Completion Corpus Callosotomy with Stereotactic Radiosurgery for Drug-Resistant, Intractable Epilepsy

Radiosurgical Corpus Callosotomy for Intractable Epilepsy: Retrospective Long-Term Safety and Efficacy Assessment in 19 Patients an Review of the Literature

BACKGROUND

Some patients suffering from intractable epileptic seizures, particularly drop attacks (DAs), are nonremediable by curative techniques. Palliative procedure carries a significant rate of surgical and neurological complications.

OBJECTIVE

To propose evaluation of safety and efficacy of Gamma Knife corpus callosotomy (GK-CC) as an alternative to microsurgical corpus callosotomy.

METHODS

This study included retrospective analysis of 19 patients who underwent GK-CC between 2005 and 2017.

RESULTS

Of the 19 patients, 13 (68%) had improvement in seizure control and 6 had no significant improvement. Of the 13/19 (68%) with improvement in seizures, 3 (16%) became completely seizure-free, 2 (11%) became free of DA and generalized tonic-clonic but with residual other seizures, 3 (16%) became free of DA only, and 5 (26%) had >50% reduction in frequency of all seizure types. In the 6 (31%) patients with no appreciable improvement, there were residual untreated commissural fibers and incomplete callosotomy rather than failure of Gamma Knife to disconnect. Seven patients showed a transient mild complication (37% of patients, 33% of the procedures). No permanent complication or neurological consequence was observed during the clinical and radiological workup with a mean of 89 (42-181) months, except 1 patient who had no improvement of epilepsy and then aggravation of the pre-existing cognitive and walking difficulties (Lennox-Gastaut). The median time of improvement after GK-CC was 3 (1-6) months.

CONCLUSION

Gamma Knife callosotomy is safe and accurate with comparable efficacy to open callosotomy in this cohort of patients with intractable epilepsy suffering from severe drop attacks.

Microsurgical anatomy of the anterior cerebral artery and the arterial supply of the cingulate gyrus

PURPOSE

The cingulate gyrus is a potential surgical area to treat tumours, psychiatric diseases, intractable pain and vascular malformations. The aim of the study was to define the topographic anatomy and arterial supply of the cingulate gyrus located on the medial surface of the cerebral hemisphere.

METHODS

We studied thirty-six hemispheres, each hemisected in the midsagittal plane. The vertical thickness of the cingulate gyrus was measured at the anterior commissure (AC), posterior commissure (PC), and genu levels of the corpus callosum. The branches of the anterior and posterior cerebral arteries supplying each zone were noted separately. The arterial pathways were transformed to digital data in AutoCAD to identify the condensation and reduction areas.

RESULTS

The mean AC-PC distance was 27.17 ± 1.63 mm. The thinnest region was the genu level of the corpus callosum (10.29 mm). The superior internal parietal artery (SIPA), inferior internal parietal artery (IIPA) and pericallosal artery (PrCA) supplied all zones of the cingulate gyrus. The anterior zone received the greatest supply. The arterial condensation and reduction areas on both sides of cingulate gyrus and its x, y, and z coordinates specified.

CONCLUSIONS

The target cingulotomy (TC) area was determined for anterior cingulotomy. The properties of the TC area are that the thinnest region of the cingulate gyrus is supplied relatively less than other areas and is close to the anterior cingulotomy areas in the literature. The arterial reduction area (ARA) was found to be suitable for corpus callosotomy in terms of avoiding haemorrhage.

Corpus Callosotomy Is a Safe and Effective Procedure for Medically Resistant Epilepsy

Corpus callosotomy (CC) is an effective surgical treatment for medically resistant generalized or multifocal epilepsy (MRE). The premise of CC extrapolates from the observation that the corpus callosum is the predominant commissural pathway that allows spread and synchroneity of epileptogenic activity between the hemispheres. Candidacy for CC is typically reserved for patients seeking palliative epilepsy treatment with the goal of reducing the frequency of drop attacks, although reduction of other seizure semiologies (absence, complex partial seizures, and tonic-clonic) has been observed. A reduction in morbidity affiliated with evolution of surgical techniques to perform CC has improved the safety profile of the procedure without necessarily sacrificing efficacy.

Treatment of Intracranial Tumors With Stereotactic Radiosurgery: Short-Term Results From Cuba

Background Although international publications on radiosurgery have increased exponentially, reports of heterogeneous series treated with linear accelerator (LINAC) are scarce. Since most intracranial tumors are irregular in size and not spherical, LINACs (Elekta Precise®, Elekta AB, Sweden), fitted with a multi-leaf collimator, allow for precise stereotactic radiosurgery for the entire tumor. Aim To evaluate the effects of LINAC on an outpatient basis with patients diagnosed with various intracranial malignancies. Methodology A retrospective observational study of a series of cases of patients with intracranial lesions treated at the Institute of Oncology and Radiobiology using LINAC was carried out from October 2019 to May 2021 to evaluate the therapeutic results of radiosurgery in patients with intracranial tumors. Results A total of 22 lesions in 20 patients were treated with LINAC. The average age of the patients was 49.7, and the male-female ratio was 1:2. The cases consisted were mostly vestibular schwannoma (7 lesions), metastases from breast cancer (3 lesions), and tuberculum sellae meningioma (2 lesions). The prescription dose covered 99% of the planning target volume in 16 lesions (72.7%) and 100% in six lesions (27.3%) (prescription volume). In meningiomas and schwannomas, doses between 12 and 14 Gy were used, in plasmacytoma 13 Gy, in pilocytic astrocytoma 14 Gy, in cavernoma 15 Gy, in breast cancer metastasis between 18 and 20 Gy, and in lung cancer metastasis 22 Gy. When evaluating local control, 11 patients exhibited stable findings at the six-month control while 10 had partial regression, and a single patient had total regression. Minor complications such as perilesional edema, facial paresthesia, facial paralysis, and transient alopecia were observed in eight of the patients. Conclusions Patients with extra-axial, low-grade malignancy, and posterior fossa lesions were predominant in the studied population. Radiosurgery treatment is associated with good local control of the treated lesions. Complications are infrequent, mild, and predominated by perilesional edema.

Efficient recognition of dynamic user emotions based on deep neural networks

The key issue at this stage is how to mine the large amount of valuable user sentiment information from the massive amount of web text and create a suitable dynamic user text sentiment analysis technique. Hence, this study offers a writing feature abstraction process based on ON-LSTM and attention mechanism to address the problem that syntactic information is ignored in emotional text feature extraction. The study found that the Att-ON-LSTM improved the micro-average F1 value by 2.27% and the macro-average F value by 1.7% compared to the Bi-LSTM model with the added attentivity mechanisms. It is demonstrated that it can perform better extraction of semantic information and hierarchical structure information in emotional text and obtain more comprehensive emotional text features. In addition, the ON-LSTM-LS, a sentiment analysis model based on ON-LSTM and tag semantics, is planned to address the problem that tag semantics is ignored in the process of text sentiment analysis. The experimental consequences exposed that the accuracy of the ON-LSTM and labeled semantic sentiment analysis model on the test set is improved by 0.78% with the addition of labeled word directions compared to the model Att-ON-LSTM without the addition of labeled semantic information. The macro-averaged F1 value improved by 1.04%, which indicates that the sentiment analysis process based on ON-LSTM and tag semantics can effectively perform the text sentiment analysis task and improve the sentiment classification effect to some extent. In conclusion, deep learning models for dynamic user sentiment analysis possess high application capabilities.

Corpus Callosotomy in the Modern Era: Origins, Efficacy, Technical Variations, Complications, and Indications

Corpus callosotomy is among the oldest surgeries performed for drug-resistant epilepsy (DRE). First performed in 1940, various studies have since assessed its outcomes in various patient populations in addition to describing different extents of sectioning and emerging technologies (i.e. endoscopic, laser interstitial thermal therapy, and radiosurgery). In order to capture the current state and offer a reappraisal, we comprehensively review corpus callosotomy's origins, efficacy for various seizure types, technical variations, complications, and indications and compare the procedure to vagus nerve stimulation therapy which has similar indications. We consider corpus callosotomy to be a safe and efficacious procedure that should be considered by clinicians when appropriate. Furthermore, it can also play an important role in treating patients with DRE in low-to-middle-income countries where resources are limited.