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Katlowitz KA, Curry DJ, Weiner HL. Novel Surgical Approaches in Childhood Epilepsy: Laser, Brain Stimulation, and Focused Ultrasound. Adv Tech Stand Neurosurg 2024; 49:291-306. [PMID: 38700689 DOI: 10.1007/978-3-031-42398-7_13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2024]
Abstract
Pediatric epilepsy has a worldwide prevalence of approximately 1% (Berg et al., Handb Clin Neurol 111:391-398, 2013) and is associated with not only lower quality of life but also long-term deficits in executive function, significant psychosocial stressors, poor cognitive outcomes, and developmental delays (Schraegle and Titus, Epilepsy Behav 62:20-26, 2016; Puka and Smith, Epilepsia 56:873-881, 2015). With approximately one-third of patients resistant to medical control, surgical intervention can offer a cure or palliation to decrease the disease burden and improve neurological development. Despite its potential, epilepsy surgery is drastically underutilized. Even today only 1% of the millions of epilepsy patients are referred annually for neurosurgical evaluation, and the average delay between diagnosis of Drug Resistant Epilepsy (DRE) and surgical intervention is approximately 20 years in adults and 5 years in children (Solli et al., Epilepsia 61:1352-1364, 2020). It is still estimated that only one-third of surgical candidates undergo operative intervention (Pestana Knight et al., Epilepsia 56:375, 2015). In contrast to the stable to declining rates of adult epilepsy surgery (Englot et al., Neurology 78:1200-1206, 2012; Neligan et al., Epilepsia 54:e62-e65, 2013), rates of pediatric surgery are rising (Pestana Knight et al., Epilepsia 56:375, 2015). Innovations in surgical approaches to epilepsy not only minimize potential complications but also expand the definition of a surgical candidate. In this chapter, three alternatives to classical resection are presented. First, laser ablation provides a minimally invasive approach to focal lesions. Next, both central and peripheral nervous system stimulation can interrupt seizure networks without creating permanent lesions. Lastly, focused ultrasound is discussed as a potential new avenue not only for ablation but also modulation of small, deep foci within seizure networks. A better understanding of the potential surgical options can guide patients and providers to explore all treatment avenues.
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Affiliation(s)
- Kalman A Katlowitz
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA
- Department of Neurosurgery, Texas Children's Hospital, Houston, TX, USA
| | - Daniel J Curry
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA
- Department of Neurosurgery, Texas Children's Hospital, Houston, TX, USA
| | - Howard L Weiner
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA.
- Department of Neurosurgery, Texas Children's Hospital, Houston, TX, USA.
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Youngerman BE, Banu MA, Khan F, McKhann GM, Schevon CA, Jagid JR, Cajigas I, Theodotou CB, Ko A, Buckley R, Ojemann JG, Miller JW, Laxton AW, Couture DE, Popli GS, Buch VP, Halpern CH, Le S, Sharan AD, Sperling MR, Mehta AD, Englot DJ, Neimat JS, Konrad PE, Sheth SA, Neal EG, Vale FL, Holloway KL, Air EL, Schwalb JM, D'Haese PF, Wu C. Long-term outcomes of mesial temporal laser interstitial thermal therapy for drug-resistant epilepsy and subsequent surgery for seizure recurrence: a multi-centre cohort study. J Neurol Neurosurg Psychiatry 2023; 94:879-886. [PMID: 37336643 PMCID: PMC10776034 DOI: 10.1136/jnnp-2022-330979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 05/30/2023] [Indexed: 06/21/2023]
Abstract
BACKGROUND Magnetic resonance-guided laser interstitial thermal therapy (MRgLITT) is a minimally invasive alternative to surgical resection for drug-resistant mesial temporal lobe epilepsy (mTLE). Reported rates of seizure freedom are variable and long-term durability is largely unproven. Anterior temporal lobectomy (ATL) remains an option for patients with MRgLITT treatment failure. However, the safety and efficacy of this staged strategy is unknown. METHODS This multicentre, retrospective cohort study included 268 patients consecutively treated with mesial temporal MRgLITT at 11 centres between 2012 and 2018. Seizure outcomes and complications of MRgLITT and any subsequent surgery are reported. Predictive value of preoperative variables for seizure outcome was assessed. RESULTS Engel I seizure freedom was achieved in 55.8% (149/267) at 1 year, 52.5% (126/240) at 2 years and 49.3% (132/268) at the last follow-up ≥1 year (median 47 months). Engel I or II outcomes were achieved in 74.2% (198/267) at 1 year, 75.0% (180/240) at 2 years and 66.0% (177/268) at the last follow-up. Preoperative focal to bilateral tonic-clonic seizures were independently associated with seizure recurrence. Among patients with seizure recurrence, 14/21 (66.7%) became seizure-free after subsequent ATL and 5/10 (50%) after repeat MRgLITT at last follow-up≥1 year. CONCLUSIONS MRgLITT is a viable treatment with durable outcomes for patients with drug-resistant mTLE evaluated at a comprehensive epilepsy centre. Although seizure freedom rates were lower than reported with ATL, this series represents the early experience of each centre and a heterogeneous cohort. ATL remains a safe and effective treatment for well-selected patients who fail MRgLITT.
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Affiliation(s)
- Brett E Youngerman
- Department of Neurological Surgery, Columbia University, New York, New York, USA
| | - Matei A Banu
- Department of Neurological Surgery, Columbia University, New York, New York, USA
| | - Farhan Khan
- Department of Neurological Surgery, Columbia University, New York, New York, USA
| | - Guy M McKhann
- Department of Neurological Surgery, Columbia University, New York, New York, USA
| | | | - Jonathan R Jagid
- Department of Neurological Surgery, Jackson Memorial Hospital, University of Miami, Miami, Florida, USA
| | - Iahn Cajigas
- Department of Neurological Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Christian B Theodotou
- Department of Neurological Surgery, Jackson Memorial Hospital, University of Miami, Miami, Florida, USA
| | - Andrew Ko
- Department of Neurological Surgery, University of Washington, Seattle, Washington, USA
| | - Robert Buckley
- Department of Neurological Surgery, University of Washington, Seattle, Washington, USA
| | - Jeffrey G Ojemann
- Department of Neurological Surgery, University of Washington, Seattle, Washington, USA
| | - John W Miller
- Department of Neurology, University of Washington, Seattle, Washington, USA
| | - Adrian W Laxton
- Department of Neurological Surgery, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Daniel E Couture
- Department of Neurological Surgery, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Gautam S Popli
- Department of Neurology, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Vivek P Buch
- Department of Neurological Surgery, Stanford Neuroscience Health Center, Stanford, California, USA
| | - Casey H Halpern
- Department of Neurological Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Scheherazade Le
- Department of Neurology, Stanford Comprehensive Epilepsy Center, Stanford, California, USA
| | - Ashwini D Sharan
- Department of Neurological Surgery, Vickie and Jack Farber Institute for Neuroscience, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Michael R Sperling
- Department of Neurology, Vickie and Jack Farber Institute for Neuroscience, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Ashesh D Mehta
- Department of Neurological Surgery, Zucker School of Medicine at Hofstra Northwell, Hempstead, New York, USA
| | - Dario J Englot
- Department of Neurological Surgery, Vanderbilt University, Nashville, Nashville, Tennessee, USA
| | - Joseph S Neimat
- Department of Neurological Surgery, University of Louisville, Louisville, Kentucky, USA
| | - Peter E Konrad
- Department of Neurological Surgery, Vanderbilt University, Nashville, Nashville, Tennessee, USA
| | - Sameer A Sheth
- Department of Neurological Surgery, Baylor College of Medicine, Houston, Texas, USA
| | - Elliot G Neal
- Department of Neurological Surgery, University of South Florida Health South Tampa Center, Tampa, Florida, USA
| | - Fernando L Vale
- Department of Neurological Surgery, Medical College of Georgia-Augusta University, Augusta, Georgia, USA
| | - Kathryn L Holloway
- Department of Neurological Surgery, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Ellen L Air
- Department of Neurological Surgery, Henry Ford Health, Detroit, Michigan, USA
| | - Jason M Schwalb
- Department of Neurological Surgery, Henry Ford Health, Detroit, Michigan, USA
| | - Pierre-François D'Haese
- Rockefeller Neuroscience Institute, West Virginia University, Morgantown, West Virginia, USA
| | - Chengyuan Wu
- Department of Neurological Surgery, Vickie and Jack Farber Institute for Neuroscience, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
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Neisser J, Abreu G, Drane DL, Pedersen NP, Parsons TD, Cleary AM. Opening a conceptual space for metamemory experience. NEW IDEAS IN PSYCHOLOGY 2023; 69:100995. [PMID: 38223256 PMCID: PMC10786624 DOI: 10.1016/j.newideapsych.2022.100995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
The experiences associated with remembering, including metamemory feelings about the act of remembering and attempts at remembering, are not often integrated into general accounts of memory. For example, David Rubin (2022) proposes a unified, three-dimensional conceptual space for mapping memory states, a map that does not systematically specify metamemory feelings. Drawing on Rubin's model, we define a distinct role for metamemory in relation to first-order memory content. We propose a fourth dimension for the model and support the proposal with conceptual, neurocognitive, and clinical lines of reasoning. We use the modified model to illustrate several cases, and show how it helps to conceptualize a new category of memory state: autonoetic knowing, exemplified by déjà vu. We also caution not to assume that memory experience is directly correlated with or caused by memory content, an assumption Tulving (1989) labeled the doctrine of concordance.
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Affiliation(s)
- Joseph Neisser
- Department of Philosophy, Grinnell College, 1120 Park St, Grinnell, IA, 50112, USA
| | - George Abreu
- Department of Philosophy, Grinnell College, 1120 Park St, Grinnell, IA, 50112, USA
| | - Daniel L Drane
- Department of Neurology, Emory University, 101 Woodruff Circle, Atlanta, GA, 30322, USA
- Department of Neurology, University of Washington School of Medicine, Seattle, WA, 98105, USA
| | - Nigel P Pedersen
- Department of Pediatrics, Emory University, 101 Woodruff Circle, Atlanta, GA, 30322, USA
- Department of Biomedical Engineering, The Georgia Institute of Technology, Atlanta, GA, 30332, USA
| | - Thomas D Parsons
- Simulation Science & Immersive Technology, Arizona State University, Tempe, AZ, 85281, USA
| | - Anne M Cleary
- Department of Psychology, Colorado State University, Fort Collins, CO, 80525, USA
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Patil AA, de Joya J. Minimally invasive surgical techniques in patients with intractable epilepsy with CT-guided stereotactic cryoablation as a superior alternative: a systematic review. EGYPTIAN JOURNAL OF NEUROSURGERY 2022. [DOI: 10.1186/s41984-022-00174-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Abstract
Background
Stereotactic cryoablation is a minimally invasive surgical technique that has been used to treat disorders of the brain in the past; however, in current practice, it is primarily used for the treatment of liver, kidney, lung, prostate, and breast neoplasms. In this paper, currently used surgical methods to treat medically refractory seizure disorder are reviewed, and a case is made for the use of stereotactic cryoablation.
Main body
Anterior temporal lobectomy is the gold standard for temporal. There are also several variations of this procedure. Since this is a resective surgery, it can result in neurological defects. To obviate this problem, minimally invasive surgical techniques such as radio frequency ablation and laser interstitial thermal therapy are currently being used for intracranial targets. Cryoablation offers certain advantages over thermal ablations. Cryoablation studies in brain, renal, breast, and other neoplasms have shown that cryoablation has superior abilities to monitor the ablation zone in real time via computerized tomography imaging and also has the capability to create lesions of both smaller and larger sizes. This allows for safer and more effective tumor destruction.
Short conclusion
Based on the review, the authors conclude that further investigation of the use of stereotactic cryoablation in patients with medically intractable epilepsy is needed.
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Abstract
Temporal lobe epilepsy (TLE) is the most common cause of refractory epilepsy amenable for surgical treatment and seizure control. Surgery for TLE is a safe and effective strategy. The seizure-free rate after surgical resection in patients with mesial or neocortical TLE is about 70%. Resective surgery has an advantage over stereotactic radiosurgery in terms of seizure outcomes for mesial TLE patients. Both techniques have similar results for safety, cognitive outcomes, and associated costs. Stereotactic radiosurgery should therefore be seen as an alternative to open surgery for patients with contraindications for or with reluctance to undergo open surgery. Laser interstitial thermal therapy (LITT) has also shown promising results as a curative technique in mesial TLE but needs to be more deeply evaluated. Brain-responsive stimulation represents a palliative treatment option for patients with unilateral or bilateral MTLE who are not candidates for temporal lobectomy or who have failed a prior mesial temporal lobe resection. Overall, despite the expansion of innovative techniques in recent years, resective surgery remains the reference treatment for TLE and should be proposed as the first-line surgical modality. In the future, ultrasound therapies could become a credible therapeutic option for refractory TLE patients.
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Affiliation(s)
- Bertrand Mathon
- Department of Neurosurgery, La Pitié-Salpêtrière University Hospital, Paris, France; Sorbonne University, Paris, France; Paris Brain Institute, Paris, France
| | - Stéphane Clemenceau
- Department of Neurosurgery, La Pitié-Salpêtrière University Hospital, Paris, France
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Youngerman BE, Save AV, McKhann GM. Magnetic Resonance Imaging-Guided Laser Interstitial Thermal Therapy for Epilepsy: Systematic Review of Technique, Indications, and Outcomes. Neurosurgery 2020; 86:E366-E382. [PMID: 31980831 DOI: 10.1093/neuros/nyz556] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Accepted: 11/20/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND For patients with focal drug-resistant epilepsy (DRE), surgical resection of the epileptogenic zone (EZ) may offer seizure freedom and benefits for quality of life. Yet, concerns remain regarding invasiveness, morbidity, and neurocognitive side effects. Magnetic resonance-guided laser interstitial thermal therapy (MRgLITT) has emerged as a less invasive option for stereotactic ablation rather than resection of the EZ. OBJECTIVE To provide an introduction to MRgLITT for epilepsy, including historical development, surgical technique, and role in therapy. METHODS The development of MRgLITT is briefly recounted. A systematic review identified reported techniques and indication-specific outcomes of MRgLITT for DRE in human studies regardless of sample size or follow-up duration. Potential advantages and disadvantages compared to available alternatives for each indication are assessed in an unstructured review. RESULTS Techniques and outcomes are reported for mesial temporal lobe epilepsy, hypothalamic hamartoma, focal cortical dysplasia, nonlesional epilepsy, tuberous sclerosis, periventricular nodular heterotopia, cerebral cavernous malformations, poststroke epilepsy, temporal encephalocele, and corpus callosotomy. CONCLUSION MRgLITT offers access to foci virtually anywhere in the brain with minimal disruption of the overlying cortex and white matter, promising fewer neurological side effects and less surgical morbidity and pain. Compared to other ablative techniques, MRgLITT offers immediate, discrete lesions with real-time monitoring of temperature beyond the fiber tip for damage estimates and off-target injury prevention. Applications of MRgLITT for epilepsy are growing rapidly and, although more evidence of safety and efficacy is needed, there are potential advantages for some patients.
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Affiliation(s)
- Brett E Youngerman
- Department of Neurological Surgery, Columbia University Medical Center, New York, New York
| | - Akshay V Save
- Department of Neurological Surgery, Columbia University Medical Center, New York, New York
| | - Guy M McKhann
- Department of Neurological Surgery, Columbia University Medical Center, New York, New York
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Abe K, Yamaguchi T, Hori H, Sumi M, Horisawa S, Taira T, Hori T. Magnetic resonance-guided focused ultrasound for mesial temporal lobe epilepsy: a case report. BMC Neurol 2020; 20:160. [PMID: 32349706 PMCID: PMC7189704 DOI: 10.1186/s12883-020-01744-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Accepted: 04/22/2020] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND We report the first case of transcranial magnetic resonance-guided focused ultrasound (MRgFUS) for mesial temporal lobe epilepsy (MTLE). CASE PRESENTATION The target was located 20 mm lateral from the midline and 15 mm above the skull base (left hippocampus). Despite the application of maximal energy, the ablation temperature did not exceed 50 °C, probably because of the low number of effective transducer elements with incident angles below 25 degrees. The skull density ratio was 0.56. Post-operative magnetic resonance imaging did not reveal any lesion and the patient remained almost seizure-free for up to 12 months. CONCLUSIONS This preliminary case report suggests that MRgFUS may be effective for treating cases of MTLE. Therefore, the safety and feasibility of MRgFUS should be evaluated in future studies with larger numbers of participants and longer follow-up duration.
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Affiliation(s)
- Keiichi Abe
- Department of Neurosurgery, Tokyo Women's Medical University, Shinjuku-ku, Kawata-cho, 8-1, Tokyo, 162-0054, Japan.
| | - Toshio Yamaguchi
- Department of Radiology, Shinyurigaoka General Hospital, Kawasaki, Japan
| | - Hiroki Hori
- Faculty of Advanced Techno-Surgery, Institute of Advanced Biomedical Engineering & Science, Graduate School of Medicine, Tokyo Women's Medical University, Tokyo, Japan
| | - Masatake Sumi
- Department of Neurosurgery, Tokyo Women's Medical University, Shinjuku-ku, Kawata-cho, 8-1, Tokyo, 162-0054, Japan
| | - Shiro Horisawa
- Department of Neurosurgery, Tokyo Women's Medical University, Shinjuku-ku, Kawata-cho, 8-1, Tokyo, 162-0054, Japan
| | - Takaomi Taira
- Department of Neurosurgery, Tokyo Women's Medical University, Shinjuku-ku, Kawata-cho, 8-1, Tokyo, 162-0054, Japan
| | - Tomokatsu Hori
- Department of Neurosurgery, Moriyama Neurological Center Hospital, Tokyo, Japan
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Bhansali AP, Gwinn RP. Ablation: Radiofrequency, Laser, and HIFU. Stereotact Funct Neurosurg 2020. [DOI: 10.1007/978-3-030-34906-6_16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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"Laser and the Tuber": thermal dynamic and volumetric factors influencing seizure outcomes in pediatric subjects with tuberous sclerosis undergoing stereoencephalography-directed laser ablation of tubers. Childs Nerv Syst 2019; 35:1333-1340. [PMID: 31209639 DOI: 10.1007/s00381-019-04255-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2019] [Accepted: 06/05/2019] [Indexed: 12/31/2022]
Abstract
PURPOSE Tuberous sclerosis (TSC) is a well-known cause of medically refractory epilepsy (MRE). Stereoencephalography-directed magnetic resonance-guided laser interstitial thermal therapy (SEEG-directed MRgLITT) is an emerging minimally invasive technique that appears aptly suited for the surgical management of TSC. Our aims are to present our experiences with patients who had undergone SEEG-directed MRgLITT to identify and treat cortical tubers responsible for clinical seizures and to perform an in-depth analysis of volumetric and thermal dynamic factors that may be related to seizure outcomes. METHODS We studied all pediatric patients with MRE due to TSC who underwent SEEG-directed MRgLITT, investigating seizure outcomes in relation to thermal dynamic and volumetric factors. RESULTS Eight cortical tubers from three pediatric patients were analyzed. Two of three patients had Engel I outcomes at last follow-up (median 18 months). Average A/T (ablation volume/tuber volume) ratio for Engel I outcomes was 1.28 (variance, 0.16) and 0.84 (variance, < 0.01) for all other outcomes (P = 0.035). There was a moderate positive correlation when comparing ablation energy to ablation volume (R2 = 0.65) in cortical tuber tissue. When the calcified tuber is excluded, the correlation is stronger (R2 = 0.77). Thus, the calculated energy needed to ablate 1 cm3 of cortical tuber tissue is 1263.6 J (calcified tuber) or 1089.5 J (non-calcified tuber). CONCLUSIONS SEEG-directed MRgLITT appears to be a safe and effective technique in the management of pediatric patients with MRE due to TSC. The A/T ratio may be a useful indicator in predicting seizure outcomes.
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Harput MV, Türe U. In Reply: The Paramedian Supracerebellar-Transtentorial Selective Amygdalohippocampectomy for Mediobasal Temporal Epilepsy. Oper Neurosurg (Hagerstown) 2018; 15:E34-E35. [DOI: 10.1093/ons/opy085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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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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Boone CE, Wojtasiewicz T, Moukheiber E, Butala A, Jordao L, Mills KA, Sair H, Anderson WS. MR-Guided Functional Neurosurgery: Laser Ablation and Deep Brain Stimulation. Top Magn Reson Imaging 2018; 27:171-177. [PMID: 29870469 DOI: 10.1097/rmr.0000000000000152] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Intraoperative magnetic resonance imaging (iMRI) is increasingly implemented for image-guided procedures in functional neurosurgery. iMRI facilitates accurate electrode implantation for deep brain stimulation (DBS) and is currently an alternative method for DBS electrode targeting. The application of iMRI also allows for greater accuracy and precision in laser-induced thermal therapy (LITT). The expanding use of functional neurosurgical procedures makes safety and feasibility of iMRI important considerations, particularly in patients with comorbidities or complex medical histories. We review here the applications of iMRI and discuss its safety, feasibility, and limitations in functional neurosurgery.To motivate discussion of this topic, we also present a 52-year-old patient with an implanted cardioverter-defibrillator (ICD) who successfully underwent iMRI-guided DBS electrode implantation for advanced Parkinson disease (PD). Neither iMRI nor the passage of electrical current through the implanted DBS electrodes demonstrated detectable interference in ICD function. This case demonstrates that, even in complex clinical contexts, iMRI is a promising tool that merits further exploration for procedures requiring highly accurate and precise identification of target structures.
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Affiliation(s)
| | | | | | | | | | | | - Haris Sair
- Department of Radiology, Neuroradiology, The Johns Hopkins University, Baltimore, MD
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Voges J, Büntjen L, Schmitt F. Radiofrequency-thermoablation: General principle, historical overview and modern applications for epilepsy. Epilepsy Res 2018; 142:113-116. [DOI: 10.1016/j.eplepsyres.2018.03.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2017] [Revised: 02/28/2018] [Accepted: 03/07/2018] [Indexed: 10/17/2022]
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Malikova H, Liscak R. A neurosurgeon’s view: Outcome after RF-ablation for mTLE. Epilepsy Res 2018; 142:126-130. [DOI: 10.1016/j.eplepsyres.2017.08.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Revised: 08/14/2017] [Accepted: 08/18/2017] [Indexed: 10/19/2022]
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Krámská L, Lukavský J, Vojtěch Z. A neuropsychologist's view: Outcome after RF-ablation for mTLE. Epilepsy Res 2017; 142:167-169. [PMID: 29031865 DOI: 10.1016/j.eplepsyres.2017.10.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Revised: 09/28/2017] [Accepted: 10/06/2017] [Indexed: 11/18/2022]
Abstract
Concern about postoperative worsening of cognitive functions after temporal lobe epilepsy surgery is an important issue. In this article we review our data on neuropsychological outcome after radiofrequency (RF) ablation of amygdalohippocampal complex (AHC). On a group level we found initial improvement in intelligence domains and unchanged memory scores one year after the surgery. During longitudinal follow-up, we found improvement in both intellectual and memory domains. This improvement was most pronounced up to two years after surgery. On an individual level, no patient worsened in any intellectual domain and most patients improved in memory. We hypothesize that this favorable outcome may be a consequence of minimization of collateral damage and incomplete destruction of target structures. We also summarize our experience with psychiatric complications of the procedure.
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Affiliation(s)
- Lenka Krámská
- Na Homolce Hospital, Epilepsy Center, Prague, Czech Republic; University of New York in Prague, Londýnská 41, 120 00 Prague 2, Czech Republic.
| | - Jiří Lukavský
- Institute of Psychology, Academy of Sciences of the Czech Republic, Hybernská 8, 110 00 Prague 1, Czech Republic
| | - Zdeněk Vojtěch
- Na Homolce Hospital, Epilepsy Center, Prague, Czech Republic
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An epileptologist's view: Seizure-related outcomes after radiofrequency ablation for mesial temporal lobe epilepsy. Epilepsy Res 2017; 142:140-142. [PMID: 28927701 DOI: 10.1016/j.eplepsyres.2017.09.004] [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: 04/16/2017] [Revised: 06/27/2017] [Accepted: 09/11/2017] [Indexed: 11/24/2022]
Abstract
In this article, we provide an overview of the reasons for the introduction of less invasive treatment modalities in the management of intractable mesial temporal lobe epilepsy (mTLE). We summarize our published research on stereotactic amygdalohippocampectomy (SAHE) and recalculate our data for the patients' last visit. In our previous work, we found that patients achieved long-term seizure-free outcomes in 70.5%. Re-analysis of results in a subgroup of patient who were diagnosed and followed-up at Epilepsy Center, Na Homolce Hospital, Prague, indicate that these outcomes are durable. Re-treatment in treatment failures was successful in all cases. The discussion compares novel treatment options and defines the place of SAHE among them.
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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.
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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
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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]
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Cossu M, Cardinale F, Casaceli G, Castana L, Consales A, D'Orio P, Lo Russo G. Stereo-EEG-guided radiofrequency thermocoagulations. Epilepsia 2017; 58 Suppl 1:66-72. [DOI: 10.1111/epi.13687] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/11/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Massimo Cossu
- “Claudio Munari” Centre for Epilepsy Surgery; Department of Neuroscience; ASST Grande Ospedale Metropolitano Niguarda; Milan Italy
| | - Francesco Cardinale
- “Claudio Munari” Centre for Epilepsy Surgery; Department of Neuroscience; ASST Grande Ospedale Metropolitano Niguarda; Milan Italy
| | - Giuseppe Casaceli
- “Claudio Munari” Centre for Epilepsy Surgery; Department of Neuroscience; ASST Grande Ospedale Metropolitano Niguarda; Milan Italy
| | - Laura Castana
- “Claudio Munari” Centre for Epilepsy Surgery; Department of Neuroscience; ASST Grande Ospedale Metropolitano Niguarda; Milan Italy
| | | | - Piergiorgio D'Orio
- “Claudio Munari” Centre for Epilepsy Surgery; Department of Neuroscience; ASST Grande Ospedale Metropolitano Niguarda; Milan Italy
| | - Giorgio Lo Russo
- “Claudio Munari” Center for Epilepsy Surgery; Department of Neuroscience; ASST Grande Ospedale Metropolitano Niguarda; Milan Italy
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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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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]
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Voges J, Wellmer J, Büntjen L, Schmitt FC. Radiofrequenz-Thermoablation – die neurochirurgische Sicht. ZEITSCHRIFT FÜR EPILEPTOLOGIE 2016. [DOI: 10.1007/s10309-016-0095-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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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: 58] [Impact Index Per Article: 7.3] [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.
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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
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Sinha S, Danish SF. History and Technical Approaches and Considerations for Ablative Surgery for Epilepsy. Neurosurg Clin N Am 2016; 27:27-36. [PMID: 26615105 DOI: 10.1016/j.nec.2015.08.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
The history of epilepsy surgery is generally noted to have begun in 1886 with Victor Horsley's first report of craniotomies for posttraumatic epilepsy. With increased understanding of brain function and development of electroencephalographic methods, nonlesional epilepsy began to be treated with resection in the 1950s. Methodological improvements and increased understanding of pathophysiology followed, and the advent of stereotaxy and ablative technology in the 1960s and 1970s heralded a new era of minimally invasive, targeted procedures for lesional and nonlesional epilepsy. Current techniques combine stereotactic methods, improved ablative technologies, and electroencephalographic methods for a multidisciplinary approach to the neurosurgical treatment of epilepsy.
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Affiliation(s)
- Saurabh Sinha
- Department of Neurosurgery, Rutgers Robert Wood Johnson Medical School, 125 Paterson Street, New Brunswick, NJ 08901, USA
| | - Shabbar F Danish
- Department of Neurosurgery, Rutgers Robert Wood Johnson Medical School, 125 Paterson Street, New Brunswick, NJ 08901, USA.
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25
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Pruitt R, Gamble A, Black K, Schulder M, Mehta AD. Complication avoidance in laser interstitial thermal therapy: lessons learned. J Neurosurg 2016; 126:1238-1245. [PMID: 27257839 DOI: 10.3171/2016.3.jns152147] [Citation(s) in RCA: 76] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Complications of laser interstitial thermal therapy (LITT) are underreported. The authors discuss how they have modified their technique in the context of technical and treatment-related adverse events. METHODS The Medtronic Visualase system was used in 49 procedures in 46 patients. Between 1 and 3 cooling catheters/laser fiber assemblies were placed, for a total of 62 implanted devices. Devices were placed using frameless stereotaxy (n = 3), frameless stereotaxy with intraoperative MRI (iMRI) (n = 9), iMRI under direct vision (n = 2), MRI alone (n = 1), or frame-based (n = 47) techniques. LITT was performed while monitoring MRI thermometry. Indications included brain tumors (n = 12), radiation necrosis (n = 2), filum terminale ependymoma (n = 1), mesial temporal lobe epilepsy (n = 21), corpus callosotomy for bifrontal epilepsy (n = 3), cavernoma (n = 1), and hypothalamic hamartomas (n = 6). RESULTS Some form of adverse event occurred in 11 (22.4%) of 49 procedures. These included 4 catheter malpositions, 3 intracranial hemorrhages, 3 cases of neurological deficit related to thermal injury, and 1 technical malfunction resulting in an aborted procedure. Of these, direct thermal injury was the only cause of prolonged neurological morbidity and occurred in 3 of 49 procedures. Use of frameless stereotaxy and increased numbers of devices were associated with significantly increased complication rates (p < 0.05). A number of procedural modifications were made to avoid complications, including the use of 1) frame-based catheter placement, a 1.8-mm alignment rod to create a track and titanium skull anchors for long trajectories to improve accuracy; 2) a narrow-gauge instrument for dural puncture and coregistration of contrast MRI with CT angiography to reduce intracranial hemorrhage; 3) general endotracheal anesthesia for posterior-placed skull anchors to reduce the likelihood of damage to the cooling catheter; 4) use of as few probes as possible to reduce complications overall; and 5) dose modification of thermal treatment and use of short (3-mm) diffusing tips to limit treatment when structures to be spared do not have intervening CSF spaces to act as heat sinks. CONCLUSIONS Laser ablation treatment may be used for a variety of neurosurgical procedures for patients with tumors and epilepsy. While catheter placement and thermal treatment may be associated with a range of suboptimal operative and postoperative courses, permanent neurological morbidity is less common. The authors' institutional experience illustrates a number of measures that may be taken to improve outcomes using this important new tool in the neurosurgical arsenal.
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Affiliation(s)
- Rachel Pruitt
- Hofstra Northwell School of Medicine, Hempstead; and
| | | | - Karen Black
- Hofstra Northwell School of Medicine, Hempstead; and.,Radiology, North Shore University Hospital, Manhasset, New York
| | - Michael Schulder
- Hofstra Northwell School of Medicine, Hempstead; and.,Departments of 2 Neurosurgery and
| | - Ashesh D Mehta
- Hofstra Northwell School of Medicine, Hempstead; and.,Departments of 2 Neurosurgery and
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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.
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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
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Bandt SK, Leuthardt EC. Minimally Invasive Neurosurgery for Epilepsy Using Stereotactic MRI Guidance. Neurosurg Clin N Am 2016; 27:51-8. [DOI: 10.1016/j.nec.2015.08.005] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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28
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Mandel M, Figueiredo EG, Mandel SA, Tutihashi R, Teixeira MJ. Minimally Invasive Transpalpebral Endoscopic-Assisted Amygdalohippocampectomy. Oper Neurosurg (Hagerstown) 2015; 13:2-14. [DOI: 10.1227/neu.0000000000001179] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2015] [Accepted: 11/24/2015] [Indexed: 11/19/2022] Open
Abstract
Abstract
BACKGROUND: Although anterior temporal lobectomy may be a definitive surgical treatment for epileptic patients with mesial temporal sclerosis, it often results in verbal, visual, and cognitive dysfunction. Studies have consistently reported the advantages of selective procedures compared with a standard anterior temporal lobectomy, mainly in terms of neuropsychological outcomes.
OBJECTIVE: To describe a new technique to perform a selective amygdalohippocampectomy (SAH) through a transpalpebral approach with endoscopic assistance.
METHODS: A mini fronto-orbitozygomatic craniotomy through an eyelid incision was performed in 8 patients. Both a microscope and neuroendoscope were used in the surgeries. An anterior SAH was performed in 5 patients who had the diagnosis of temporal lobe epilepsy with mesial temporal sclerosis. One patient had a mesial temporal lesion suggesting a ganglioglioma. Two patients presented mesial temporal cavernomas with seizures originating from the temporal lobe.
RESULTS: The anterior approach allowed removal of the amygdala and hippocampus. The image-guided system and postoperative evaluation confirmed that the amygdala may be accessed and completely removed through this route. The hippocampus was partially resected. All patients have discontinued medication with no more epileptic seizures. The patients with cavernomas and ganglioglioma also had their lesions completely removed. One-year follow-up has shown no visible scars.
CONCLUSION: The anterior route for SAH is a rational and direct approach to the mesial temporal lobe. Anterior SAH is a safe, less invasive procedure that provides early identification of critical vascular and neural structures in the basal cisterns. The transpalpebral approach provides a satisfactory cosmetic outcome.
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Affiliation(s)
- Mauricio Mandel
- Department of Neurosurgery, Hospital das Clínicas of University of São Paulo Medical School, São Paulo, Brazil
- Hospital Sírio Libanês, São Paulo, Brazil
- Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Eberval Gadelha Figueiredo
- Department of Neurosurgery, Hospital das Clínicas of University of São Paulo Medical School, São Paulo, Brazil
- Hospital Sírio Libanês, São Paulo, Brazil
| | - Suzana Abramovicz Mandel
- Department of Neurosurgery, Hospital das Clínicas of University of São Paulo Medical School, São Paulo, Brazil
- Hospital Sírio Libanês, São Paulo, Brazil
- Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Rafael Tutihashi
- Hospital Sírio Libanês, São Paulo, Brazil
- Hospital Israelita Albert Einstein, São Paulo, Brazil
- Department of Plastic Surgery, Hospital das Clínicas of University of São Paulo Medical School, São Paulo, Brazil
| | - Manoel Jacobsen Teixeira
- Department of Neurosurgery, Hospital das Clínicas of University of São Paulo Medical School, São Paulo, Brazil
- Hospital Sírio Libanês, São Paulo, Brazil
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Cossu M, Fuschillo D, Casaceli G, Pelliccia V, Castana L, Mai R, Francione S, Sartori I, Gozzo F, Nobili L, Tassi L, Cardinale F, Lo Russo G. Stereoelectroencephalography-guided radiofrequency thermocoagulation in the epileptogenic zone: a retrospective study on 89 cases. J Neurosurg 2015; 123:1358-67. [DOI: 10.3171/2014.12.jns141968] [Citation(s) in RCA: 90] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT
Radiofrequency thermocoagulation (RF-TC) of presumed epileptogenic lesions and/or structures has gained new popularity as a treatment option for drug-resistant focal epilepsy, mainly in patients with mesial temporal lobe epilepsy. The role of this minimally invasive procedure in more complex cases of drug-resistant epilepsy, which may require intracranial electroencephalographic evaluation, has not been fully assessed. This retrospective study reports on a case series of patients with particularly complex focal epilepsy who underwent stereoelectroencephalography (SEEG) evaluation with stereotactically implanted multicontact intracerebral electrodes for the detailed identification of the epileptogenic zone (EZ) and who received RF-TC in their supposed EZ (according to SEEG findings).
METHODS
Eighty-nine patients (49 male and 40 female; age range 2–49 years) who underwent SEEG evaluation and subsequent RF-TC of the presumed EZ at the authors' institution between January 2008 and December 2013 were selected. Brain MRI revealed structural abnormalities in 43 cases and no lesions in 46 cases. After SEEG, 67 patients were judged suitable for resective surgery (Group 1), whereas surgery was excluded for 22 patients (Group 2). Thermocoagulation was performed in each of these patients by using the previously implanted multicontact recording electrodes and delivering RF-generated currents to adjacent electrode contacts.
RESULTS
The mean number of TC sites per patient was 10.6 ± 7.2 (range 1–33). Sustained seizure freedom occurred after TC in 16 patients (18.0%) (13 in Group 1 and 3 in Group 2). A sustained worthwhile improvement was reported by 9 additional patients (10.1%) (3 in Group 1 and 6 in Group 2). As a whole, 25 patients (28.1%) exhibited a persistent significant improvement in their seizures. More favorable results were observed in patients with nodular heterotopy (p = 0.0001389), those with a lesion found on MRI (not significant), and those with hippocampal sclerosis (not significant). Other variables significantly correlated to seizure freedom were the patient's age (p = 0.02885) and number of intralesional TC sites (p = 0.0271). The patients in Group 1 who did not benefit at all (21 patients) or who experienced only a transient benefit (30 patients) from TC underwent microsurgical resection of their EZ. Thermocoagulation was followed by severe permanent neurological deficits in 2 patients (an unexpected complex neuropsychological syndrome in one patient and an expected and anticipated permanent motor deficit in the other).
CONCLUSIONS
This study provides evidence that SEEG-guided TC in the EZ may be a treatment option for particularly complex drug-resistant focal epilepsy that requires invasive evaluation. A small subset of patients who achieve seizure freedom or worthwhile improvement may avoid open surgery or take advantage of an otherwise unexpected treatment if resection is not an option. Patients with epileptogenic nodular heterotopy are probably ideal candidates for this treatment.
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Affiliation(s)
| | - Dalila Fuschillo
- 2Section of Neurosurgery, Department of Neurosciences and of Sense Organs, University of Milan; and
| | - Giuseppe Casaceli
- 1Epilepsy Surgery Center and
- 3Department of Neuroscience, University of Parma, Italy
| | - Veronica Pelliccia
- 1Epilepsy Surgery Center and
- 3Department of Neuroscience, University of Parma, Italy
| | | | | | | | | | | | - Lino Nobili
- 1Epilepsy Surgery Center and
- 4Center of Sleep Medicine, Department of Neuroscience, Niguarda Hospital, Milan
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Gross RE, Willie JT, Drane DL. The Role of Stereotactic Laser Amygdalohippocampotomy in Mesial Temporal Lobe Epilepsy. Neurosurg Clin N Am 2015; 27:37-50. [PMID: 26615106 DOI: 10.1016/j.nec.2015.08.004] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Stereotactic laser amygdalohippocampotomy (SLAH) uses laser interstitial thermal therapy guided by magnetic resonance thermography. This novel intervention can achieve seizure freedom while minimizing collateral damage compared to traditional open surgery, in patients with mesial temporal lobe epilepsy. An algorithm is presented to guide treatment decisions for initial and repeat procedures in patients with and without mesial temporal sclerosis. SLAH may improve access by medication-refractory patients to effective surgical treatments and thereby decrease medical complications, increase productivity, and minimize socioeconomic consequences in patients with chronic epilepsy.
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Affiliation(s)
- Robert E Gross
- Department of Neurosurgery, Emory University School of Medicine, 1365 Clifton Road N.E., Atlanta, GA 30322, USA; Department of Neurology, Emory University School of Medicine, 101 Woodruff Circle, Suite 6111, Atlanta, GA 30322, USA; Interventional MRI Program, Emory University Hospital, 1364 Clifton Road, N.E., Atlanta, GA 30322, USA; Coulter Department of Biomedical Engineering, Emory University, 1760 Haygood Dr, Ste W 200, Atlanta, GA 30322, USA.
| | - Jon T Willie
- Department of Neurosurgery, Emory University School of Medicine, 1365 Clifton Road N.E., Atlanta, GA 30322, USA; Department of Neurology, Emory University School of Medicine, 101 Woodruff Circle, Suite 6111, Atlanta, GA 30322, USA; Interventional MRI Program, Emory University Hospital, 1364 Clifton Road, N.E., Atlanta, GA 30322, USA
| | - Daniel L Drane
- Department of Neurology, Emory University School of Medicine, 101 Woodruff Circle, Suite 6111, Atlanta, GA 30322, USA; Department of Neurology, University of Washington School of Medicine, Harborview Medical Center, 325 9th Avenue, Seattle, WA 98104, USA
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Medvid R, Ruiz A, Komotar RJ, Jagid JR, Ivan ME, Quencer RM, Desai MB. Current Applications of MRI-Guided Laser Interstitial Thermal Therapy in the Treatment of Brain Neoplasms and Epilepsy: A Radiologic and Neurosurgical Overview. AJNR Am J Neuroradiol 2015; 36:1998-2006. [PMID: 26113069 DOI: 10.3174/ajnr.a4362] [Citation(s) in RCA: 117] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Minimally invasive stereotactic tumor ablation is a viable option for the treatment of benign and malignant intracranial lesions. Although surgical excision constitutes first-line therapy for various brain pathologies, it can cause irreversible neurologic deficits. Additionally, many patients who may benefit from surgery do not qualify as surgical candidates due to multiple comorbidities. Recent advancements in laser interstitial thermal therapy, namely the ability to monitor ablation in real-time under MR imaging, have improved the safety and efficacy of the procedure. MRI-guided laser interstitial thermal therapy is currently used as a minimally invasive treatment for brain metastases, radiation necrosis, glioma, and epilepsy. This article will discuss the principles, suggested indications, complications, and imaging characteristics of MRI-guided laser interstitial thermal therapy as they pertain to the treatment of brain pathology.
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Affiliation(s)
- R Medvid
- From the Department of Radiology (R.M., A.R., R.M.Q., M.B.D.), Division of Neuroradiology
| | - A Ruiz
- From the Department of Radiology (R.M., A.R., R.M.Q., M.B.D.), Division of Neuroradiology
| | - R J Komotar
- Department of Neurological Surgery (J.R.J., R.J.K., M.E.I.), Jackson Memorial Hospital/University of Miami Hospital, Miami, Florida
| | - J R Jagid
- Department of Neurological Surgery (J.R.J., R.J.K., M.E.I.), Jackson Memorial Hospital/University of Miami Hospital, Miami, Florida
| | - M E Ivan
- Department of Neurological Surgery (J.R.J., R.J.K., M.E.I.), Jackson Memorial Hospital/University of Miami Hospital, Miami, Florida
| | - R M Quencer
- From the Department of Radiology (R.M., A.R., R.M.Q., M.B.D.), Division of Neuroradiology
| | - M B Desai
- From the Department of Radiology (R.M., A.R., R.M.Q., M.B.D.), Division of Neuroradiology
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Malikova H, Liscak R, Vojtěch Z. Letter to the Editor: Minimally invasive technique for epilepsy surgery. J Neurosurg 2015; 122:1513-4. [PMID: 25859813 DOI: 10.3171/2014.12.jns142834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Hana Malikova
- Epilepsy Center Na Homolce Hospital, Prague, Czech Republic
| | - Roman Liscak
- Epilepsy Center Na Homolce Hospital, Prague, Czech Republic
| | - Zdeněk Vojtěch
- Epilepsy Center Na Homolce Hospital, Prague, Czech Republic
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35
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Surgical treatment for mesial temporal lobe epilepsy associated with hippocampal sclerosis. Rev Neurol (Paris) 2015; 171:315-25. [DOI: 10.1016/j.neurol.2015.01.561] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Revised: 01/01/2015] [Accepted: 01/30/2015] [Indexed: 02/07/2023]
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36
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Willie JT, Laxpati NG, Drane DL, Gowda A, Appin C, Hao C, Brat DJ, Helmers SL, Saindane A, Nour SG, Gross RE. Real-time magnetic resonance-guided stereotactic laser amygdalohippocampotomy for mesial temporal lobe epilepsy. Neurosurgery 2015; 74:569-84; discussion 584-5. [PMID: 24618797 DOI: 10.1227/neu.0000000000000343] [Citation(s) in RCA: 251] [Impact Index Per Article: 27.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Open surgery effectively treats mesial temporal lobe epilepsy, but carries the risk of neurocognitive deficits, which may be reduced with minimally invasive alternatives. OBJECTIVE To describe technical and clinical outcomes of stereotactic laser amygdalohippocampotomy with real-time magnetic resonance thermal imaging guidance. METHODS With patients under general anesthesia and using standard stereotactic methods, 13 adult patients with intractable mesial temporal lobe epilepsy (with and without mesial temporal sclerosis [MTS]) prospectively underwent insertion of a saline-cooled fiberoptic laser applicator in amygdalohippocampal structures from an occipital trajectory. Computer-controlled laser ablation was performed during continuous magnetic resonance thermal imaging followed by confirmatory contrast-enhanced anatomic imaging and volumetric reconstruction. Clinical outcomes were determined from seizure diaries. RESULTS A mean 60% volume of the amygdalohippocampal complex was ablated in 13 patients (9 with MTS) undergoing 15 procedures. Median hospitalization was 1 day. With follow-up ranging from 5 to 26 months (median, 14 months), 77% (10/13) of patients achieved meaningful seizure reduction, of whom 54% (7/13) were free of disabling seizures. Of patients with preoperative MTS, 67% (6/9) achieved seizure freedom. All recurrences were observed before 6 months. Variances in ablation volume and length did not account for individual clinical outcomes. Although no complications of laser therapy itself were observed, 1 significant complication, a visual field defect, resulted from deviated insertion of a stereotactic aligning rod, which was corrected before ablation. CONCLUSION Real-time magnetic resonance-guided stereotactic laser amygdalohippocampotomy is a technically novel, safe, and effective alternative to open surgery. Further evaluation with larger cohorts over time is warranted.
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Affiliation(s)
- Jon T Willie
- Departments of *Neurosurgery, ‡Neurology, §Pathology, and ¶Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia; ‖Interventional MRI Program, Emory University Hospital, Atlanta, Georgia; #Coulter Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, Georgia; **Department of Neurology, University of Washington School of Medicine, Seattle, Washington; ††Visualase, Inc., Houston, Texas
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Vojtěch Z, Malíková H, Krámská L, Liščák R, Vladyka V. MRI-guided stereotactic amygdalohippocampectomy: a single center experience. Neuropsychiatr Dis Treat 2015; 11:359-74. [PMID: 25709460 PMCID: PMC4334329 DOI: 10.2147/ndt.s69350] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND This paper presents our experience of stereotactic radiofrequency amygdalohippocampectomy performed for intractable mesial temporal lobe epilepsy. METHODS The article describes the cases of 61 patients who were treated during the period from 2004 to 2010. Mean postoperative follow-up was 5.3 years. Neuropsychological results were obtained for a subset of 31 patients. RESULTS At their last postsurgical visit, 43 (70.5%) patients were Engel class I, six (9.8%) class II, nine (14.8%) class III, and three (4.9%) class IV. The surgery was complicated by four intracranial hematomas. One of them caused acute hydrocephalus and was treated by shunting and resolved without sequelae, while another caused transitory aphasia. The remaining hematomas were asymptomatic. There were two cases of meningitis which required antibiotic treatment. One patient committed suicide due to postoperative depression. After the procedure, we performed open epilepsy surgery and rethermolesions in three and two patients, respectively (8.2%). Patients showed increases in their mean full scale, verbal, and performance intelligence quotient (IQ) scores of 4, 3, and 4 IQ points, respectively (P<0.05). Five (17.2%), four (13.8%), and four (13.3%) patients improved their full scale, verbal, and performance IQ scores, respectively. No significant changes were found in memory performance, with a mean increase of 1, 3, and 0 memory quotient points in global, verbal, and visual memory, respectively (P<0.05). Global memory improved in three (10.3%) patients, verbal memory in one (3.4%), and one patient (3.3%) showed deterioration in visual memory. CONCLUSION Stereotactic radiofrequency amygdalohippocampectomy offers a safe, effective, and less aggressive treatment modality in cases of well-defined mesial temporal lobe epilepsy. Seizure outcome is comparable with the results of conventional epilepsy surgery and cognitive results could be even better.
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Affiliation(s)
- Zdeněk Vojtěch
- Department of Neurology, Na Homolce Hospital, Prague, Czech Republic
| | - Hana Malíková
- Department of Radiodiagnostics, Na Homolce Hospital, Prague, Czech Republic
| | - Lenka Krámská
- Department of Psychology, Na Homolce Hospital, Prague, Czech Republic
| | - Roman Liščák
- Department of Stereotactic and Radiation Neurosurgery, Na Homolce Hospital, Prague, Czech Republic
| | - Vilibald Vladyka
- Department of Stereotactic and Radiation Neurosurgery, Na Homolce Hospital, Prague, Czech Republic
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Malikova H, Kramska L, Vojtech Z, Sroubek J, Lukavsky J, Liscak R. Relationship between remnant hippocampus and amygdala and memory outcomes after stereotactic surgery for mesial temporal lobe epilepsy. Neuropsychiatr Dis Treat 2015; 11:2927-33. [PMID: 26640379 PMCID: PMC4657808 DOI: 10.2147/ndt.s95497] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND AND PURPOSE Mesial temporal structures play an important role in human memory. In mesial temporal lobe epilepsy (MTLE), seizure activity is generated from the same structures. Surgery is the definitive treatment for medically intractable MTLE. In addition to standard temporal lobe microsurgical resection, stereotactic radiofrequency amygdalohippocampectomy (SAHE) is used as an alternative MTLE treatment. While memory impairments after standard epilepsy surgery are well known, it has been shown that memory decline is not a feature of SAHE. The aim of the present study was to correlate the volume of the remnant hippocampus and amygdala in patients treated by SAHE with changes in memory parameters. MATERIALS AND METHODS Thirty-seven MTLE patients treated by SAHE (ten right, 27 left) were included. Patients underwent magnetic resonance imaging examinations including hippocampal and amygdalar volumetry and neuropsychological evaluation preoperatively and 1 year after surgery. RESULTS Using Spearman correlation analyses, larger left-sided hippocampal reductions were associated with lower verbal memory performance (ρ=-0.46; P=0.02). On the contrary, improvement of global memory quotient (MQ) was positively correlated with larger right-sided hippocampal reduction (ρ=0.66; P=0.04). Similarly, positive correlations between the extent of right amygdalar reduction and verbal MQ (ρ=0.74; P=0.02) and global MQ change (ρ=0.69; P=0.03) were found. Thus, larger right hippocampal and amygdalar reduction was associated with higher global and verbal MQ change after SAHE. CONCLUSION Larger left-sided hippocampal reductions were associated with lower verbal memory performance. This finding is in accordance with the material-specific model of human memory, which states that the dominant hemisphere is specialized for the learning and recall of verbal information. We hypothesize that larger right-sided ablations enable the left temporal lobe to support memory more effectively, perhaps as a consequence of epileptiform discharges spreading from remnants of right mesiotemporal structures to the left.
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Affiliation(s)
- Hana Malikova
- Department of Radiology, Na Homolce Hospital, Prague, Czech Republic ; Institute of Anatomy, Second Medical Faculty, Charles University in Prague, Prague, Czech Republic
| | - Lenka Kramska
- Department of Clinical Psychology, Na Homolce Hospital, Prague, Czech Republic
| | - Zdenek Vojtech
- Department of Neurology, Na Homolce Hospital, Prague, Czech Republic ; Department of Neurology, 3rd Medical Faculty, Charles University in Prague, Prague, Czech Republic
| | - Jan Sroubek
- Department of Neurosurgery, Na Homolce Hospital, Prague, Czech Republic
| | - Jiri Lukavsky
- Institute of Psychology, Academy of Sciences of the Czech Republic, Prague, Czech Republic
| | - Roman Liscak
- Department of Radiation and Stereotactic Neurosurgery, Na Homolce Hospital, Prague, Czech Republic
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Malikova H, Kramska L, Vojtech Z, Liscak R, Sroubek J, Lukavsky J, Druga R. Different surgical approaches for mesial temporal epilepsy: resection extent, seizure, and neuropsychological outcomes. Stereotact Funct Neurosurg 2014; 92:372-80. [PMID: 25359168 DOI: 10.1159/000366003] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Accepted: 07/14/2014] [Indexed: 11/19/2022]
Abstract
BACKGROUND Surgical therapy of intractable mesial temporal lobe epilepsy (MTLE) is an effective and well-established treatment. OBJECTIVES We compared two different surgical approaches, standard microsurgical anterior temporal resection (ATL) and stereotactic radiofrequency amygdalohippocampectomy (SAHE) for MTLE, with respect to the extent of resection or destruction, clinical outcomes, and complications. MATERIAL AND METHODS 75 MTLE patients were included: 41 treated by SAHE (11 right sided, 30 left sided) and 34 treated by ATL (21 right sided, 13 left sided). RESULTS SAHE and ATL seizure control were comparable (Engel I in 75.6 and 76.5% 2 years after surgery and 79.3 and 76.5% 5 years after procedures, respectively). The neuropsychological results of SAHE patients were better than in ATL. In SAHE patients, no memory deficit was found. Hippocampal (60.6 ± 18.7%) and amygdalar (50.3 ± 21.9%) volume reduction by SAHE was significantly lower than by ATL (86.0 ± 12.7% and 80.2 ± 20.9%, respectively). The overall rate of surgical nonsilent complications without permanent neurological deficit after ATL was 11.8%, and another 8.8% silent infarctions were found on MRI. The rate of clinically manifest complications after SAHE was 4.9%. The rate of visual field defects after SAHE was expectably less frequent than after ATL. CONCLUSION Seizure control by SAHE was comparable to ATL. However, SAHE was safer with better neuropsychological results.
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Affiliation(s)
- Hana Malikova
- Department of Radiology, Na Homolce Hospital, Prague, Czech Republic
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Vojtěch Z, Malíková H, Krámská L, Anýž J, Syrůček M, Zámečník J, Liščák R, Vladyka V. Long-term seizure outcome after stereotactic amygdalohippocampectomy. Acta Neurochir (Wien) 2014; 156:1529-37. [PMID: 24875613 DOI: 10.1007/s00701-014-2126-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2014] [Accepted: 05/02/2014] [Indexed: 01/28/2023]
Abstract
BACKGROUND The aim of the study was to evaluate the long-term seizure outcome and complications after stereotactic radiofrequency amygdalohippocampectomy (SAHE) performed for mesial temporal lobe epilepsy (MTLE). METHODS The article describes the cases of 61 patients who were treated at our institution during the period 2004-2010. Mean post-operative follow-up was 5.3 years. RESULTS At the last postsurgical visit, 43 (70.5 %) patients were Engel Class I, six (9.8 %) Class II, nine (14.8 %) Class III and three (4.9 %) Class IV. The surgery was complicated by four intracranial haematomas. One of them caused acute hydrocephalus and was treated by shunting and resolved without sequelae. After SAHE, we performed open epilepsy surgery and re-thermo lesions in three and two patients, respectively (8.2 %). There were two cases of meningitis which required antibiotic treatment. In six patients psychiatric disorders developed and one of these committed suicide due to postoperative depression. CONCLUSIONS Our results provide preliminary evidence for good long-term seizure outcomes after SAHE. SAHE could be an alternative therapy for MTLE.
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Riordan M, Tovar-Spinoza Z. Laser induced thermal therapy (LITT) for pediatric brain tumors: case-based review. Transl Pediatr 2014; 3:229-35. [PMID: 26835340 PMCID: PMC4729851 DOI: 10.3978/j.issn.2224-4336.2014.07.07] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Integration of Laser induced thermal therapy (LITT) to magnetic resonance imaging (MRI) have created new options for treating surgically challenging tumors in locations that would otherwise have represented an intrinsic comorbidity by the approach itself. As new applications and variations of the use are discussed, we present a case-based review of the history, development, and subsequent updates of minimally invasive MRI-guided laser interstitial thermal therapy (MRgLITT) ablation in pediatric brain tumors.
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Affiliation(s)
- Margaret Riordan
- Department of Neurosurgery, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Zulma Tovar-Spinoza
- Department of Neurosurgery, SUNY Upstate Medical University, Syracuse, NY, USA
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Chen HI, Bohman LE, Loevner LA, Lucas TH. Transorbital endoscopic amygdalohippocampectomy: a feasibility investigation. J Neurosurg 2014; 120:1428-36. [DOI: 10.3171/2014.2.jns131060] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object
Resection of the hippocampus is the standard of care for medically intractable epilepsy in patients with mesial temporal sclerosis. Although temporal craniotomy in this setting is highly successful, the procedure carries certain immutable risks and may be associated with cognitive deficits related to cortical and white matter disruption. Alternative surgical approaches may reduce some of these risks by preserving the lateral temporal lobe. This study examined the feasibility of transorbital endoscopic amygdalohippocampectomy (TEA) as an alternative to open craniotomy in cadaveric specimens.
Methods
TEA dissections were performed in 4 hemispheres from 2 injected cadaveric specimens fixed in alcohol. Quantitative predictions of the limits of exposure based on predissection imaging were compared with intradissection measurements. The extent of resection and angles of exposure during the dissection and on postdissection imaging were recorded. These measurements were validated with MRI studies from 10 epilepsy patients undergoing standard surgical evaluations.
Results
The transorbital approach permitted direct access to the mesial temporal structures through the lateral orbital wall. Up to 97% of the hippocampal formation was resected with no brain retraction and minimal (mean 6.0 ± 1.4 mm) globe displacement. Lateral temporal lobe white matter tracts were preserved.
Conclusions
TEA permits hippocampectomy comparable to standard surgical approaches without disrupting the lateral temporal cortex or white matter. This novel approach is feasible in cadaveric specimens and warrants clinical investigation in carefully selected cases.
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Affiliation(s)
| | | | - Laurie A. Loevner
- 1Department of Neurosurgery and
- 2Division of Neuroradiology, University of Pennsylvania, Philadelphia, Pennsylvania
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Stereotactic radiofrequency amygdalohippocampectomy: Two years of good neuropsychological outcomes. Epilepsy Res 2013; 106:423-32. [DOI: 10.1016/j.eplepsyres.2013.07.009] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2013] [Revised: 06/18/2013] [Accepted: 07/26/2013] [Indexed: 10/26/2022]
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Malikova H, Kramska L, Liscak R, Vojtech Z, Prochazka T, Mareckova I, Lukavsky J, Druga R. Stereotactic radiofrequency amygdalohippocampectomy for the treatment of temporal lobe epilepsy: Do good neuropsychological and seizure outcomes correlate with hippocampal volume reduction? Epilepsy Res 2012; 102:34-44. [DOI: 10.1016/j.eplepsyres.2012.04.017] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2012] [Revised: 03/28/2012] [Accepted: 04/21/2012] [Indexed: 11/26/2022]
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Curry DJ, Gowda A, McNichols RJ, Wilfong AA. MR-guided stereotactic laser ablation of epileptogenic foci in children. Epilepsy Behav 2012; 24:408-14. [PMID: 22687387 DOI: 10.1016/j.yebeh.2012.04.135] [Citation(s) in RCA: 355] [Impact Index Per Article: 29.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2012] [Revised: 04/29/2012] [Accepted: 04/30/2012] [Indexed: 10/28/2022]
Abstract
OBJECTIVE For about 30% of epilepsy patients, pharmaceutical therapy fails to control their seizures. MR-guided laser interstitial thermal therapy (MRgLITT) allows for real-time thermal monitoring of the ablation process and feedback control over the laser energy delivery. We report on minimally invasive surgical techniques of MRgLITT and short-term follow-up results from the first five pediatric cases in which this system was used to ablate focal epileptic lesions. METHODS We studied the patients with MRI of the brain, localized the seizure with video-EEG and used the Visualase Thermal Therapy 25 System for laser ablation of their seizure foci. RESULTS All 5 patients are seizure free and there were no complications as of 2-13-month follow-up. CONCLUSION MR-guided laser interstitial thermal therapy has a significant potential to be a minimally invasive alternative to more conventional techniques to surgically treat medically refractory epilepsy in children.
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Affiliation(s)
- Daniel J Curry
- Division of Pediatric Neurosurgery, Texas Children's Hospital, Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA.
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Vojtěch Z, Krámská L, Malíková H, Seltenreichová K, Procházka T, Kalina M, Liščák R. Cognitive outcome after stereotactic amygdalohippocampectomy. Seizure 2012; 21:327-33. [PMID: 22445176 DOI: 10.1016/j.seizure.2012.02.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2011] [Revised: 02/20/2012] [Accepted: 02/21/2012] [Indexed: 10/28/2022] Open
Abstract
PURPOSE We sought to determine the neuropsychological outcome after stereotactic radiofrequency amygdalohippocampectomy performed for intractable mesial temporal lobe epilepsy. METHODS The article describes the cases of 31 patients who were evaluated using the Wechsler Adult Intelligence Scale-Revised and the Wechsler Memory Scale-Revised prior to, and one year after, surgery. KEY FINDINGS Patients showed increases in their mean Full Scale, Verbal and Performance IQ scores of 4, 3 and 4 IQ points respectively (p<.05). 5 (17.2%), 4 (13.8%) and 4 (13.3%) patients improved in their Full-scale, Verbal and Performance IQ respectively. No significant changes were found in memory performance - with a mean increase of 1, 3 and 0 MQ points in Global, Verbal and Visual memory respectively (p<.05). Global memory improved in 3 (10.3%) patients, verbal memory in 1 (3.4%) and 1 patient (3.3%) showed deterioration in visual memory. SIGNIFICANCE Our results provide evidence for unchanged memory in patients with MTLE after the procedure. No verbal memory deterioration was detected in any of our patients, while improvements were found in intellectual performance. The results suggest that stereotactic radiofrequency amygdalahippocampectomy could be superior to open surgery in terms of its neurocognitive outcomes. A larger randomised trial of these approaches is justified.
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Affiliation(s)
- Zdeněk Vojtěch
- Department of Neurology, Na Homolce Hospital, Prague, Czech Republic.
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Malikova H, Liscak R, Vojtech Z, Prochazka T, Vymazal J, Vladyka V, Druga R. Stereotactic radiofrequency amygdalohippocampectomy: Does reduction of entorhinal and perirhinal cortices influence good clinical seizure outcome? Epilepsia 2011; 52:932-40. [DOI: 10.1111/j.1528-1167.2011.03048.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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