Canada
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Verhaeghe A, Decramer T, Naets W, Van Paesschen W, van Loon J, Theys T. Posterior Quadrant Disconnection: A Fiber Dissection Study. Oper Neurosurg (Hagerstown) 2017; 14:45-50. [DOI: 10.1093/ons/opx060] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Accepted: 03/01/2017] [Indexed: 11/13/2022] Open
Abstract
AbstractBACKGROUNDPosterior quadrant disconnection can be highly effective in the surgical treatment of selected cases of refractory epilepsy. The technique aims to deafferent extensive areas of epileptogenic posterior cortex from the rest of the brain by isolating the temporoparietooccipital cortex.OBJECTIVETo describe this procedure and relevant white matter tracts with a specific emphasis on the extent of callosotomy in an anatomic study.METHODSTwenty hemispheres were dissected according to Klingler's fiber dissection technique illustrating the peri-insular (temporal stem, superior longitudinal fasciculus, corona radiata) and mesial disconnection (mesiotemporal cortex, cingulum, and corpus callosum).RESULTSExtensive white matter tract disconnection is obtained after posterior quadrant disconnection. Callosal fibers connecting the anterior most part of the parietal cortex invariably ran through the isthmus of the corpus callosum and need to be disconnected, while frontal lobe connections including the corticospinal tract and the anterior two-thirds of the corpus callosum are spared during the procedure.CONCLUSIONOur findings suggest the involvement of both the splenium and the isthmus in interhemispheric propagation in posterior cortex epilepsies. Sectioning the total extent of the posterior one-third of the corpus callosum might therefore be necessary to achieve optimal outcomes in posterior quadrant epilepsy surgery.
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Affiliation(s)
| | - Thomas Decramer
- Department of Neurosurgery, University Hospitals Leuven, Leuven, Belgium
| | - Wim Naets
- Department of Neurosurgery, University Hospitals Leuven, Leuven, Belgium
| | - Wim Van Paesschen
- Department of Neurology, University Hospitals Leuven, Leuven, Belgium
| | - Johannes van Loon
- Department of Neurosurgery, University Hospitals Leuven, Leuven, Belgium
| | - Tom Theys
- Department of Neurosurgery, University Hospitals Leuven, Leuven, Belgium
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Liang SL. [Surgery for posterior quadrant epilepsy]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2017; 19:264-267. [PMID: 28302193 PMCID: PMC7390159 DOI: 10.7499/j.issn.1008-8830.2017.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Accepted: 01/03/2017] [Indexed: 06/06/2023]
Affiliation(s)
- Shu-Li Liang
- Department of Neurosurgery, General Hospital of People's Liberation Army, Beijing 100853, China
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Ono Y, Saito Y, Maegaki Y, Tohyama J, Montassir H, Fujii S, Sugai K, Ohno K. Three cases of right frontal megalencephaly: Clinical characteristics and long-term outcome. Brain Dev 2016; 38:302-9. [PMID: 26415548 DOI: 10.1016/j.braindev.2015.09.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2015] [Revised: 09/08/2015] [Accepted: 09/11/2015] [Indexed: 11/30/2022]
Abstract
AIM To delineate the clinical and neuroimaging characteristics of localized megalencephaly involving the right frontal lobe. METHOD Data from three patients aged 14-16 years at the last follow-up were retrospectively reviewed. RESULTS All the patients were normal on neurological examination with no signs of hemiparesis. Enlargement of the right frontal lobe with increased volume of subcortical and deep white matter, as well as thickening of the ipsilateral genu of the corpus callosum was common. The onset of epilepsy was 4-7 years of age, with seizure types of massive myoclonus in two and generalized tonic-clonic in two, which could be eventually controlled by antiepileptics. Interictal electroencephalography showed frontal alpha-like activity in one, and abundant spike-wave complexes resulting in diffuse continuous spike-wave activity during sleep in two patients even after suppression of clinical seizures. Psychomotor development appeared unaffected or slightly delayed before the onset of epilepsy, but became mildly disturbed during follow-up period of 7-11 years. CONCLUSION Certain patients with right frontal megalencephaly can present with a milder epileptic and intellectual phenotype among those with localized megalencephaly and holohemispheric hemimegalencephaly, whose characteristic as epileptic encephalopathy was assumed from this study.
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Affiliation(s)
- Yoichi Ono
- Division of Child Neurology, Institute of Neurological Sciences, Faculty of Medicine, Tottori University, Yonago, Japan
| | - Yoshiaki Saito
- Division of Child Neurology, Institute of Neurological Sciences, Faculty of Medicine, Tottori University, Yonago, Japan.
| | - Yoshihiro Maegaki
- Division of Child Neurology, Institute of Neurological Sciences, Faculty of Medicine, Tottori University, Yonago, Japan
| | - Jun Tohyama
- Department of Pediatrics, Epilepsy Center, Nishi-Niigata Chuo National Hospital, Niigata, Japan
| | - Hesham Montassir
- Division of Child Neurology, Institute of Neurological Sciences, Faculty of Medicine, Tottori University, Yonago, Japan
| | - Shinya Fujii
- Division of Radiology, Faculty of Medicine, Tottori University, Yonago, Japan
| | - Kenji Sugai
- Department of Child Neurology, National Center of Neurology and Psychiatry, Kodaira, Japan
| | - Kousaku Ohno
- Division of Child Neurology, Institute of Neurological Sciences, Faculty of Medicine, Tottori University, Yonago, Japan
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