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De Benedictis A, de Palma L, Rossi-Espagnet MC, Marras CE. Connectome-based approaches in pediatric epilepsy surgery: "State-of-the art" and future perspectives. Epilepsy Behav 2023; 149:109523. [PMID: 37944286 DOI: 10.1016/j.yebeh.2023.109523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Revised: 10/29/2023] [Accepted: 11/03/2023] [Indexed: 11/12/2023]
Abstract
Modern epilepsy science has overcome the traditional interpretation of a strict region-specific origin of epilepsy, highlighting the involvement of wider patterns of altered neuronal circuits. In selected cases, surgery may constitute a valuable option to achieve both seizure freedom and neurocognitive improvement. Although epilepsy is now considered as a brain network disease, the most relevant literature concerning the "connectome-based" epilepsy surgery mainly refers to adults, with a limited number of studies dedicated to the pediatric population. In this review, the Authors summarized the main current available knowledge on the relevance of WM surgical anatomy in epilepsy surgery, the post-surgical modifications of brain structural connectivity and the related clinical impact of such modifications within the pediatric context. In the last part, possible implications and future perspectives of this approach have been discussed, especially concerning the optimization of surgical strategies and the predictive value of the epilepsy network analysis for planning tailored approaches, with the final aim of improving case selection, presurgical planning, intraoperative management, and postoperative results.
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Affiliation(s)
| | - Luca de Palma
- Epilepsy and Movement Disorders Neurology Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
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De Benedictis A, Rossi-Espagnet MC, de Palma L, Sarubbo S, Marras CE. Structural networking of the developing brain: from maturation to neurosurgical implications. Front Neuroanat 2023; 17:1242757. [PMID: 38099209 PMCID: PMC10719860 DOI: 10.3389/fnana.2023.1242757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 11/09/2023] [Indexed: 12/17/2023] Open
Abstract
Modern neuroscience agrees that neurological processing emerges from the multimodal interaction among multiple cortical and subcortical neuronal hubs, connected at short and long distance by white matter, to form a largely integrated and dynamic network, called the brain "connectome." The final architecture of these circuits results from a complex, continuous, and highly protracted development process of several axonal pathways that constitute the anatomical substrate of neuronal interactions. Awareness of the network organization of the central nervous system is crucial not only to understand the basis of children's neurological development, but also it may be of special interest to improve the quality of neurosurgical treatments of many pediatric diseases. Although there are a flourishing number of neuroimaging studies of the connectome, a comprehensive vision linking this research to neurosurgical practice is still lacking in the current pediatric literature. The goal of this review is to contribute to bridging this gap. In the first part, we summarize the main current knowledge concerning brain network maturation and its involvement in different aspects of normal neurocognitive development as well as in the pathophysiology of specific diseases. The final section is devoted to identifying possible implications of this knowledge in the neurosurgical field, especially in epilepsy and tumor surgery, and to discuss promising perspectives for future investigations.
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Affiliation(s)
| | | | - Luca de Palma
- Clinical and Experimental Neurology, Bambino Gesù Children’s Hospital, Rome, Italy
| | - Silvio Sarubbo
- Department of Neurosurgery, Santa Chiara Hospital, Azienda Provinciale per i Servizi Sanitari (APSS), Trento, Italy
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Barrit S, Park EH, Madsen JR. Posterior quadrant disconnection for refractory epilepsy: how I do it. Acta Neurochir (Wien) 2022; 164:2159-2164. [PMID: 35578117 DOI: 10.1007/s00701-022-05221-x] [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] [Received: 02/05/2022] [Accepted: 04/16/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Posterior quadrant disconnection (PQD) is intended to interrupt the propagation of intractable unilateral temporo-parieto-occipital epilepsy. METHOD An enhanced operative video presents the illustrative case of a total PQD indicated for a 15-year-old boy with Sturge-Weber syndrome suffering from seizure recurrence after a partial PQD. We describe the surgical procedure with emphasis on relevant anatomy and multimodal intraoperative guidance in three steps: (i) parieto-occipital disconnection, (ii) posterior callosotomy, and (iii) temporal disconnection/resection. Pearls and pitfalls of surgical management are discussed. CONCLUSION PQD is a less invasive surgical option to typical hemispherotomy and hemispherectomy for selected indications of posterior multilobar epilepsy.
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Affiliation(s)
- Sami Barrit
- Service de Neurochirurgie, Hôpital Erasme, Université Libre de Bruxelles, Anderlecht, Belgium
- Neurodynamics Laboratory, Department of Neurosurgery, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Eun-Hyoung Park
- Neurodynamics Laboratory, Department of Neurosurgery, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
- Division of Epilepsy Surgery, Department of Neurosurgery, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Joseph R Madsen
- Neurodynamics Laboratory, Department of Neurosurgery, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.
- Division of Epilepsy Surgery, Department of Neurosurgery, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.
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4
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Evaluation of Ideal Extent of Corpus Callosotomy Based on the Location of Intracallosal Motor Fibers. World Neurosurg 2020; 144:e568-e575. [DOI: 10.1016/j.wneu.2020.09.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Revised: 09/01/2020] [Accepted: 09/02/2020] [Indexed: 12/13/2022]
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Dziedzic TA, Balasa A, Jeżewski MP, Michałowski Ł, Marchel A. White matter dissection with the Klingler technique: a literature review. Brain Struct Funct 2020; 226:13-47. [PMID: 33165658 PMCID: PMC7817571 DOI: 10.1007/s00429-020-02157-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 10/13/2020] [Indexed: 12/21/2022]
Abstract
The aim of this literature review is to present a summary of the published literature relating the details of the different modifications of specimen preparation for white matter dissection with the Klingler technique. For this review, 3 independent investigators performed an electronic literature search that was carried out in the Pubmed, Scopus and Web of Science databses up to December 2019. Furthermore, we performed citation tracking for the articles missed in the initial search. Studies were eligible for inclusion when they reported details of at least the first 2 main steps of Klingler's technique: fixation and freezing. A total of 37 full-text articles were included in the analysis. We included original anatomical studies in which human white matter dissection was performed for study purposes. The main three steps of preparation are the same in each laboratory, but the details of each vary between studies. Ten percent formalin is the most commonly used (34 studies) solution for fixation. The freezing time varied between 8 h and a month, and the temperature varied from - 5 to - 80 °C. After thawing and during dissections, the specimens were most often kept in formalin solution (13), and the concentration varied from 4 to 10%. Klingler's preparation technique involves three main steps: fixation, freezing and thawing. Even though the details of the technique are different in most of the studies, all provide subjectively good quality specimens for anatomical dissections and studies.
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Affiliation(s)
- Tomasz A Dziedzic
- Department of Neurosurgery, Medical University of Warsaw, Warsaw, Poland.
| | - Artur Balasa
- Department of Neurosurgery, Medical University of Warsaw, Warsaw, Poland
| | - Mateusz P Jeżewski
- Department of Neurosurgery, Medical University of Warsaw, Warsaw, Poland
| | | | - Andrzej Marchel
- Department of Neurosurgery, Medical University of Warsaw, Warsaw, Poland
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Vaddiparti A, Huang R, Blihar D, Du Plessis M, Montalbano MJ, Tubbs RS, Loukas M. The Evolution of Corpus Callosotomy for Epilepsy Management. World Neurosurg 2020; 145:455-461. [PMID: 32889189 DOI: 10.1016/j.wneu.2020.08.178] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 08/25/2020] [Indexed: 01/11/2023]
Abstract
Corpus callosotomy, first used in the management of epilepsy by William P. van Wagenen in 1940, was for years a contentious procedure. Two decades later, Nobel Laureate Roger W. Sperry's split-brain studies inspired surgeons to reexamine the role of corpus callosotomy in the control of epileptic seizures. In 1962, Joseph Bogen and Philip Vogel performed complete corpus callosotomies in patients with a history of generalized seizures. The identification of a set of postsurgical disconnection symptoms and other neurologic deficits begged the improvement of the surgical technique. Modifications to the operation, including anterior callosotomy, posterior callosotomy, partial callosotomy, staged callosotomy, microsurgical techniques, and radiosurgical techniques, continue to refine the procedure.
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Affiliation(s)
- Aparna Vaddiparti
- Department of Neurology, Yale School of Medicine, New Haven, Connecticut, USA
| | - Richard Huang
- Department of Pathology, Massachusetts General Hospital/Harvard Medical School, Boston, Massachusetts, USA
| | - David Blihar
- Department of Anatomical Sciences, School of Medicine, St. George's University, Grenada, West Indies
| | - Maira Du Plessis
- Department of Anatomical Sciences, School of Medicine, St. George's University, Grenada, West Indies
| | - Michael J Montalbano
- Department of Anatomical Sciences, School of Medicine, St. George's University, Grenada, West Indies
| | - R Shane Tubbs
- Department of Anatomical Sciences, School of Medicine, St. George's University, Grenada, West Indies; Department of Neurosurgery, Tulane University School of Medicine, New Orleans, Louisiana, USA; Department of Structural and Cellular Biology, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Marios Loukas
- Department of Anatomical Sciences, School of Medicine, St. George's University, Grenada, West Indies; Department of Anatomy University of Warmia and Mazury, Olsztyn, Poland.
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Doddamani RS, Tripathi M, Samala R, Agarwal M, Ramanujan B, Chandra SP. Posterior quadrant disconnection for sub-hemispheric drug refractory epilepsy. Neurol India 2020; 68:270-273. [PMID: 32415002 DOI: 10.4103/0028-3886.284358] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
The posterior quadratic epilepsy (PQE) is a form of a multilobar epilepsy, involving the temporal-parietal and occipital lobes. Basically, epilepsies with localized networks to the posterior temporal, posterior parietal, and occipital lobes can benefit from this type of surgery. Gliosis due to perinatal insult and cortical dysplasis and angiomas in Sturge Weber syndrome involving the PQ have often been cited in the literature as the etiology for PQE. However, before considering surgery, it is important to localize the epileptogenic focus through a complete pre operative work up involving; EEG (Electro-Encephalo-Graphy), video EEG, single photon emission computed tomography (SPECT), positron emission tomography (PET), and magneto encephalography (MEG). Historically, these pathologies were dealt with multi-lobar resections, which were associated with high morbidity and mortality, owing to blood loss, especially in young children, hydrocephalus, and hemosiderosis. Based on the theory of networks involved in epileptogenesis, the concept of disconnection in epilepsy surgery was introduced. Delalande and colleagues, described the technique of hemispheric disconnection (functional hemispherectomy) for pathologies like: hemimegalencephaly, rasmussens encephalitis involving the entire hemisphere. The technique has evolved with time, moving towards minimally invasive endoscopic vertical hemispherotomy, described by Chandra and colleagues.[1],[2] The posterior quadrant disconnection (PQD) evolved as a tailored disconnection on similar lines as hemispherotomy, for managing refractory epilepsy arising from the posterior quadrant.[3] The technique and principles involved in the PQD surgery are similar to the those of peri-insular hemispherotomy and has been described in the literature by few authors.[3],[4],[5],[6] The technique of performing PQD will be described here in a step-wise fashion with illustrations supplemented by a surgical video.
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Affiliation(s)
- Ramesh S Doddamani
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Manjari Tripathi
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Raghu Samala
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Mohit Agarwal
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Bhargavi Ramanujan
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Sarat P Chandra
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
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Nachtergaele P, Radwan A, Swinnen S, Decramer T, Uytterhoeven M, Sunaert S, van Loon J, Theys T. The temporoinsular projection system: an anatomical study. J Neurosurg 2020; 132:615-623. [PMID: 30797196 DOI: 10.3171/2018.11.jns18679] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Accepted: 11/08/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Connections between the insular cortex and the amygdaloid complex have been demonstrated using various techniques. Although functionally well connected, the precise anatomical substrate through which the amygdaloid complex and the insula are wired remains unknown. In 1960, Klingler briefly described the "fasciculus amygdaloinsularis," a white matter tract connecting the posterior insula with the amygdala. The existence of such a fasciculus seems likely but has not been firmly established, and the reported literature does not include a thorough description and documentation of its anatomy. In this fiber dissection study the authors sought to elucidate the pathway connecting the insular cortex and the mesial temporal lobe. METHODS Fourteen brain specimens obtained at routine autopsy were dissected according to Klingler's fiber dissection technique. After fixation and freezing, anatomical dissections were performed in a stepwise progressive fashion. RESULTS The insula is connected with the opercula of the frontal, parietal, and temporal lobes through the extreme capsule, which represents a network of short association fibers. At the limen insulae, white matter fibers from the extreme capsule converge and loop around the uncinate fasciculus toward the temporal pole and the mesial temporal lobe, including the amygdaloid complex. CONCLUSIONS The insula and the mesial temporal lobe are directly connected through white matter fibers in the extreme capsule, resulting in the appearance of a single amygdaloinsular fasciculus. This apparent fasciculus is part of the broader network of short association fibers of the extreme capsule, which connects the entire insular cortex with the temporal pole and the amygdaloid complex. The authors propose the term "temporoinsular projection system" (TIPS) for this complex.
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Affiliation(s)
- Pieter Nachtergaele
- 1Department of Neurosciences, Research Group Experimental Neurosurgery and Neuroanatomy, KU Leuven, and
| | - Ahmed Radwan
- 2Department of Imaging & Pathology, Translational MRI, KU Leuven, Leuven, Belgium
| | - Stijn Swinnen
- 1Department of Neurosciences, Research Group Experimental Neurosurgery and Neuroanatomy, KU Leuven, and
| | - Thomas Decramer
- 1Department of Neurosciences, Research Group Experimental Neurosurgery and Neuroanatomy, KU Leuven, and
| | - Mats Uytterhoeven
- 1Department of Neurosciences, Research Group Experimental Neurosurgery and Neuroanatomy, KU Leuven, and
| | - Stefan Sunaert
- 2Department of Imaging & Pathology, Translational MRI, KU Leuven, Leuven, Belgium
| | - Johannes van Loon
- 1Department of Neurosciences, Research Group Experimental Neurosurgery and Neuroanatomy, KU Leuven, and
| | - Tom Theys
- 1Department of Neurosciences, Research Group Experimental Neurosurgery and Neuroanatomy, KU Leuven, and
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Neurosurgical approaches to pediatric epilepsy: Indications, techniques, and outcomes of common surgical procedures. Seizure 2018; 77:76-85. [PMID: 30473268 DOI: 10.1016/j.seizure.2018.11.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Revised: 11/07/2018] [Accepted: 11/14/2018] [Indexed: 01/01/2023] Open
Abstract
Epilepsy is a common pediatric neurological condition, and approximately one-third of children with epilepsy are refractory to medical management. For these children neurosurgery may be indicated, but operative success is dependent on complete delineation of the epileptogenic zone. In this review, surgical techniques for pediatric epilepsy are considered. First, potentially-curative operations are discussed and broadly divided into resections and disconnections. Then, two palliative approaches to seizure control are reviewed. Finally, future neurosurgical approaches to epilepsy are considered.
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Shi J, Gao Z, Gao J, Li G, Chen Y. Predictors and outcome surgery for posterior cortex epilepsies. Clin Neurol Neurosurg 2018; 171:124-128. [DOI: 10.1016/j.clineuro.2018.06.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Revised: 06/02/2018] [Accepted: 06/09/2018] [Indexed: 01/29/2023]
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White matter tract anatomy in the rhesus monkey: a fiber dissection study. Brain Struct Funct 2018; 223:3681-3688. [PMID: 30022250 DOI: 10.1007/s00429-018-1718-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Accepted: 07/12/2018] [Indexed: 01/31/2023]
Abstract
Brain connectivity in non-human primates (NHPs) has been mainly investigated using tracer techniques and functional connectivity studies. Data on structural connections are scarce and come from diffusion tensor imaging (DTI), since gross anatomical white matter dissection studies in the NHP are lacking. The current study aims to illustrate the course and topography of the major white matter tracts in the macaque using Klingler's fiber dissection. 10 hemispheres obtained from 5 primate brains (Macaca mulatta) were studied according to Klingler's fiber dissection technique. Dissection was performed in a stepwise mesial and lateral fashion exposing the course and topography of the major white matter bundles. Major white matter tracts in the NHP include the corona radiata, tracts of the sagittal stratum, the uncinate fasciculus, the cingulum and the fornix. Callosal fiber topography was homologous to the human brain with leg motor fibers running in the posterior half of the corpus callosum. The relative size of the anterior commissure was larger in the NHP. NHPs and humans share striking homologies with regard to the course and topography of the major white matter tracts.
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