1
|
Thiong'o GM, Looi T, Rutka JT, Kulkarni AV, Drake JM. Design and validation of a hemispherectomy simulator for neurosurgical education. J Neurosurg 2023; 138:1-8. [PMID: 35901759 DOI: 10.3171/2022.5.jns22545] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Accepted: 05/04/2022] [Indexed: 01/04/2023]
Abstract
OBJECTIVE Early adaptors of surgical simulation have documented a translation to improved intraoperative surgical performance. Similar progress would boost neurosurgical education, especially in highly nuanced epilepsy surgeries. This study introduces a hands-on cerebral hemispheric surgery simulator and evaluates its usefulness in teaching epilepsy surgeries. METHODS Initially, the anatomical realism of the simulator and its perceived effectiveness as a training tool were evaluated by two epilepsy neurosurgeons. The surgeons independently simulated hemispherotomy procedures and provided questionnaire feedback. Both surgeons agreed on the anatomical realism and effectiveness of this training tool. Next, construct validity was evaluated by modeling the proficiency (task-completion time) of 13 participants, who spanned the experience range from novice to expert. RESULTS Poisson regression yielded a significant whole-model fit (χ2 = 30.11, p < 0.0001). The association between proficiency when using the training tool and the combined effect of prior exposure to hemispherotomy surgery and career span was statistically significant (χ2 = 7.30, p = 0.007); in isolation, pre-simulation exposure to hemispherotomy surgery (χ2 = 6.71, p = 0.009) and career length (χ2 = 14.21, p < 0.001) were also significant. The mean (± SD) task-completion time was 25.59 ± 9.75 minutes. Plotting career length against task-completion time provided insights on learning curves of epilepsy surgery. Prediction formulae estimated that 10 real-life hemispherotomy cases would be needed to approach the proficiency seen in experts. CONCLUSIONS The cerebral hemispheric surgery simulator is a reasonable epilepsy surgery training tool in the quest to increase preoperative practice opportunities for neurosurgical education.
Collapse
Affiliation(s)
- Grace M Thiong'o
- 1The Hospital for Sick Children, Posluns Center for Image Guided Innovation and Therapeutic Intervention; and.,2Department of Surgery, University of Toronto, Ontario, Canada
| | - Thomas Looi
- 1The Hospital for Sick Children, Posluns Center for Image Guided Innovation and Therapeutic Intervention; and
| | - James T Rutka
- 2Department of Surgery, University of Toronto, Ontario, Canada
| | | | - James M Drake
- 1The Hospital for Sick Children, Posluns Center for Image Guided Innovation and Therapeutic Intervention; and.,2Department of Surgery, University of Toronto, Ontario, Canada
| |
Collapse
|
2
|
Meador KJ, Jobst BC. Epilepsy Centers in the US: The Times They Are A-Changing. Neurology 2021; 98:175-176. [PMID: 34880096 DOI: 10.1212/wnl.0000000000013132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Kimford J Meador
- Department of Neurology & Neurological Sciences, Stanford University, Palo Alto, Ca, USA
| | - Barbara C Jobst
- Department of Neurology, Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| |
Collapse
|
3
|
Ostendorf AP, Ahrens SM, Lado FA, Arnold ST, Bai S, Bensalem Owen MK, Chapman KE, Clarke DF, Eisner M, Fountain NB, Gray JM, Hopp JL, Riker E, Schuele SU, Small BV, Herman ST. United States Epilepsy Center Characteristics: A Data Analysis From the National Association of Epilepsy Centers. Neurology 2021; 98:e449-e458. [PMID: 34880093 PMCID: PMC8826463 DOI: 10.1212/wnl.0000000000013130] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 11/04/2021] [Indexed: 11/25/2022] Open
Abstract
Background and Objectives Patients with drug-resistant epilepsy (DRE) may benefit from specialized testing and treatments to better control seizures and improve quality of life. Most evaluations and procedures for DRE in the United States are performed at epilepsy centers accredited by the National Association of Epilepsy Centers (NAEC). On an annual basis, the NAEC collects data from accredited epilepsy centers on hospital-based epilepsy monitoring unit (EMU) size and admissions, diagnostic testing, surgeries, and other services. This article highlights trends in epilepsy center services from 2012 through 2019. Methods We analyzed data reported in 2012, 2016, and 2019 from all level 3 and level 4 NAEC accredited epilepsy centers. Data were described using frequency for categorical variables and median for continuous variables and were analyzed by center level and center population category. EMU beds, EMU admissions, epileptologists, and aggregate procedure volumes were also described using rates per population per year. Results During the period studied, the number of NAEC accredited centers increased from 161 to 256, with the largest increases in adult- and pediatric-only centers. Growth in EMU admissions (41%), EMU beds (26%), and epileptologists (109%) per population occurred. Access to specialized testing and services broadly expanded. The largest growth in procedure volumes occurred in laser interstitial thermal therapy (LiTT) (61%), responsive neurostimulation (RNS) implantations (114%), and intracranial monitoring without resection (152%) over the study period. Corpus callosotomies and vagus nerve stimulator (VNS) implantations decreased (−12.8% and −2.4%, respectively), while growth in temporal lobectomies (5.9%), extratemporal resections (11.9%), and hemispherectomies/otomies (13.1%) lagged center growth (59%), leading to a decrease in median volumes of these procedures per center. Discussion During the study period, the availability of specialty epilepsy care in the United States improved as the NAEC implemented its accreditation program. Surgical case complexity increased while aggregate surgical volume remained stable or declined across most procedure types, with a corresponding decline in cases per center. This article describes recent data trends and current state of resources and practice across NAEC member centers and identifies several future directions for driving systematic improvements in epilepsy care.
Collapse
Affiliation(s)
- Adam P Ostendorf
- Department of Pediatrics, Nationwide Children's Hospital and Ohio State University, Columbus, OH
| | - Stephanie M Ahrens
- Department of Pediatrics, Nationwide Children's Hospital and Ohio State University, Columbus, OH
| | - Fred Alexander Lado
- Department of Neurology, Hofstra Northwell Comprehensive Epilepsy Center, Great Neck, NY
| | - Susan T Arnold
- Department of Pediatrics, Children's Medical Center, Dallas, TX
| | - Shasha Bai
- Pediatric Biostatistics Core, Emory University School of Medicine, Atlanta, GA
| | | | - Kevin E Chapman
- Department of Child Health, University of Arizona College of Medicine and Barrow's Neurological Institute at Phoenix Children's Hospital, Phoenix, AZ
| | - Dave F Clarke
- Division of Pediatric Neurology, Department of Neurology, Dell Medical School, University of Texas at Austin, Austin, TX
| | - Mariah Eisner
- Biostatistics Resource at Nationwide Children's Hospital, Columbus, OH
| | - Nathan B Fountain
- Department of Neurology, Comprehensive Epilepsy Program, University of Virginia, Charlottesville, Virginia
| | - Johanna M Gray
- National Association of Epilepsy Centers, Washington, DC
| | | | - Ellen Riker
- National Association of Epilepsy Centers, Washington, DC
| | - Stephan U Schuele
- Ken and Ruth Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | | | - Susan T Herman
- Department of Neurology, Barrow Neurological Institute, Phoenix, AZ
| |
Collapse
|
4
|
Beatty CW, Lockrow JP, Gedela S, Gehred A, Ostendorf AP. The Missed Value of Underutilizing Pediatric Epilepsy Surgery: A Systematic Review. Semin Pediatr Neurol 2021; 39:100917. [PMID: 34620465 DOI: 10.1016/j.spen.2021.100917] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Revised: 08/09/2021] [Accepted: 08/11/2021] [Indexed: 10/20/2022]
Abstract
Pediatric epilepsy surgery is underutilized. Only 1%-11% of children with drug resistant epilepsy (DRE) undergo surgical treatment, or less than half of those estimated to benefit. We conducted a systematic review of articles published in PubMed, EMBASE, and Web of Science in order to study the factors related to surgery underutilization as well as the impact on both the individual and the healthcare system. Our review demonstrates multiple factors leading to underutilization, including family misconceptions about epilepsy surgery, lack of provider knowledge, as well as systemic health disparities. While the upfront cost of epilepsy surgery is significant, the long-term financial benefits and reduced health resource utilization tilt the economic advantage in favor of surgery in children with DRE. Additionally, timely interventions improve seizure and cognitive outcomes with low risk of complications. Further interventions are needed at the levels of family, provider, and the healthcare system to increase access to pediatric epilepsy surgery.
Collapse
Affiliation(s)
- Christopher W Beatty
- The Ohio State University and Nationwide Children's Hospital, Division of Neurology, Department of Pediatrics, Columbus, OH
| | - Jason P Lockrow
- Department of Neurology, Section of Pediatric Neurology, University of Washington, Seattle, WA
| | - Satyanarayana Gedela
- Emory University and Children's Healthcare of Atlanta, Division of Neurology, Department of Pediatrics, Atlanta, GA
| | - Alison Gehred
- Medical Library Division, Nationwide Children's Hospital, Columbus, OH
| | - Adam P Ostendorf
- The Ohio State University and Nationwide Children's Hospital, Division of Neurology, Department of Pediatrics, Columbus, OH.
| |
Collapse
|
5
|
Gaillard WD, Jette N, Arnold ST, Arzimanoglou A, Braun KPJ, Cukiert A, Dick A, Harvey AS, Jacobs J, Rydenhag B, Udani V, Wilmshurst JM, Cross JH, Jayakar P. Establishing criteria for pediatric epilepsy surgery center levels of care: Report from the ILAE Pediatric Epilepsy Surgery Task Force. Epilepsia 2020; 61:2629-2642. [DOI: 10.1111/epi.16698] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 08/27/2020] [Accepted: 08/27/2020] [Indexed: 02/04/2023]
Affiliation(s)
- William D. Gaillard
- Center for Neuroscience Research Children’s National Medical Center Washington DC USA
| | - Nathalie Jette
- Department of Neurology Icahn School of Medicine at Mount Sinai New York NY USA
| | - Susan T. Arnold
- Division of Child Neurology University of Texas Southwestern Medical Center Dallas TX USA
| | - Alexis Arzimanoglou
- Department of Pediatric Epileptology and Functional Neurology University Hospitals of Lyon and Lyon Neuroscience Research Lyons France
- Epilepsy Unit Child Neurology Department Hospital San Juan de Dios Barcelona Spain
| | - Kees P. J. Braun
- Department of Child Neurology University Medical Center Utrecht the Netherlands
| | - Arthur Cukiert
- Department of Neurosurgery San Paolo Epilepsy Clinic San Paolo Brazil
| | - Alexander Dick
- Center for Neuroscience Research Children’s National Medical Center Washington DC USA
| | - A. Simon Harvey
- Department of Neurology Royal Children's Hospital Melbourne Victoria Australia
| | - Julia Jacobs
- Department of Pediatrics and Clinical Neuroscience Alberta Children’s HospitalUniversity of Calgary Calgary Alberta Canada
| | - Bertil Rydenhag
- Division of Neurosurgery Institute of Neuroscience and Physiology Sahlgrenska AcademyUniversity of Gothenburg Gothenburg Sweden
| | - Vrajesh Udani
- Department of Neurology P. D. Hinduja Hospital Mumbai India
| | - Jo M. Wilmshurst
- Department of Paediatric Neurology Red Cross War Memorial Children’s HospitalNeuroscience InstituteUniversity of Cape Town Cape Town South Africa
| | - J. Helen Cross
- Neurosciences Unit Great Ormond Street Institute of Child Health University College London London UK
| | - Prasanna Jayakar
- Department of Neurology Nicklaus Children’s Hospital Miami FL USA
| | | |
Collapse
|
6
|
Costs and Complications Associated With Resection of Supratentorial Tumors With and Without the Operative Microscope in the United States. World Neurosurg 2020; 138:e607-e619. [PMID: 32171932 DOI: 10.1016/j.wneu.2020.03.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 03/02/2020] [Accepted: 03/03/2020] [Indexed: 11/23/2022]
Abstract
BACKGROUND The operative microscope, a commonly used tool in neurosurgery, is critical in many supratentorial tumor cases. However, use of operating microscope for supratentorial tumor varies by surgeon. OBJECTIVES To assess complication rates, readmissions, and costs associated with operative microscope use in supratentorial resections. METHODS A retrospective analysis was conducted using a national administrative database to identify patients with glioma or brain metastases who underwent supratentorial resection between 2007 and 2016. Univariate and multivariate analyses were used to assess 30-day complications, readmissions, and costs between patients who underwent resection with and without use of microscope. RESULTS The cohort included 12,058 glioma patients and 5433 metastasis patients. Rates of microscope use varied by state from 19.0% to 68.6%. Microscope use was associated with $5228.90 in additional costs of index hospitalization among glioma patients (P <0.001), and $2824.00 among metastasis patients (P <0.001). Rates of intraoperative cerebral edema were lower among the microscope cohort than among the nonmicroscope cohort (P <0.027). Microscope use was associated with a slight reduction in 30-day rates of neurological complications (14.7% vs. 16.7%, P = 0.048), specifically in nonspecific cerebrovascular complications. There were no differences in rates of other complications, readmissions, or 30-day postoperative costs. CONCLUSIONS Use of operative microscope for supratentorial resections varies by state and is associated with higher cost of surgery. Microscope use may be associated with lower rates of intraoperative cerebral edema and some cerebrovascular complications, but is not associated with significant differences in other complications, readmissions, or 30-day costs.
Collapse
|
7
|
Joudi Mashhad M, Harati H, Parooie F, Salarzaei M. Epilepsy surgery for refractory seizures: a systematic review and meta-analysis in different complications. THE EGYPTIAN JOURNAL OF NEUROLOGY, PSYCHIATRY AND NEUROSURGERY 2020. [DOI: 10.1186/s41983-020-00168-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Nearly one-third of epilepsy patients are refractory/resistant to medical treatment. Developments made in surgical techniques have significantly increased the effectiveness and safety of these techniques, as such techniques have been demonstrated to improve seizure control/freedom outcomes.
Objectives
The aim of this systematic review and meta-analysis was to evaluate the complications of epilepsy surgery.
Patient and methods
The searches were conducted by three independent researchers to find the relevant studies published from January 1, 2009, until the end of January 6, 2019. For English published statistical studies, all studies conducted on epileptic patients who have undergone epilepsy surgery were included.
Statistical analysis
A meta-analysis was conducted in the STATA14 statistical software.
Results
A total of 6735 patients with epilepsy who had undergone the epilepsy surgery were studied. The overall prevalence of complications was 5%. The prevalence of major and minor complications was 5.4% and 3.2% respectively. The prevalence of complications related to the temporal epilepsy surgery and the extra-temporal epilepsy surgery based on 3 studies was 7.9% and 8.2 % respectively. The frequency of neurological and surgical complications after epilepsy surgery was 4.4% and 4.1% respectively.
Conclusion
The overall rate of complications caused by epilepsy surgery was reasonably low (5%), implying that epilepsy surgery especially temporal lobe resection can be safe preferably when performed by an experienced surgeon.
Collapse
|
8
|
Foiadelli T, Lagae L, Goffin K, Theys T, De Amici M, Sacchi L, Van Loon J, Savasta S, Jansen K. Subtraction Ictal SPECT coregistered to MRI (SISCOM) as a guide in localizing childhood epilepsy. Epilepsia Open 2019; 5:61-72. [PMID: 32140644 PMCID: PMC7049808 DOI: 10.1002/epi4.12373] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Revised: 10/28/2019] [Accepted: 11/10/2019] [Indexed: 01/26/2023] Open
Abstract
Objective To assess feasibility and efficacy of subtraction ictal SPECT coregistered to MRI (SISCOM) for epilepsy localization in children who are candidates for resective surgery. Methods We retrospectively reviewed all patients ≤16 years with drug‐resistant epilepsy screened for epilepsy surgery in the University Hospital of Leuven from January 2009 to January 2018. Fifty‐eight hospitalizations for ictal SPECT and 51 SISCOM analyses in 44 patients were included. Mean age was 9.1 years. Hospitalizations for SISCOM were analyzed in terms of multiple variables affecting feasibility and efficacy. The localization of SISCOM was compared with the localization of the presumed epileptogenic zone (PEZ) as determined by video‐EEG. Results SISCOM was feasible in terms of chronic medication management, rescue antiepileptic therapy during hospitalization, and operative timings. Radiotracer injection occurred within 30 seconds from seizure onset in 91.4% of the patients. ictal SPECT imaging was performed within two hours from injection in 100% of the patients (mean: 40 minutes). SISCOM was able to localize the PEZ in 51.0% (26/51) and to additionally lateralize the PEZ in 17.6% (9/51), achieving better localizations than ictal SPECT, FDG‐PET, and MRI (P < .01). SISCOM was useful to localize the PEZ in 25% of patients with poorly localizing video‐EEG and in 27.8% of MRI‐negative cases. The occurrence of habitual seizures during injection for ictal SPECT and the temporal localization of the PEZ both correlated with a better SISCOM localization (P < .05). 36.4% (16/44) patients were finally selected for resective surgery, with a 87.5% seizure‐free rate at 12 months. A localizing SISCOM was associated with seizure freedom in 66.7% and with a Engel I‐II in 75.0% of our patients. Significance SISCOM is a reliable tool to localize the epileptogenic zone in clinical practice and is both feasible and useful in children, adding precious presurgical information especially in patients with noninformative MRI or a poorly localizing video‐EEG.
Collapse
Affiliation(s)
- Thomas Foiadelli
- Pediatric Clinic Fondazione IRCCS Policlinico San Matteo University of Pavia Pavia Italy
| | - Lieven Lagae
- Department of Development and Regeneration University Hospitals Leuven Leuven Belgium
| | - Karolien Goffin
- Nuclear Medicine and Molecular Imaging University Hospitals Leuven KU Leuven Leuven Belgium
| | - Tom Theys
- Neurosurgery Department University Hospitals Leuven Leuven Belgium
| | - Mara De Amici
- Laboratory of Immuno-Allergology Fondazione IRCCS Policlinico San Matteo Pavia Italy
| | - Lucia Sacchi
- Department of Electrical, Computer, and Biomedical Engineering University of Pavia Pavia Italy
| | | | - Salvatore Savasta
- Pediatric Clinic Fondazione IRCCS Policlinico San Matteo University of Pavia Pavia Italy
| | - Katrien Jansen
- Department of Development and Regeneration University Hospitals Leuven Leuven Belgium
| |
Collapse
|
9
|
Blount JP. Extratemporal resections in pediatric epilepsy surgery-an overview. Epilepsia 2017; 58 Suppl 1:19-27. [PMID: 28386926 DOI: 10.1111/epi.13680] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/26/2016] [Indexed: 11/28/2022]
Abstract
Despite optimized medical treatment, approximately one third of all patients with epilepsy continue to have seizures and by definition have medically resistant epilepsy (MRE). For these patients, surgical disruption of the epileptogenic network may enable freedom or great improvement in control of their seizures. The success of surgery is dependent on accurate localization of the epileptogenic zone and network. Epilepsy arising from regions of cortical dysplasia within the neocortex of the frontal, parietal, and occipital lobes show a propensity for reorganization and progressive decline in seizure freedom and consequent poorer surgical outcome. These procedures often require staged investigation with intracranial electrodes via subdural grids or stereoelectroencephalography (SEEG) and are considered extratemporal resections (ETRs). Central concepts include the following: (1) localization of epileptogenic and eloquent functional regions, (2) safe and effective placement of intracranial electrode arrays, (3) resection of epileptogenic cortex, and (4) avoidance of complications. Each of these concepts is summarized and developed in this summary paper.
Collapse
Affiliation(s)
- Jeffrey P Blount
- Pediatric Neurosurgery, Children's of Alabama, Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, Alabama, U.S.A
| |
Collapse
|
10
|
Rydenhag B, Cukiert A. Introduction-Pediatric epilepsy surgery techniques. Epilepsia 2017; 58 Suppl 1:7-9. [PMID: 28386928 DOI: 10.1111/epi.13677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/14/2016] [Indexed: 11/28/2022]
Abstract
This supplement includes the proceedings from the Pediatric Epilepsy Surgery Techniques Meeting held in Gothenburg (July 4-5, 2014), which focused on presentations and discussions regarding specific surgical technical issues in pediatric epilepsy surgery. Pediatric epilepsy neurosurgeons from all over the world were present and active in very fruitful and live presentations and discussions. These articles represent a synopsis of the areas and subjects dealt with there.
Collapse
Affiliation(s)
- Bertil Rydenhag
- Institute of Neuroscience and Physiology, Sahlgrens Academy and Department of Neurosurgery, Gothenburg University, Gothenburg, Sweden
| | - Arthur Cukiert
- Hospital Brigadeiro, Epilepsy Clinic of de Sao Paulo, Sao Paulo, Brazil
| |
Collapse
|
11
|
Skoch J, Adelson PD, Bhatia S, Greiner HM, Rydenhag B, Scavarda D, Mangano FT. Subdural grid and depth electrode monitoring in pediatric patients. Epilepsia 2017; 58 Suppl 1:56-65. [DOI: 10.1111/epi.13685] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/21/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Jesse Skoch
- Division of Pediatric Neurosurgery; Cincinnati Children's Hospital Medical Center; Cincinnati Ohio U.S.A
| | - P. David Adelson
- Barrow Neurological Institute at Phoenix Children's Hospital; Phoenix Arizona U.S.A
| | | | - Hansel M. Greiner
- Division of Pediatric Neurosurgery; Cincinnati Children's Hospital Medical Center; Cincinnati Ohio U.S.A
| | - Bertil Rydenhag
- Epilepsy Research Group; Institute of Neuroscience and Physiology; The Sahlgrenska Academy at the University of Gothenburg; Gothenburg Sweden
| | - Didier Scavarda
- Department of Pediatric Neurosurgery; La Timone Children's Hospital; Marseille France
| | - Francesco T. Mangano
- Division of Pediatric Neurosurgery; Cincinnati Children's Hospital Medical Center; Cincinnati Ohio U.S.A
- Barrow Neurological Institute at Phoenix Children's Hospital; Phoenix Arizona U.S.A
| |
Collapse
|
12
|
Barba C, Mai R, Grisotto L, Gozzo F, Pellacani S, Tassi L, Francione S, Giordano F, Cardinale F, Guerrini R. Unilobar surgery for symptomatic epileptic spasms. Ann Clin Transl Neurol 2016; 4:36-45. [PMID: 28078313 PMCID: PMC5221449 DOI: 10.1002/acn3.373] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Accepted: 10/11/2016] [Indexed: 11/13/2022] Open
Abstract
Objective To assess factors associated with favorable seizure outcome after surgery for symptomatic epileptic spasms and improve knowledge on pathophysiology of this seizure type. Methods Inclusion criteria were: (1) age between 6 months and 15 years at surgery; (2) active epileptic spasms; (3) follow‐up after surgery >1 year. Results We retrospectively studied 80 children (aged 1.3 ± 2 years at seizure onset; 5.8 ± 4 years at surgery, 11.7 ± 5.7 years at last follow up). Magnetic resonance imaging (MRI) revealed structural abnormalities in 77/80 patients (96.3%; unilateral in 69: 89.6%). We performed invasive recordings in 24 patients (30%). In 21 patients in whom MRI or histopathology detected a lesion, electrodes exploring it constantly captured initial ictal activity at spasm onset. Fifty‐eight patients (72.5%) underwent unilobar and 22 (27.5%) multilobar or hemispheric procedures. At last follow‐up, 49 patients (61.3%) were in Engel class I. Multivariate logistic models showed completeness of resection of the seizure onset zone (OR = 0.016, 95%CI: 0.002, 0.122) and of the MRI visible lesion (OR = 0.179, 95% CI: 0.032, 0.999) to be significantly associated with Engel class IA outcome. Unfavorable outcome was associated with an older age at surgery, when it reflected a longer duration of epilepsy (OR = 1.383, 95% CI: 0.994,1.926). Interpretation Data emerging from invasive recordings and the good seizure outcome following removal of discrete epileptogenic lesions support a focal cortical origin of spasms. In patients with discrete epileptogenic lesions, the pragmatic approach to surgery should follow the same principles applied to focal epilepsy favoring, whenever possible, unilobar, one‐stage resections.
Collapse
Affiliation(s)
- Carmen Barba
- Neuroscience Department Children's Hospital Anna Meyer-University of Florence Florence Italy
| | - Roberto Mai
- "Claudio Munari" Epilepsy Surgery Center Niguarda Hospital Milan Italy
| | - Laura Grisotto
- Department of Statistics, Computer Science, Applications "G. Parenti" University of Florence Florence Italy
| | - Francesca Gozzo
- "Claudio Munari" Epilepsy Surgery Center Niguarda Hospital Milan Italy
| | - Simona Pellacani
- Neuroscience Department Children's Hospital Anna Meyer-University of Florence Florence Italy; IRCCS Stella Maris Pisa Italy
| | - Laura Tassi
- "Claudio Munari" Epilepsy Surgery Center Niguarda Hospital Milan Italy
| | - Stefano Francione
- "Claudio Munari" Epilepsy Surgery Center Niguarda Hospital Milan Italy
| | - Flavio Giordano
- Neurosurgery Department Children's Hospital Anna Meyer-University of Florence Florence Italy
| | | | - Renzo Guerrini
- Neuroscience Department Children's Hospital Anna Meyer-University of Florence Florence Italy; IRCCS Stella Maris Pisa Italy
| |
Collapse
|