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Castellano JF, Singla S, Barot N, Aronson JP. Stereoelectroencephalography-Guided Radiofrequency Thermocoagulation: Diagnostic and Therapeutic Implications. Brain Sci 2024; 14:110. [PMID: 38391685 PMCID: PMC10887298 DOI: 10.3390/brainsci14020110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Revised: 01/15/2024] [Accepted: 01/21/2024] [Indexed: 02/24/2024] Open
Abstract
Despite recent medical therapeutic advances, approximately one third of patients do not attain seizure freedom with medications. This drug-resistant epilepsy population suffers from heightened morbidity and mortality. In appropriate patients, resective epilepsy surgery is far superior to continued medical therapy. Despite this efficacy, there remain drawbacks to traditional epilepsy surgery, such as the morbidity of open neurosurgical procedures as well as neuropsychological adverse effects. SEEG-guided Radiofrequency Thermocoagulation (SgRFTC) is a minimally invasive, electrophysiology-guided intervention with both diagnostic and therapeutic implications for drug-resistant epilepsy that offers a convenient adjunct or alternative to ablative and resective approaches. We review the international experience with this procedure, including methodologies, diagnostic benefit, therapeutic benefit, and safety considerations. We propose a framework in which SgRFTC may be incorporated into intracranial EEG evaluations alongside passive recording. Lastly, we discuss the potential role of SgRFTC in both delineating and reorganizing epilepsy networks.
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Affiliation(s)
- James F Castellano
- Department of Neurology, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA
| | - Shobhit Singla
- Department of Neurology, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA
| | - Niravkumar Barot
- Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA
| | - Joshua P Aronson
- Department of Neurosurgery, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA
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Pitskhelauri D, Kudieva E, Vlasov P, Eliseeva N, Zaitsev O, Kamenetskaya M, Kozlova A, Shishkina L, Danilov G, Sanikidze A, Kuprava T, Ishkinin R, Melikyan A. Burr hole microsurgical subtemporal selective amygdalohippocampectomy. Acta Neurochir (Wien) 2023; 165:1215-1226. [PMID: 36867249 DOI: 10.1007/s00701-023-05536-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 02/15/2023] [Indexed: 03/04/2023]
Abstract
INTRODUCTION At present, selective amygdalohippocampectomy (SAH) has become popular in the treatment of drug-resistant mesial temporal lobe epilepsy (TLE). However, there is still an ongoing discussion about the advantages and disadvantages of this approach. METHODS The study included a consecutive series of 43 adult patients with drug-resistant TLE, involving 24 women and 19 men (1.8/1). Surgeries were performed at the Burdenko Neurosurgery Center from 2016 to 2019. To perform subtemporal SAH through the burr hole with the diameter of 14 mm, we used two types of approaches: preauricular, 25 cases, and supra-auricular, 18 cases. The follow-up ranged from 36 to 78 months (median 59 months). One patient died 16 months after surgery (accident). RESULTS By the third year after surgery, Engel I outcome was achieved in 80.9% (34 cases) of cases and Engel II in 4 (9.5%) and Engel III and Engel IV in 4 (9.6%) cases. Among the patients with Engel I outcomes, anticonvulsant therapy was completed in 15 (44.1%), and doses were reduced in 17 (50%) cases. Verbal and delayed verbal memory decreased after surgery in 38.5% and 46.1%, respectively. Verbal memory was mainly affected by preauricular approach in comparison with supra-auricular (p = 0.041). In 15 (51.7%) cases, minimal visual field defects were detected in the upper quadrant. At the same time, visual field defects did not extend into the lower quadrant and inside the 20° of the upper affected quadrant in any case. CONCLUSIONS Burr hole microsurgical subtemporal SAH is an effective surgical procedure for drug-resistant TLE. It involves minimal risks of loss of visual field within the 20° of the upper quadrant. Supra-auricular approach, compared to preauricular, results in a reduction in the incidence of upper quadrant hemianopia and is associated with a lower risk of verbal memory impairment.
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Affiliation(s)
- David Pitskhelauri
- N. N. Burdenko National Medical Research Center of Neurosurgery, Ministry of Health of the Russian Federation, 16 4th Tverskaya-Yamskaya St, 125047, Moscow, Russia.
| | - Elina Kudieva
- N. N. Burdenko National Medical Research Center of Neurosurgery, Ministry of Health of the Russian Federation, 16 4th Tverskaya-Yamskaya St, 125047, Moscow, Russia
| | - Pavel Vlasov
- N. N. Burdenko National Medical Research Center of Neurosurgery, Ministry of Health of the Russian Federation, 16 4th Tverskaya-Yamskaya St, 125047, Moscow, Russia
| | - Natalya Eliseeva
- N. N. Burdenko National Medical Research Center of Neurosurgery, Ministry of Health of the Russian Federation, 16 4th Tverskaya-Yamskaya St, 125047, Moscow, Russia
| | - Oleg Zaitsev
- N. N. Burdenko National Medical Research Center of Neurosurgery, Ministry of Health of the Russian Federation, 16 4th Tverskaya-Yamskaya St, 125047, Moscow, Russia
| | - Maria Kamenetskaya
- N. N. Burdenko National Medical Research Center of Neurosurgery, Ministry of Health of the Russian Federation, 16 4th Tverskaya-Yamskaya St, 125047, Moscow, Russia
| | - Antonina Kozlova
- N. N. Burdenko National Medical Research Center of Neurosurgery, Ministry of Health of the Russian Federation, 16 4th Tverskaya-Yamskaya St, 125047, Moscow, Russia
| | - Ludmila Shishkina
- N. N. Burdenko National Medical Research Center of Neurosurgery, Ministry of Health of the Russian Federation, 16 4th Tverskaya-Yamskaya St, 125047, Moscow, Russia
| | - Gleb Danilov
- N. N. Burdenko National Medical Research Center of Neurosurgery, Ministry of Health of the Russian Federation, 16 4th Tverskaya-Yamskaya St, 125047, Moscow, Russia
| | - Alexander Sanikidze
- N. N. Burdenko National Medical Research Center of Neurosurgery, Ministry of Health of the Russian Federation, 16 4th Tverskaya-Yamskaya St, 125047, Moscow, Russia
| | | | - Ruslan Ishkinin
- N. N. Burdenko National Medical Research Center of Neurosurgery, Ministry of Health of the Russian Federation, 16 4th Tverskaya-Yamskaya St, 125047, Moscow, Russia
| | - Armen Melikyan
- N. N. Burdenko National Medical Research Center of Neurosurgery, Ministry of Health of the Russian Federation, 16 4th Tverskaya-Yamskaya St, 125047, Moscow, Russia
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McIntosh AM, Wynd AW, Berkovic SF. Extended follow-up after anterior temporal lobectomy demonstrates seizure recurrence 20+ years postsurgery. Epilepsia 2023; 64:92-102. [PMID: 36268808 PMCID: PMC10098858 DOI: 10.1111/epi.17440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Revised: 10/19/2022] [Accepted: 10/19/2022] [Indexed: 01/21/2023]
Abstract
OBJECTIVE Anterior temporal lobectomy (ATL) for medication-resistant localized epilepsy results in ablation or reduction of seizures for most patients. However, some individuals who attain an initial extended period of postsurgical seizure freedom will experience a later seizure recurrence. In this study, we examined the prevalence and some risk factors for late recurrence in an ATL cohort with extensive regular follow-up. METHODS Included were 449 patients who underwent ATL at Austin Health, Australia, from 1978 to 2008. Postsurgical follow-up was undertaken 2-3 yearly. Seizure recurrence was tested using Kaplan-Meier analysis, log-rank test, and Cox regression. Late recurrence was qualified as a first disabling seizure >2 years postsurgery. We examined risks within the ATL cohort according to broad pathology groups and tested whether late recurrence differed for the ATL cohort compared to patients who had resections outside the temporal lobe (n = 98). RESULTS Median post-ATL follow-up was 22 years (range = .1-38.6), 6% were lost to follow-up, and 12% had died. Probabilities for remaining completely seizure-free after surgery were 51% (95% confidence interval [CI] = 53-63) at 2 postoperative years, 36% (95% CI = 32-41) at 10 years, 32% (95% CI = 27-36) at 20 years, and 30% (95% CI = 25-34) at 25 years. Recurrences were reported up to 23 years postoperatively. Late seizures occurred in all major ATL pathology groups, with increased risk in the "normal" and "distant lesion" groups (p ≤ .03). Comparison between the ATL cohort and patients who underwent extratemporal resection demonstrated similar patterns of late recurrence (p = .74). SIGNIFICANCE Some first recurrences were very late, reported decades after ATL. Late recurrences were not unique to any broad ATL pathology group and did not differ according to whether resections were ATL or extratemporal. Reports of these events by patients with residual pathology suggest that potentially epileptogenic abnormalities outside the area of resection may be implicated as one of several possible underlying mechanisms.
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Affiliation(s)
- Anne M McIntosh
- Epilepsy Research Centre, Department of Medicine (Austin Health), University of Melbourne, Melbourne, Victoria, Australia.,Bladin-Berkovic Comprehensive Epilepsy Program, Department of Neurology, Austin Health, Melbourne, Victoria, Australia.,Melbourne Brain Centre at Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Alex W Wynd
- Epilepsy Research Centre, Department of Medicine (Austin Health), University of Melbourne, Melbourne, Victoria, Australia.,Bladin-Berkovic Comprehensive Epilepsy Program, Department of Neurology, Austin Health, Melbourne, Victoria, Australia
| | - Samuel F Berkovic
- Epilepsy Research Centre, Department of Medicine (Austin Health), University of Melbourne, Melbourne, Victoria, Australia.,Bladin-Berkovic Comprehensive Epilepsy Program, Department of Neurology, Austin Health, Melbourne, Victoria, Australia
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Abstract
PURPOSE OF REVIEW More than 20 new antiseizure medications have been approved by the US Food and Drug Administration (FDA) in the past 3 decades; however, outcomes in newly diagnosed epilepsy have not improved, and epilepsy remains drug resistant in up to 40% of patients. Evidence supports improved seizure outcomes and quality of life in those who have undergone epilepsy surgery, but epilepsy surgery remains underutilized. This article outlines indications for epilepsy surgery, describes the presurgical workup, and summarizes current available surgical approaches. RECENT FINDINGS Class I evidence has demonstrated the superiority of resective surgery compared to medical therapy for seizure control and quality of life in patients with drug-resistant epilepsy. The use of minimally invasive options, such as laser interstitial thermal therapy and stereotactic radiosurgery, are alternatives to resective surgery in well-selected patients. Neuromodulation techniques, such as responsive neurostimulation, deep brain stimulation, and vagus nerve stimulation, offer a suitable alternative, especially in those where resective surgery is contraindicated or where patients prefer nonresective surgery. Although neuromodulation approaches reduce seizure frequency, they are less likely to be associated with seizure freedom than resective surgery. SUMMARY Appropriate patients with drug-resistant epilepsy benefit from epilepsy surgery. If two well-chosen and tolerated medication trials do not achieve seizure control, referral to a comprehensive epilepsy center for a thorough presurgical workup and discussion of surgical options is appropriate. Mounting Class I evidence supports a significantly higher chance of stopping disabling seizures with surgery than with further medication trials.
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Pintor L. Temporal Lobectomy: Does It Worsen or Improve Presurgical Psychiatric Disorders? Curr Top Behav Neurosci 2022; 55:307-327. [PMID: 33959938 DOI: 10.1007/7854_2021_224] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Temporal lobe epilepsy (TLE) is the type of epilepsy most frequently associated with psychiatric morbidity. Respective surgery for focal epilepsy remains the preferred treatment for medically resistant epilepsy. The aim of this chapter is to review what happens with psychiatric disorders once patients have undergone surgery.Early studies demonstrated a post-surgical increase in the incidence rates of anxiety and depressive disorders, while recent studies found that the prevalence of depression and anxiety decreased 12 months after surgery. In spite of this improvement, de novo anxiety and depressive or psychotic cases can be seen. In particular, de novo psychosis ranges from 1% to 14%, with risk factors including bilateral temporal damage, tumors rather than mesial temporal sclerosis, and seizures emerging after surgery again.Personality changes after temporal lobectomy are yet to be established, but decline in schizotypal behavior and neuroticism is the most replicated so far.In children's studies surgery resolved 16% of the participants' psychiatric problems, while 12% presented a de novo psychiatric diagnosis, but further, more conclusive results are needed.The main limitations of these studies are the inconsistent systematic post-surgical psychiatric evaluations, the small sample sizes of case series, the short follow-up post-surgical periods, and the small number of controlled studies.A psychiatric assessment should be conducted before surgery, and most of all, patients with a psychiatric history should be followed after surgery.
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Friedrich F, Pataraia E, Aull-Watschinger S, Zehetmayer S, Weitensfelder L, Watschinger C, Mossaheb N. Psychiatric symptoms and comorbidities in patients with drug-resistant epilepsy in presurgical assessment-A prospective explorative single center study. Front Psychiatry 2022; 13:966721. [PMID: 36276308 PMCID: PMC9584747 DOI: 10.3389/fpsyt.2022.966721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Accepted: 09/08/2022] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION People with epilepsy (PWE) have a higher prevalence of psychiatric disorders. Some individuals with drug-resistant epilepsy might benefit from surgical interventions. The aim of this study was to perform an assessment of psychiatric comorbidities with a follow-up period of 12 months in patients with drug-resistant epilepsy, comparing those who underwent surgery to those who did not. MATERIAL AND METHODS We assessed psychiatric comorbidities at baseline, after 4 months and after 12 months. Psychiatric symptoms and diagnoses were assessed using SCID-Interview, Hamilton Rating Scale for Depression, Beck-Depression Inventory, Hamilton Anxiety Rating Scale, Prodromal-Questionnaire and the Global Assessment of Functioning Scale. RESULTS Twenty-five patients were included in the study, 12 underwent surgery, 11 were esteemed as being neurologically unqualified for surgery and two refused surgery. Patients in the no-surgery group were significantly older, reported more substance use, had significantly higher levels of anxiety and were more often diagnosed with a personality disorder. Age and levels of anxiety were significant predictors of being in the surgery or the no-surgery group. The described differences between surgery and no-surgery patients did not change significantly over the follow-up period. DISCUSSION These data point toward a higher expression of baseline psychiatric symptoms in drug-resistant PWE without surgery. Further studies are warranted to further elucidate these findings and to clarify potential psychotropic effects of epilepsy itself, drug-resistant epilepsy and of epilepsy surgery and their impact on psychopathology. Clinically, it seems highly relevant to include psychiatrists in an interdisciplinary state-of-the-art perioperative management of drug-resistant PWE.
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Affiliation(s)
- Fabian Friedrich
- Clinical Division of Social Psychiatry, Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | | | | | - Sonja Zehetmayer
- Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Vienna, Austria
| | - Lisbeth Weitensfelder
- Center for Public Health, Department of Environmental Health, Medical University of Vienna, Vienna, Austria
| | - Clara Watschinger
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Nilufar Mossaheb
- Clinical Division of Social Psychiatry, Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
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7
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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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Marathe K, Alim-Marvasti A, Dahele K, Xiao F, Buck S, O'Keeffe AG, Duncan JS, Vakharia VN. Resective, Ablative and Radiosurgical Interventions for Drug Resistant Mesial Temporal Lobe Epilepsy: A Systematic Review and Meta-Analysis of Outcomes. Front Neurol 2021; 12:777845. [PMID: 34956057 PMCID: PMC8695716 DOI: 10.3389/fneur.2021.777845] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 11/01/2021] [Indexed: 11/13/2022] Open
Abstract
Objectives: One-third of individuals with focal epilepsy do not achieve seizure freedom despite best medical therapy. Mesial temporal lobe epilepsy (MTLE) is the most common form of drug resistant focal epilepsy. Surgery may lead to long-term seizure remission if the epileptogenic zone can be defined and safely removed or disconnected. We compare published outcomes following open surgical techniques, radiosurgery (SRS), laser interstitial thermal therapy (LITT) and radiofrequency ablation (RF-TC). Methods: PRISMA systematic review was performed through structured searches of PubMed, Embase and Cochrane databases. Inclusion criteria encompassed studies of MTLE reporting seizure-free outcomes in ≥10 patients with ≥12 months follow-up. Due to variability in open surgical approaches, only comparative studies were included to minimize the risk of bias. Random effects meta-analysis was performed to calculate effects sizes and a pooled estimate of the probability of seizure freedom per person-year. A mixed effects linear regression model was performed to compare effect sizes between interventions. Results: From 1,801 screened articles, 41 articles were included in the quantitative analysis. Open surgery included anterior temporal lobe resection as well as transcortical and trans-sylvian selective amygdalohippocampectomy. The pooled seizure-free rate per person-year was 0.72 (95% CI 0.66-0.79) with trans-sylvian selective amygdalohippocampectomy, 0.59 (95% CI 0.53-0.65) with LITT, 0.70 (95% CI 0.64-0.77) with anterior temporal lobe resection, 0.60 (95% CI 0.49-0.73) with transcortical selective amygdalohippocampectomy, 0.38 (95% CI 0.14-1.00) with RF-TC and 0.50 (95% CI 0.34-0.73) with SRS. Follow up duration and study sizes were limited with LITT and RF-TC. A mixed-effects linear regression model suggests significant differences between interventions, with LITT, ATLR and SAH demonstrating the largest effects estimates and RF-TC the lowest. Conclusions: Overall, novel "minimally invasive" approaches are still comparatively less efficacious than open surgery. LITT shows promising seizure effectiveness, however follow-up durations are shorter for minimally invasive approaches so the durability of the outcomes cannot yet be assessed. Secondary outcome measures such as Neurological complications, neuropsychological outcome and interventional morbidity are poorly reported but are important considerations when deciding on first-line treatments.
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Affiliation(s)
- Kajol Marathe
- Department of Clinical and Experimental Epilepsy, University College London, London, United Kingdom
| | - Ali Alim-Marvasti
- Department of Clinical and Experimental Epilepsy, University College London, London, United Kingdom.,National Hospital for Neurology and Neurosurgery, London, United Kingdom.,Wellcome/EPSRC Centre for Interventional and Surgical Sciences, University College London, London, United Kingdom
| | - Karan Dahele
- Department of Clinical and Experimental Epilepsy, University College London, London, United Kingdom
| | - Fenglai Xiao
- Department of Clinical and Experimental Epilepsy, University College London, London, United Kingdom
| | - Sarah Buck
- Department of Clinical and Experimental Epilepsy, University College London, London, United Kingdom
| | - Aidan G O'Keeffe
- Department of Statistical Science, University College London, London, United Kingdom
| | - John S Duncan
- Department of Clinical and Experimental Epilepsy, University College London, London, United Kingdom.,National Hospital for Neurology and Neurosurgery, London, United Kingdom
| | - Vejay N Vakharia
- Department of Clinical and Experimental Epilepsy, University College London, London, United Kingdom.,National Hospital for Neurology and Neurosurgery, London, United Kingdom
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Vakharia VN, Vos SB, Winston GP, Gutman MJ, Wykes V, McEvoy AW, Miserocchi A, Sparks R, Ourselin S, Duncan JS. Intraoperative overlay of optic radiation tractography during anteromesial temporal resection: a prospective validation study. J Neurosurg 2021; 136:543-552. [PMID: 34330090 DOI: 10.3171/2020.12.jns203437] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Accepted: 12/02/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Anteromesial temporal lobe resection (ATLR) results in long-term seizure freedom in patients with drug-resistant focal mesial temporal lobe epilepsy (MTLE). There is significant anatomical variation in the anterior projection of the optic radiation (OR), known as Meyer's loop, between individuals and between hemispheres in the same individual. Damage to the OR results in contralateral superior temporal quadrantanopia that may preclude driving in 33%-66% of patients who achieve seizure freedom. Tractography of the OR has been shown to prevent visual field deficit (VFD) when surgery is performed in an interventional MRI (iMRI) suite. Because access to iMRI is limited at most centers, the authors investigated whether use of a neuronavigation system with a microscope overlay in a conventional theater is sufficient to prevent significant VFD during ATLR. METHODS Twenty patients with drug-resistant MTLE who underwent ATLR (9 underwent right-side ATLR, and 9 were male) were recruited to participate in this single-center prospective cohort study. Tractography of the OR was performed with preoperative 3-T multishell diffusion data that were overlaid onto the surgical field by using a conventional neuronavigation system linked to a surgical microscope. Phantom testing confirmed overlay projection errors of < 1 mm. VFD was quantified preoperatively and 3 to 12 months postoperatively by using Humphrey and Esterman perimetry. RESULTS Perimetry results were available for all patients postoperatively, but for only 11/20 (55%) patients preoperatively. In 1/20 (5%) patients, a significant VFD occurred that would prevent driving in the UK on the basis of the results on Esterman perimetry. The VFD was identified early in the series, despite the surgical approach not transgressing OR tractography, and was subsequently found to be due to retraction injury. Tractography was also used from this point onward to inform retractor placement, and no further significant VFDs occurred. CONCLUSIONS Use of OR tractography with overlay outside of an iMRI suite, with application of an appropriate error margin, can be used during approach to the temporal horn of the lateral ventricle and carries a 5% risk of VFD that is significant enough to preclude driving postoperatively. OR tractography can also be used to inform retractor placement. These results warrant a larger prospective comparative study of the use of OR tractography-guided mesial temporal resection.
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Affiliation(s)
- Vejay N Vakharia
- 1Department of Clinical and Experimental Epilepsy, University College London and Epilepsy Society MRI Unit, London.,2National Hospital for Neurology and Neurosurgery, Queen Square, London
| | - Sjoerd B Vos
- 3Wellcome/EPSRC Centre for Interventional and Surgical Sciences, University College London, United Kingdom
| | - Gavin P Winston
- 1Department of Clinical and Experimental Epilepsy, University College London and Epilepsy Society MRI Unit, London.,2National Hospital for Neurology and Neurosurgery, Queen Square, London.,4Department of Medicine, Division of Neurology, Queen's University, Kingston, Ontario, Canada
| | | | - Victoria Wykes
- 6Institute of Cancer and Genomic Sciences, University of Birmingham.,7Department of Neurosurgery, Queen Elizabeth Hospital, Birmingham; and
| | - Andrew W McEvoy
- 1Department of Clinical and Experimental Epilepsy, University College London and Epilepsy Society MRI Unit, London.,2National Hospital for Neurology and Neurosurgery, Queen Square, London
| | - Anna Miserocchi
- 1Department of Clinical and Experimental Epilepsy, University College London and Epilepsy Society MRI Unit, London.,2National Hospital for Neurology and Neurosurgery, Queen Square, London
| | - Rachel Sparks
- 8School of Biomedical Engineering and Imaging Sciences, St Thomas' Hospital, King's College London, United Kingdom
| | - Sebastien Ourselin
- 8School of Biomedical Engineering and Imaging Sciences, St Thomas' Hospital, King's College London, United Kingdom
| | - John S Duncan
- 1Department of Clinical and Experimental Epilepsy, University College London and Epilepsy Society MRI Unit, London.,2National Hospital for Neurology and Neurosurgery, Queen Square, London
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Sokolov E, Sisterson ND, Hussein H, Plummer C, Corson D, Antony AR, Mettenburg JM, Ghearing GR, Pan JW, Urban A, Bagić A, Richardson RM, Kokkinos V. Intracranial monitoring contributes to seizure freedom for temporal lobectomy patients with nonconcordant preoperative data. Epilepsia Open 2021; 7:36-45. [PMID: 34786887 PMCID: PMC8886064 DOI: 10.1002/epi4.12483] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2020] [Revised: 03/10/2021] [Accepted: 03/19/2021] [Indexed: 11/20/2022] Open
Abstract
Objective The question of whether a patient with presumed temporal lobe seizures should proceed directly to temporal lobectomy surgery versus undergo intracranial monitoring arises commonly. We evaluate the effect of intracranial monitoring on seizure outcome in a retrospective cohort of consecutive subjects who specifically underwent an anterior temporal lobectomy (ATL) for refractory temporal lobe epilepsy (TLE). Methods We performed a retrospective analysis of 85 patients with focal refractory TLE who underwent ATL following: (a) intracranial monitoring via craniotomy and subdural/depth electrodes (SDE/DE), (b) intracranial monitoring via stereotactic electroencephalography (sEEG), or (c) no intracranial monitoring (direct ATL—dATL). For each subject, the presurgical primary hypothesis for epileptogenic zone localization was characterized as unilateral TLE, unilateral TLE plus (TLE+), or TLE with bilateral/poor lateralization. Results At one‐year and most recent follow‐up, Engel Class I and combined I/II outcomes did not differ significantly between the groups. Outcomes were better in the dATL group compared to the intracranial monitoring groups for lesional cases but were similar in nonlesional cases. Those requiring intracranial monitoring for a hypothesis of TLE+had similar outcomes with either intracranial monitoring approach. sEEG was the only approach used in patients with bilateral or poorly lateralized TLE, resulting in 77.8% of patients seizure‐free at last follow‐up. Importantly, for 85% of patients undergoing SEEG, recommendation for ATL resulted from modifying the primary hypothesis based on iEEG data. Significance Our study highlights the value of intracranial monitoring in equalizing seizure outcomes in difficult‐to‐treat TLE patients undergoing ATL.
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Affiliation(s)
- Elisaveta Sokolov
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | | | - Helweh Hussein
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Cheryl Plummer
- University of Pittsburgh Comprehensive Epilepsy Center, Pittsburgh, PA, USA
| | - Danielle Corson
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA, USA.,University of Pittsburgh Comprehensive Epilepsy Center, Pittsburgh, PA, USA
| | - Arun R Antony
- Department of Neurology, University of Pittsburgh, Pittsburgh, PA, USA
| | | | - Gena R Ghearing
- Department of Neurology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Jullie W Pan
- University of Pittsburgh Comprehensive Epilepsy Center, Pittsburgh, PA, USA.,Department of Neurology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Alexandra Urban
- University of Pittsburgh Comprehensive Epilepsy Center, Pittsburgh, PA, USA.,Department of Neurology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Anto Bagić
- University of Pittsburgh Comprehensive Epilepsy Center, Pittsburgh, PA, USA.,Department of Neurology, University of Pittsburgh, Pittsburgh, PA, USA
| | - R Mark Richardson
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA, USA.,University of Pittsburgh Comprehensive Epilepsy Center, Pittsburgh, PA, USA
| | - Vasileios Kokkinos
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA, USA.,University of Pittsburgh Comprehensive Epilepsy Center, Pittsburgh, PA, USA
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Kohlhase K, Zöllner JP, Tandon N, Strzelczyk A, Rosenow F. Comparison of minimally invasive and traditional surgical approaches for refractory mesial temporal lobe epilepsy: A systematic review and meta-analysis of outcomes. Epilepsia 2021; 62:831-845. [PMID: 33656182 DOI: 10.1111/epi.16846] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 01/29/2021] [Accepted: 01/29/2021] [Indexed: 01/10/2023]
Abstract
Magnetic resonance-guided laser interstitial laser therapy (MRgLITT) and radiofrequency ablation (RFA) represent two minimally invasive methods for the treatment of drug-refractory mesial temporal lobe epilepsy (mTLE). We performed a systematic review and a meta-analysis to compare outcomes and complications between MRgLITT, RFA, and conventional surgical approaches to the temporal lobe (i.e., anterior temporal lobe resection [ATL] or selective amygdalohippocampectomy [sAHE]). Forty-three studies (13 MRgLITT, 6 RFA, and 24 surgery studies) involved 554, 123, 1504, and 1326 patients treated by MRgLITT, RFA, ATL, or sAHE, respectively. Engel Class I (Engel-I) outcomes were achieved after MRgLITT in 57% (315/554, range = 33.3%-67.4%), RFA in 44% (54/123, range = 0%-67.2%), ATL in 69% (1032/1504, range = 40%-92.9%), and sAHE in 66% (887/1326, range = 21.4%-93.3%). Meta-analysis revealed no significant difference in seizure outcome between MRgLITT and RFA (Q = 2.74, p = .098), whereas ATL and sAHE were both superior to MRgLITT (ATL: Q = 8.92, p = .002; sAHE: Q = 4.33, p = .037) and RFA (ATL: Q = 6.42, p = .0113; sAHE: Q = 5.04, p = .0247), with better outcome in patients at follow-up of 60 months or more. Mesial hippocampal sclerosis (mTLE + hippocampal sclerosis) was associated with significantly better outcome after MRgLITT (Engel-I outcome in 64%; Q = 8.55, p = .0035). The rate of major complications was 3.8% for MRgLITT, 3.7% for RFA, 10.9% for ATL, and 7.4% for sAHE; the differences did not show statistical significance. Neuropsychological deficits occurred after all procedures, with left-sided surgeries having a higher rate of verbal memory impairment. Lateral functions such as naming or object recognition may be more preserved in MRgLITT. Thermal therapies are effective techniques but show a significantly lower rate of Engel-I outcome in comparison to ATL and sAHE. Between MRgLITT and RFA there were no significant differences in Engel-I outcome, whereby the success of treatment seems to depend on the approach used (e.g., occipital approach). MRgLITT shows a similar rate of complications compared to RFA, whereas patients undergoing MRgLITT may experience fewer major complications compared to ATL or sAHE and might have a more beneficial neuropsychological outcome.
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Affiliation(s)
- Konstantin Kohlhase
- Department of Neurology, Epilepsy Center Frankfurt Rhine-Main, University Hospital Frankfurt, Frankfurt am Main, Germany.,Landes-Offensive zur Entwicklung wissenschaftlich-ökonomischer Exzellen, Center for Personalized and Translational Epilepsy Research, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Johann Philipp Zöllner
- Department of Neurology, Epilepsy Center Frankfurt Rhine-Main, University Hospital Frankfurt, Frankfurt am Main, Germany.,Landes-Offensive zur Entwicklung wissenschaftlich-ökonomischer Exzellen, Center for Personalized and Translational Epilepsy Research, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Nitin Tandon
- Department of Neurosurgery, McGovern Medical School at University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Adam Strzelczyk
- Department of Neurology, Epilepsy Center Frankfurt Rhine-Main, University Hospital Frankfurt, Frankfurt am Main, Germany.,Landes-Offensive zur Entwicklung wissenschaftlich-ökonomischer Exzellen, Center for Personalized and Translational Epilepsy Research, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Felix Rosenow
- Department of Neurology, Epilepsy Center Frankfurt Rhine-Main, University Hospital Frankfurt, Frankfurt am Main, Germany.,Landes-Offensive zur Entwicklung wissenschaftlich-ökonomischer Exzellen, Center for Personalized and Translational Epilepsy Research, Goethe University Frankfurt, Frankfurt am Main, Germany
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12
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Zilli J, Kressin M, Schänzer A, Kampschulte M, Schmidt MJ. Partial cortico-hippocampectomy in cats, as therapy for refractory temporal epilepsy: A descriptive cadaveric study. PLoS One 2021; 16:e0244892. [PMID: 33449929 PMCID: PMC7810294 DOI: 10.1371/journal.pone.0244892] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 12/17/2020] [Indexed: 11/18/2022] Open
Abstract
Cats, similar to humans, are known to be affected by hippocampal sclerosis (HS), potentially causing antiepileptic drug (AED) resistance. HS can occur as a consequence of chronic seizure activity, trauma, inflammation, or even as a primary disease. In humans, temporal lobe resection is the standardized therapy in patients with refractory temporal lobe epilepsy (TLE). The majority of TLE patients are seizure free after surgery. Therefore, the purpose of this prospective cadaveric study is to establish a surgical technique for hippocampal resection in cats as a treatment for AED resistant seizures. Ten cats of different head morphology were examined. Pre-surgical magnetic resonance imaging (MRI) and computed tomography (CT) studies of the animals’ head were carried out to complete 3D reconstruction of the head, brain, and hippocampus. The resected hippocampal specimens and the brains were histologically examined for tissue injury adjacent to the hippocampus. The feasibility of the procedure, as well as the usability of the removed specimen for histopathological examination, was assessed. Moreover, a micro-CT (mCT) examination of the brain of two additional cats was performed in order to assess temporal vasculature as a reason for possible intraoperative complications. In all cats but one, the resection of the temporal cortex and the hippocampus were successful without any evidence of traumatic or vascular lesions in the surrounding neurovascular structures. In one cat, the presence of mechanical damage (a fissure) of the thalamic surface was evident in the histopathologic examination of the brain post-resection. All hippocampal fields and the dentate gyrus were identified in the majority of the cats via histological examination. The study describes a new surgical approach (partial temporal cortico-hippocampectomy) offering a potential treatment for cats with clinical and diagnostic evidence of temporal epilepsy which do not respond adequately to the medical therapy.
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Affiliation(s)
- Jessica Zilli
- Department of Veterinary Clinical Sciences, Small Animal Clinic, Justus-Liebig-University, Giessen, Germany
- * E-mail:
| | - Monika Kressin
- Institute for Veterinary Anatomy, Histology and Embryology, Justus-Liebig-University, Giessen, Germany
| | - Anne Schänzer
- Institute of Neuropathology, Justus-Liebig-University, Giessen, Germany
| | | | - Martin J. Schmidt
- Department of Veterinary Clinical Sciences, Small Animal Clinic, Justus-Liebig-University, Giessen, Germany
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13
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Kim LH, Parker JJ, Ho AL, Feng AY, Kumar KK, Chen KS, Ojukwu DI, Shuer LM, Grant GA, Graber KD, Halpern CH. Contemporaneous evaluation of patient experience, surgical strategy, and seizure outcomes in patients undergoing stereoelectroencephalography or subdural electrode monitoring. Epilepsia 2020; 62:74-84. [PMID: 33236777 DOI: 10.1111/epi.16762] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2019] [Revised: 10/24/2020] [Accepted: 10/26/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Intracranial electrographic localization of the seizure onset zone (SOZ) can guide surgical approaches for medically refractory epilepsy patients, especially when the presurgical workup is discordant or functional cortical mapping is required. Minimally invasive stereotactic placement of depth electrodes, stereoelectroencephalography (SEEG), has garnered increasing use, but limited data exist to evaluate its postoperative outcomes in the context of the contemporaneous availability of both SEEG and subdural electrode (SDE) monitoring. We aimed to assess the patient experience, surgical intervention, and seizure outcomes associated with these two epileptic focus mapping techniques during a period of rapid adoption of neuromodulatory and ablative epilepsy treatments. METHODS We retrospectively reviewed 66 consecutive adult intracranial electrode monitoring cases at our institution between 2014 and 2017. Monitoring was performed with either SEEG (n = 47) or SDEs (n = 19). RESULTS Both groups had high rates of SOZ identification (SEEG 91.5%, SDE 88.2%, P = .69). The majority of patients achieved Engel class I (SEEG 29.3%, SDE 35.3%) or II outcomes (SEEG 31.7%, SDE 29.4%) after epilepsy surgery, with no significant difference between groups (P = .79). SEEG patients reported lower median pain scores (P = .03) and required less narcotic pain medication (median = 94.5 vs 594.6 milligram morphine equivalents, P = .0003). Both groups had low rates of symptomatic hemorrhage (SEEG 0%, SDE 5.3%, P = .11). On multivariate logistic regression, undergoing resection or ablation (vs responsive neurostimulation/vagus nerve stimulation) was the only significant independent predictor of a favorable outcome (adjusted odds ratio = 25.4, 95% confidence interval = 3.48-185.7, P = .001). SIGNIFICANCE Although both SEEG and SDE monitoring result in favorable seizure control, SEEG has the advantage of superior pain control, decreased narcotic usage, and lack of routine need for intensive care unit stay. Despite a heterogenous collection of epileptic semiologies, seizure outcome was associated with the therapeutic surgical modality and not the intracranial monitoring technique. The potential for an improved postoperative experience makes SEEG a promising method for intracranial electrode monitoring.
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Affiliation(s)
- Lily H Kim
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Jonathon J Parker
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Allen L Ho
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Austin Y Feng
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Kevin K Kumar
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Kevin S Chen
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Disep I Ojukwu
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Lawrence M Shuer
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Gerald A Grant
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA, USA.,Division of Pediatric Neurosurgery, Lucile Packard Children's Hospital Stanford, Stanford, CA, USA
| | - Kevin D Graber
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Casey H Halpern
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA, USA
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Xu K, Wang X, Guan Y, Zhao M, Zhou J, Zhai F, Wang M, Li T, Luan G. Comparisons of the seizure-free outcome and visual field deficits between anterior temporal lobectomy and selective amygdalohippocampectomy: A systematic review and meta-analysis. Seizure 2020; 81:228-235. [DOI: 10.1016/j.seizure.2020.07.024] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Revised: 07/21/2020] [Accepted: 07/23/2020] [Indexed: 11/24/2022] Open
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15
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Figueroa J, Morell A, Bowory V, Shah AH, Eichberg D, Buttrick SS, Richardson A, Sarkiss C, Ivan ME, Komotar RJ. Minimally invasive keyhole temporal lobectomy approach for supramaximal glioma resection: A safety and feasibility study. J Clin Neurosci 2020; 72:57-62. [PMID: 31948883 DOI: 10.1016/j.jocn.2020.01.031] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2019] [Accepted: 01/05/2020] [Indexed: 10/25/2022]
Abstract
With a recent trend towards supra-maximal resection for gliomas and minimally invasive techniques, keyhole temporal lobectomies may serve an important role in neurosurgical oncology. Due to their location and proximity to eloquent brain, temporal lobe gliomas offer unique challenges that may limit the extent of resection. Here we describe a modified technique using mini-craniotomies through a keyhole approach for temporal lobectomies in glioma patients. We retrospectively reviewed data from consecutive patients who underwent temporal lobectomies for resection of gliomas from 2012 to 2018. Demographic data, extent of tumor resection, pre and post-op KPS, short term and long term complications, as well as other relevant data were collected. We identified 57 patients who underwent keyhole-mini craniotomy for temporal lobectomies for glioma. Surgical procedures were performed in 12 patients for low-grade glioma (LGG) and 45 patients for high-grade glioma (HGG). Awake craniotomies were performed in 15 of the cases, and 13 cases were for tumor recurrence. Supra-maximal resection (SMR) was achieved in 15 patients, while gross total resection (GTR) and near total resection (NTR) achieved in 32 patients and 10 patients, respectively. Average pre- and post-op KPS were equivalent, and post-operative complications requiring surgical intervention were experienced in 4 patients. Here we show that our modified keyhole craniotomy is both safe and effective in achieving SMR or GTR in glioma patients, with minimal morbidity. This minimally-invasive temporal lobectomy may be an instrumental tool for neurosurgical oncologists transitioning to less invasive techniques.
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Affiliation(s)
- Javier Figueroa
- Department of Neurological Surgery, University of Miami Miller School of MedicineLois Pope Life Center, 1095 NW 14th Terrace, Miami, FL 33136, United States.
| | - Alexis Morell
- Department of Neurological Surgery, University of Miami Miller School of MedicineLois Pope Life Center, 1095 NW 14th Terrace, Miami, FL 33136, United States
| | - Veronica Bowory
- Department of Neurological Surgery, University of Miami Miller School of MedicineLois Pope Life Center, 1095 NW 14th Terrace, Miami, FL 33136, United States
| | - Ashish H Shah
- Department of Neurological Surgery, University of Miami Miller School of MedicineLois Pope Life Center, 1095 NW 14th Terrace, Miami, FL 33136, United States
| | - Daniel Eichberg
- Department of Neurological Surgery, University of Miami Miller School of MedicineLois Pope Life Center, 1095 NW 14th Terrace, Miami, FL 33136, United States
| | - Simon S Buttrick
- Department of Neurological Surgery, University of Miami Miller School of MedicineLois Pope Life Center, 1095 NW 14th Terrace, Miami, FL 33136, United States
| | - Angela Richardson
- Department of Neurological Surgery, University of Miami Miller School of MedicineLois Pope Life Center, 1095 NW 14th Terrace, Miami, FL 33136, United States
| | - Christopher Sarkiss
- Department of Neurological Surgery, University of Miami Miller School of MedicineLois Pope Life Center, 1095 NW 14th Terrace, Miami, FL 33136, United States
| | - Michael E Ivan
- Department of Neurological Surgery, University of Miami Miller School of MedicineLois Pope Life Center, 1095 NW 14th Terrace, Miami, FL 33136, United States
| | - Ricardo J Komotar
- Department of Neurological Surgery, University of Miami Miller School of MedicineLois Pope Life Center, 1095 NW 14th Terrace, Miami, FL 33136, United States
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16
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Xu J, Lyu H, Li T, Xu Z, Fu X, Jia F, Wang J, Hu Q. Delineating functional segregations of the human middle temporal gyrus with resting-state functional connectivity and coactivation patterns. Hum Brain Mapp 2019; 40:5159-5171. [PMID: 31423713 PMCID: PMC6865466 DOI: 10.1002/hbm.24763] [Citation(s) in RCA: 63] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2019] [Revised: 07/25/2019] [Accepted: 07/31/2019] [Indexed: 12/25/2022] Open
Abstract
Although the middle temporal gyrus (MTG) has been parcellated into subregions with distinguished anatomical connectivity patterns, whether the structural topography of MTG can inform functional segregations of this area remains largely unknown. Accumulating evidence suggests that the brain's underlying organization and function can be directly and effectively delineated with resting-state functional connectivity (RSFC) by identifying putative functional boundaries between cortical areas. Here, RSFC profiles were used to explore functional segregations of the MTG and defined four subregions from anterior to posterior in two independent datasets, which showed a similar pattern with MTG parcellation scheme obtained using anatomical connectivity. The functional segregations of MTG were further supported by whole brain RSFC, coactivation, and specific RFSC, and coactivation mapping. Furthermore, the fingerprint with predefined 10 networks and functional characterizations of each subregion using meta-analysis also identified functional distinction between subregions. The specific connectivity analysis and functional characterization indicated that the bilateral most anterior subregions mainly participated in social cognition and semantic processing; the ventral middle subregions were involved in social cognition in left hemisphere and auditory processing in right hemisphere; the bilateral ventro-posterior subregions participated in action observation, whereas the left subregion was also involved in semantic processing; both of the dorsal subregions in superior temporal sulcus were involved in language, social cognition, and auditory processing. Taken together, our findings demonstrated MTG sharing similar structural and functional topographies and provide more detailed information about the functional organization of the MTG, which may facilitate future clinical and cognitive research on this area.
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Affiliation(s)
- Jinping Xu
- Institute of Biomedical and Health Engineering, Shenzhen Institutes of Advanced Technology, Chinese Academy of SciencesShenzhenChina
- University of Chinese Academy of SciencesBeijingChina
| | - Hanqing Lyu
- Radiology DepartmentShenzhen Traditional Chinese Medicine HospitalShenzhenChina
| | - Tian Li
- Institute of Biomedical and Health Engineering, Shenzhen Institutes of Advanced Technology, Chinese Academy of SciencesShenzhenChina
| | - Ziyun Xu
- Institute of Biomedical and Health Engineering, Shenzhen Institutes of Advanced Technology, Chinese Academy of SciencesShenzhenChina
| | - Xianjun Fu
- Institute of Biomedical and Health Engineering, Shenzhen Institutes of Advanced Technology, Chinese Academy of SciencesShenzhenChina
| | - Fucang Jia
- Institute of Biomedical and Health Engineering, Shenzhen Institutes of Advanced Technology, Chinese Academy of SciencesShenzhenChina
| | - Jiaojian Wang
- Key Laboratory for NeuroInformation of the Ministry of EducationSchool of Life Science and Technology, University of Electronic Science and Technology of ChinaChengduChina
| | - Qingmao Hu
- Institute of Biomedical and Health Engineering, Shenzhen Institutes of Advanced Technology, Chinese Academy of SciencesShenzhenChina
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17
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Jain P, Tomlinson G, Snead C, Sander B, Widjaja E. Systematic review and network meta-analysis of resective surgery for mesial temporal lobe epilepsy. J Neurol Neurosurg Psychiatry 2018; 89:1138-1144. [PMID: 29769251 DOI: 10.1136/jnnp-2017-317783] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Revised: 03/05/2018] [Accepted: 04/22/2018] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To evaluate the effectiveness of anterior temporal lobectomy (ATL) versus selective amygdalohippocampectomy (SAH) on seizure-free outcome in patients with temporal lobe epilepsy, using both direct and indirect evidence from the literature. METHODS MEDLINE, Embase and Cochrane databases were searched for original research articles and systematic reviews comparing ATL versus SAH, and ATL or SAH versus medical management (MM). The outcome was seizure freedom at 12 months of follow-up or longer. Direct pairwise meta-analyses were conducted, followed by a random-effect Bayesian network meta-analysis (NMA) combining direct and indirect evidence. RESULTS Twenty-eight articles were included (18 compared ATL vs SAH, 1 compared ATL vs SAH vs MM, 8 compared ATL vs MM, and 1 compared SAH vs MM). Direct pairwise meta-analyses showed no significant differences in seizure-free outcome of ATL versus SAH (OR 1.14, 95% CI 0.93 to 1.39; p=0.201), but the odds of seizure-free outcome were higher for ATL versus MM (OR 29.16, 95% CI 10.44 to 81.50; p<0.00001), and SAH versus MM (OR 28.42, 95% CI 10.17 to 79.39; p<0.00001). NMA also showed that the odds of seizure-free outcome were no different in ATL versus SAH (OR 1.15, 95% credible interval (CrI) 0.84-1.15), but higher for ATL versus MM (OR 27.22, 95% CrI 15.38-27.22), and SAH versus MM (OR 23.57, 95% CrI 12.67-23.57). There were no significant differences between direct and indirect comparisons (all p>0.05). CONCLUSION Direct evidence, indirect evidence and NMA did not identify a difference in seizure-free outcome of ATL versus SAH.
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Affiliation(s)
- Puneet Jain
- Epilepsy Program, Division of Neurology, Department of Pediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - George Tomlinson
- Toronto Health Economics and Technology Assessment (THETA), University Health Network, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Carter Snead
- Epilepsy Program, Division of Neurology, Department of Pediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Beate Sander
- Toronto Health Economics and Technology Assessment (THETA), University Health Network, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Elysa Widjaja
- Epilepsy Program, Division of Neurology, Department of Pediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Diagnostic Imaging, The Hospital for Sick Children, Toronto, Ontario, Canada
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18
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Ramos-Perdigués S, Baillés E, Mané A, Carreño M, Donaire A, Rumià J, Bargalló N, Boget T, Setoain X, Valdés M, Pintor L. Psychiatric Symptoms in Refractory Epilepsy During the First Year After Surgery. Neurotherapeutics 2018; 15:1082-1092. [PMID: 30066084 PMCID: PMC6277301 DOI: 10.1007/s13311-018-0652-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
Psychiatric morbidity in drug-resistant epilepsy is frequent. Surgery is the best therapeutic alternative for treating seizures, but the current evidence concerning the effects of surgery on psychiatric disorders (PDs) is inconclusive. We aim to clarify surgery's role in long-term PDs. Using a prospective controlled study, we analyzed the psychopathologic outcomes of patients with drug-resistant epilepsy, comparing those who underwent surgery to those who did not due to not being suitable. Surgical candidates were paired (n = 84) with the immediately following nonsurgical candidates (n = 68). Both groups continued their usual medical treatment. We studied psychiatric changes for each group and analyzed de novo and remission cases. The assessments were made during the presurgical evaluation, and at 6 months (6-M) and 12 months (12-M) after surgery. Finally, we determined associated factors for postsurgical PDs. At 12 months, using the Hospital Anxiety and Depression Scale (HADS), anxiety improved in both groups (p = 0.000), while depression improved only in the surgical group (p = 0.016). Moreover, all symptom dimensions on the Symptom Checklist-90-R (SCL-90), as well as severity, distress, and total symptoms, decreased only in the surgical group. These ameliorations reached not only statistical significance but also clinical significance for depression (HADS) (p = 0.014) and the interictal dysphoric disorder (p = 0.013). The main predictors for PDs after surgery were as follows: the presurgical and 6-month psychiatric symptoms, the absence of surgery, seizure outcomes, and some antiepileptic and psychiatric drugs. This study provides evidence that surgery for epilepsy could have a role in improving some symptoms of psychiatric disorders 12-M after the surgery.
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Affiliation(s)
- Sònia Ramos-Perdigués
- Sant Joan de Déu Terres de Lleida Hospital, Avinguda de la Canadiense, 28, 25001, Lleida, Catalonia, Spain.
- Nostra Senyora de Meritxell Hospital, Escaldes-Engordany, AD700, Andorra.
| | - Eva Baillés
- Department of Experimental and Health Sciences, University Pompeu Fabra, Barcelona, 08002, Spain
- Autonomous University of Barcelona, Barcelona, 08193, Spain
| | - Anna Mané
- Institute of Neuropsychiatry and Addictions, Parc de Salut Mar and Foundation IMIM, Barcelona, 08003, Spain
- Center for Biomedical Research in Mental Health Network (CIBERSAM), Madrid, 28029, Spain
| | - Mar Carreño
- Clinical Institute of Neurosciences, Hospital Clinic of Barcelona, Barcelona, 08036, Spain
- Epilepsy Unit, Hospital Clínic de Barcelona, Barcelona, 08036, Spain
- Hospital Clinic of Barcelona, Biomedical Research Institute August Pi i Sunyer (IDIBAPS), Barcelona, 08036, Spain
| | - Antonio Donaire
- Clinical Institute of Neurosciences, Hospital Clinic of Barcelona, Barcelona, 08036, Spain
- Epilepsy Unit, Hospital Clínic de Barcelona, Barcelona, 08036, Spain
- Hospital Clinic of Barcelona, Biomedical Research Institute August Pi i Sunyer (IDIBAPS), Barcelona, 08036, Spain
| | - Jordi Rumià
- Clinical Institute of Neurosciences, Hospital Clinic of Barcelona, Barcelona, 08036, Spain
- Epilepsy Unit, Hospital Clínic de Barcelona, Barcelona, 08036, Spain
| | - Nuria Bargalló
- Clinical Institute of Neurosciences, Hospital Clinic of Barcelona, Barcelona, 08036, Spain
- Epilepsy Unit, Hospital Clínic de Barcelona, Barcelona, 08036, Spain
- Hospital Clinic of Barcelona, Biomedical Research Institute August Pi i Sunyer (IDIBAPS), Barcelona, 08036, Spain
| | - Teresa Boget
- Clinical Institute of Neurosciences, Hospital Clinic of Barcelona, Barcelona, 08036, Spain
- Epilepsy Unit, Hospital Clínic de Barcelona, Barcelona, 08036, Spain
- Hospital Clinic of Barcelona, Biomedical Research Institute August Pi i Sunyer (IDIBAPS), Barcelona, 08036, Spain
| | - Xavier Setoain
- Clinical Institute of Neurosciences, Hospital Clinic of Barcelona, Barcelona, 08036, Spain
- Epilepsy Unit, Hospital Clínic de Barcelona, Barcelona, 08036, Spain
- Hospital Clinic of Barcelona, Biomedical Research Institute August Pi i Sunyer (IDIBAPS), Barcelona, 08036, Spain
| | - Manuel Valdés
- Clinical Institute of Neurosciences, Hospital Clinic of Barcelona, Barcelona, 08036, Spain
| | - Luís Pintor
- Clinical Institute of Neurosciences, Hospital Clinic of Barcelona, Barcelona, 08036, Spain
- Epilepsy Unit, Hospital Clínic de Barcelona, Barcelona, 08036, Spain
- Hospital Clinic of Barcelona, Biomedical Research Institute August Pi i Sunyer (IDIBAPS), Barcelona, 08036, Spain
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Abstract
The goal of any epilepsy surgery is to improve patient's quality of life by achieving seizure freedom or by reducing the frequency of severely debilitating seizures. To achieve this goal, non-invasive and invasive diagnostic methods must precisely delineate the epileptogenic zone (EZ), which is defined as the area that needs to be resected to obtain seizure freedom. At the same time, the correct identification of eloquent brain areas is inevitable to avoid new neurological deficits from surgery. In recent years, the technical advances in diagnostics have enabled us to achieve these goals in an increasing number of cases. As a consequence, and with new surgical treatment options available, the number of patients who might benefit from epilepsy surgery is constantly increasing. Especially in pediatric epilepsy, early surgical intervention is becoming frequently advocated as it has been shown to improve cognitive and behavioral outcome. Specialized epilepsy centers and multidisciplinary teams are required to provide adequate care and treatment. The goal of this review is to describe important diseases that are accessible to epilepsy surgery and to give an overview of current diagnostic methods. The focus lies on established as well as novel techniques in epilepsy surgery. The presurgical work-up and patient selection is outlined.
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Affiliation(s)
- Johannes Herta
- Department of Neurosurgery, Vienna General Hospital, Medical University of Vienna, Vienna, Austria
| | - Christian Dorfer
- Department of Neurosurgery, Vienna General Hospital, Medical University of Vienna, Vienna, Austria -
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20
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A modern epilepsy surgery treatment algorithm: Incorporating traditional and emerging technologies. Epilepsy Behav 2018; 80:68-74. [PMID: 29414561 PMCID: PMC5845806 DOI: 10.1016/j.yebeh.2017.12.041] [Citation(s) in RCA: 67] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Revised: 12/30/2017] [Accepted: 12/31/2017] [Indexed: 12/13/2022]
Abstract
Epilepsy surgery has seen numerous technological advances in both diagnostic and therapeutic procedures in recent years. This has increased the number of patients who may be candidates for intervention and potential improvement in quality of life. However, the expansion of the field also necessitates a broader understanding of how to incorporate both traditional and emerging technologies into the care provided at comprehensive epilepsy centers. This review summarizes both old and new surgical procedures in epilepsy using an example algorithm. While treatment algorithms are inherently oversimplified, incomplete, and reflect personal bias, they provide a general framework that can be customized to each center and each patient, incorporating differences in provider opinion, patient preference, and the institutional availability of technologies. For instance, the use of minimally invasive stereotactic electroencephalography (SEEG) has increased dramatically over the past decade, but many cases still benefit from invasive recordings using subdural grids. Furthermore, although surgical resection remains the gold-standard treatment for focal mesial temporal or neocortical epilepsy, ablative procedures such as laser interstitial thermal therapy (LITT) or stereotactic radiosurgery (SRS) may be appropriate and avoid craniotomy in many cases. Furthermore, while palliative surgical procedures were once limited to disconnection surgeries, several neurostimulation treatments are now available to treat eloquent cortical, bitemporal, and even multifocal or generalized epilepsy syndromes. An updated perspective in epilepsy surgery will help guide surgical decision making and lay the groundwork for data collection needed in future studies and trials.
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Surgical Considerations of Intractable Mesial Temporal Lobe Epilepsy. Brain Sci 2018; 8:brainsci8020035. [PMID: 29461485 PMCID: PMC5836054 DOI: 10.3390/brainsci8020035] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Revised: 02/14/2018] [Accepted: 02/15/2018] [Indexed: 11/30/2022] Open
Abstract
Surgery of temporal lobe epilepsy is the best opportunity for seizure freedom in medically intractable patients. The surgical approach has evolved to recognize the paramount importance of the mesial temporal structures in the majority of patients with temporal lobe epilepsy who have a seizure origin in the mesial temporal structures. For those individuals with medically intractable mesial temporal lobe epilepsy, a selective amygdalohippocampectomy surgery can be done that provides an excellent opportunity for seizure freedom and limits the resection to temporal lobe structures primarily involved in seizure genesis.
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22
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Dorfer C, Czech T, Aull-Watschinger S, Baumgartner C, Jung R, Kasprian G, Novak K, Pirker S, Seidl B, Stefanits H, Trimmel K, Pataraia E. Mesial temporal lobe epilepsy: long-term seizure outcome of patients primarily treated with transsylvian selective amygdalohippocampectomy. J Neurosurg 2017; 129:174-181. [PMID: 29027855 DOI: 10.3171/2017.4.jns162699] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The aim of this study was to present long-term seizure outcome data in a consecutive series of patients with refractory mesial temporal lobe epilepsy primarily treated with transsylvian selective amygdalohippocampectomy (SAHE). METHODS The authors retrospectively analyzed prospectively collected data for all patients who had undergone resective surgery for medically refractory epilepsy at their institution between July 1994 and December 2014. Seizure outcome was assessed according to the International League Against Epilepsy (ILAE) and the Engel classifications. RESULTS The authors performed an SAHE in 158 patients (78 males, 80 females; 73 right side, 85 left side) with a mean age of 37.1 ± 10.0 years at surgery. Four patients lost to follow-up and 1 patient who committed suicide were excluded from analysis. The mean follow-up period was 9.7 years. At the last available follow-up (or before reoperation), 68 patients (44.4%) had achieved an outcome classified as ILAE Class 1a, 46 patients (30.1%) Class 1, 6 patients (3.9%) Class 2, 16 patients (10.4%) Class 3, 15 patients (9.8%) Class 4, and 2 patients (1.3%) Class 5. These outcomes correspond to Engel Class I in 78.4% of the patients, Engel Class II in 10.5%, Engel Class III in 8.5%, and Engel Class IV in 2.0%. Eleven patients underwent a second surgery (anterior temporal lobectomy) after a mean of 4.4 years from the SAHE (left side in 6 patients, right side in 5). Eight (72.7%) of these 11 patients achieved seizure freedom. The overall ILEA seizure outcome since (re)operation after a mean follow-up of 10.0 years was Class 1a in 72 patients (47.0%), Class 1 in 50 patients (32.6%), Class 2 in 7 patients (4.6%), Class 3 in 15 patients (9.8%), Class 4 in 8 patients (5.2%), and Class 5 in 1 patient (0.6%). These outcomes correspond to an Engel Class I outcome in 84.3% of the patients. CONCLUSIONS A satisfactory long-term seizure outcome following transsylvian SAHE was demonstrated in a selected group of patients with refractory temporal lobe epilepsy.
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Affiliation(s)
| | | | | | - Christoph Baumgartner
- 3Karl Landsteiner Institute for Clinical Epilepsy Research and Cognitive Neurology, General Hospital Hietzing with Neurological Center Rosenhügel, Vienna, Austria
| | | | - Gregor Kasprian
- 4Radiology and Nuclear Medicine, Medical University of Vienna; and
| | | | - Susanne Pirker
- 3Karl Landsteiner Institute for Clinical Epilepsy Research and Cognitive Neurology, General Hospital Hietzing with Neurological Center Rosenhügel, Vienna, Austria
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Prognostic significance of postoperative spikes varied in different surgical procedures for mesial temporal sclerosis. Seizure 2017; 52:71-75. [PMID: 29017080 DOI: 10.1016/j.seizure.2017.09.018] [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] [Received: 06/18/2017] [Revised: 09/24/2017] [Accepted: 09/26/2017] [Indexed: 11/23/2022] Open
Abstract
PURPOSE We conducted this study to compare the occurrence and prognostic significance of early postoperative interictal epileptiform discharges (IEDs) on seizure outcomes between corticoamygdalohippocampectomy (CAH) and selective amygdalohippocampectomy (SAH). METHODS We reviewed our database of patients who had epilepsy surgery with hippocampus atrophy or signal changes on brain MRIs and pathology of mesial temporal sclerosis. One hundred and seventy-seven CAH and 39 SAH patients were enrolled. Postoperative EEG within 30days, other preoperative variables and seizure outcome 2years after surgery were obtained for analysis. Engel's IA and IB were defined as seizure-free. RESULTS There was no significant difference in the seizure-free rate between the two procedures (127 (71.8%) of CAH vs 30 (76.9%) of SAH, p=0.51). Postoperative IEDs were more frequently seen in the SAH group (64.1%) than in the CAH group (29.9%), p<0.001. The IEDs in the SAH group did not show correlation with the seizure outcome 2 years after surgery. In the CAH group, patients who had no postoperative IEDs showed a higher seizure-free rate compared to those with IEDs (78.2% vs 56.6%, p=0.003; OR 2.267, 95% CI 1.09-4.73, p=0.029 in multivariate logistic regression). CONCLUSIONS Early postoperative IEDs are more frequently seen in SAH than in CAH. Unlike in patients with CAH, the presence of IEDs after SAH was not a predictor of seizure recurrence. The type of surgery should be considered while utilizing postoperative IEDs for evaluating the prognosis.
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Mathon B, Bielle F, Samson S, Plaisant O, Dupont S, Bertrand A, Miles R, Nguyen-Michel VH, Lambrecq V, Calderon-Garcidueñas AL, Duyckaerts C, Carpentier A, Baulac M, Cornu P, Adam C, Clemenceau S, Navarro V. Predictive factors of long-term outcomes of surgery for mesial temporal lobe epilepsy associated with hippocampal sclerosis. Epilepsia 2017; 58:1473-1485. [DOI: 10.1111/epi.13831] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/29/2017] [Indexed: 12/26/2022]
Affiliation(s)
- Bertrand Mathon
- Department of Neurosurgery; AP-HP; La Pitié-Salpêtrière-Charles Foix University Hospital; Paris France
- Sorbonne University; UPMC University of Paris 06; Paris France
| | - Franck Bielle
- Sorbonne University; UPMC University of Paris 06; Paris France
- Department of Neuropathology; AP-HP; La Pitié-Salpêtrière-Charles Foix University Hospital; Paris France
| | - Séverine Samson
- Epileptology Unit; AP-HP; La Pitié-Salpêtrière-Charles Foix University Hospital; Paris France
- PSITEC Laboratory (EA 4072); University of Lille 3; Lille France
| | - Odile Plaisant
- Epileptology Unit; AP-HP; La Pitié-Salpêtrière-Charles Foix University Hospital; Paris France
- ANCRE; URDIA EA 4465; Paris Descartes University; Sorbonne Paris Cité University; Paris France
| | - Sophie Dupont
- Sorbonne University; UPMC University of Paris 06; Paris France
- Epileptology Unit; AP-HP; La Pitié-Salpêtrière-Charles Foix University Hospital; Paris France
- Rehabilitation Unit; AP-HP; La Pitié-Salpêtrière-Charles Foix University Hospital; Paris France
- Brain and Spine Institute (ICM; INSERM; UMRS 1127; CNRS; UMR 7225); Paris France
| | - Anne Bertrand
- Sorbonne University; UPMC University of Paris 06; Paris France
- Brain and Spine Institute (ICM; INSERM; UMRS 1127; CNRS; UMR 7225); Paris France
- Department of Neuroradiology; AP-HP; La Pitié-Salpêtrière-Charles Foix University Hospital; Paris France
- Inria Paris; Aramis Project Team; Paris France
| | - Richard Miles
- Brain and Spine Institute (ICM; INSERM; UMRS 1127; CNRS; UMR 7225); Paris France
| | - Vi-Huong Nguyen-Michel
- Epileptology Unit; AP-HP; La Pitié-Salpêtrière-Charles Foix University Hospital; Paris France
| | - Virginie Lambrecq
- Sorbonne University; UPMC University of Paris 06; Paris France
- Epileptology Unit; AP-HP; La Pitié-Salpêtrière-Charles Foix University Hospital; Paris France
- Brain and Spine Institute (ICM; INSERM; UMRS 1127; CNRS; UMR 7225); Paris France
| | - Ana Laura Calderon-Garcidueñas
- Department of Neuropathology; AP-HP; La Pitié-Salpêtrière-Charles Foix University Hospital; Paris France
- Institute of Forensic Medicine; Veracruzana University; Boca del Río Mexico
| | - Charles Duyckaerts
- Sorbonne University; UPMC University of Paris 06; Paris France
- Department of Neuropathology; AP-HP; La Pitié-Salpêtrière-Charles Foix University Hospital; Paris France
| | - Alexandre Carpentier
- Department of Neurosurgery; AP-HP; La Pitié-Salpêtrière-Charles Foix University Hospital; Paris France
- Sorbonne University; UPMC University of Paris 06; Paris France
- Brain and Spine Institute (ICM; INSERM; UMRS 1127; CNRS; UMR 7225); Paris France
| | - Michel Baulac
- Sorbonne University; UPMC University of Paris 06; Paris France
- Epileptology Unit; AP-HP; La Pitié-Salpêtrière-Charles Foix University Hospital; Paris France
- Brain and Spine Institute (ICM; INSERM; UMRS 1127; CNRS; UMR 7225); Paris France
| | - Philippe Cornu
- Department of Neurosurgery; AP-HP; La Pitié-Salpêtrière-Charles Foix University Hospital; Paris France
- Sorbonne University; UPMC University of Paris 06; Paris France
| | - Claude Adam
- Epileptology Unit; AP-HP; La Pitié-Salpêtrière-Charles Foix University Hospital; Paris France
- Brain and Spine Institute (ICM; INSERM; UMRS 1127; CNRS; UMR 7225); Paris France
| | - Stéphane Clemenceau
- Department of Neurosurgery; AP-HP; La Pitié-Salpêtrière-Charles Foix University Hospital; Paris France
- Brain and Spine Institute (ICM; INSERM; UMRS 1127; CNRS; UMR 7225); Paris France
| | - Vincent Navarro
- Sorbonne University; UPMC University of Paris 06; Paris France
- Epileptology Unit; AP-HP; La Pitié-Salpêtrière-Charles Foix University Hospital; Paris France
- Brain and Spine Institute (ICM; INSERM; UMRS 1127; CNRS; UMR 7225); Paris France
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Sherrod BA, Davis MC, Riley KO. Thirty-day non-seizure outcomes following temporal lobectomy for adult epilepsy. Clin Neurol Neurosurg 2017; 160:12-18. [PMID: 28618390 DOI: 10.1016/j.clineuro.2017.05.027] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Revised: 05/03/2017] [Accepted: 05/29/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Multi-institutional rates of acute adverse outcomes other than seizures after temporal lobectomy (TL) are not well understood. Here we analyzed short-term morbidity and mortality following TL using a validated national database. PATIENTS AND METHODS The multi-institutional American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database was queried by Current Procedural Terminology (CPT) code for TL procedures performed for adult patients with diagnoses related to epilepsy from 2008 to 2014. Patient demographics, operative variables, hospital variables, preoperative laboratory values, and preexisting comorbidities were analyzed using univariate and multivariate techniques to determine associations with 30-day postoperative morbidity and mortality. RESULTS A total of 202 TL procedures were analyzed, 80 (39.6%) with intraoperative electrocorticography (ECOG) and 122 (60.4%) without ECOG. Mean age was 40.4±13.7years, and 47.5% of patients were male. Overall morbidity and mortality were 11.4% and 2.0%, respectively. The most common adverse outcomes were reoperation (5.4%), stroke with residual deficit (2.5%), failure to wean from ventilator (2.0%), and surgical site infection (2.0%). Adverse event rates were not significantly different between TLs with and without ECOG (13.1% vs. 8.8%, p=0.375). Independent predictors of adverse events included prior stroke (OR 7.60, 95% CI 1.22-47.17, p=0.029) and chronic steroid use (OR 10.90, 95% CI 1.03-115.79, p=0.048). Diabetes mellitus (p=0.078) and older age (p=0.145) approached but did not reach significance in the multivariate model. CONCLUSIONS We report rates of acute morbidity and mortality following TL procedures using a national database. These findings can be used both to assist with patient selection as well as patient counseling prior to surgery.
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Affiliation(s)
- Brandon A Sherrod
- Department of Neurological Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Matthew C Davis
- Department of Neurological Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Kristen O Riley
- Department of Neurological Surgery, University of Alabama at Birmingham, Birmingham, AL, USA.
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Schmeiser B, Wagner K, Schulze-Bonhage A, Mader I, Wendling AS, Steinhoff BJ, Prinz M, Scheiwe C, Weyerbrock A, Zentner J. Surgical Treatment of Mesiotemporal Lobe Epilepsy: Which Approach is Favorable? Neurosurgery 2017; 81:992-1004. [DOI: 10.1093/neuros/nyx138] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2015] [Accepted: 05/24/2017] [Indexed: 11/14/2022] Open
Abstract
Abstract
BACKGROUND
Mesiotemporal lobe epilepsy is one of the most frequent causes for pharmacoresistant epilepsy. Different surgical approaches to the mesiotemporal area are used.
OBJECTIVE
To analyze epileptological and neuropsychological results as well as complications of different surgical strategies.
METHODS
This retrospective study is based on a consecutive series of 458 patients all harboring pharmacoresistant mesiotemporal lobe epilepsy. Following procedures were performed: standard anterior temporal lobectomy, anterior temporal or key-hole resection, extended lesionectomy, and transsylvian and subtemporal selective amygdalohippocampectomy. Postoperative outcome was evaluated according to different surgical procedures.
RESULTS
Overall, 1 yr after surgery 315 of 432 patients (72.9%) were classified Engel I; in particular, 72.8% were seizure-free after anterior temporal lobectomy, 76.9% after key-hole resection, 84.4% after extended lesionectomy, 70.3% after transylvian selective amygdalohippocampectomy, and 59.1% after subtemporal selective amygdalohippocampectomy. No significant differences in seizure outcome were found between different resective procedures, neither in short-term nor long-term follow-up. There was no perioperative mortality. Permanent morbidity was encountered in 4.4%. There were no significant differences in complications between different resection types. In the majority of patients, selective attention improved following surgery. Patients after left-sided operations performed significantly worse regarding verbal memory as compared to right-sided procedures. However, surgical approach had no significant effect on memory outcome.
CONCLUSION
Different surgical approaches for mesiotemporal epilepsy analyzed resulted in similar epileptological, neuropsychological results, and complication rates. Therefore, the approach for the individual patient does not only depend on the specific localization of the epileptogenic area, but also on the experience of the surgeon.
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Affiliation(s)
- Barbara Schmeiser
- Department of Neurosurgery, University Hospital Freiburg, Freiburg, Germany
| | - Kathrin Wagner
- Department of Epileptology, University Hospital Freiburg, Freiburg, Germany
| | | | - Irina Mader
- Department of Neuroradiology, University Hospital Freiburg, Freiburg, Germany
| | | | | | - Marco Prinz
- Institute of Neuropathology, University Hospital Freiburg, BIOSS Centre for Biological Signalling Studies, University of Freiburg, Freiburg, Germany
| | - Christian Scheiwe
- Department of Neurosurgery, University Hospital Freiburg, Freiburg, Germany
| | - Astrid Weyerbrock
- Department of Neurosurgery, University Hospital Freiburg, Freiburg, Germany
| | - Josef Zentner
- Department of Neurosurgery, University Hospital Freiburg, Freiburg, Germany
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Psychiatric symptoms after temporal epilepsy surgery. A one-year follow-up study. Epilepsy Behav 2017; 70:154-160. [PMID: 28427025 DOI: 10.1016/j.yebeh.2017.02.029] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2016] [Revised: 02/17/2017] [Accepted: 02/17/2017] [Indexed: 11/22/2022]
Abstract
Psychiatric symptoms must be considered in patients with refractory temporal lobe epilepsy after epilepsy surgery. The main objectives of our study were to describe clinical and socio-demographical characteristics of a cohort of patients with pharmacoresistant temporal lobe epilepsy who underwent temporal lobe epilepsy surgery, and moreover, to evaluate possible risk factors for developing psychiatric symptoms. In order to achieve those goals, we conducted a prospective evaluation of psychopathology throughout the first year after surgery in a clinical sample of 72 patients, by means of three clinical rated measures; the Hamilton Anxiety Rating Scale (HARS), the Hamilton Depression Rating Scale (HDRS), and the Brief Psychiatric Rating Scale (BPRS). The psychopathological evaluations were performed by an experienced psychiatrist. A presurgical evaluation was done by a multidisciplinary team (that includes neurologist, psychiatrist, neurosurgeon, neurophysiologist, radiologists, and nuclear medicine specialist) in all patients. The decision to proceed to surgery was taken after a surgical meeting of all members of the Multidisciplinary Epilepsy Unit team. The psychiatrist conducted two postoperative assessments at 6months and 12months after surgery. The main finding was that past history of mental illness (patients who were receiving psychiatric treatment prior to the baseline evaluation) was a risk factor for anxiety, depression, and psychosis after temporal lobe epilepsy surgery.
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Abstract
In common with other stereotactic procedures, stereotactic laser thermocoagulation (SLT) promises gentle destruction of pathological tissue, which might become especially relevant for epilepsy surgery in the future. Compared to standard resection, no large craniotomy is necessary, cortical damage during access to deep-seated lesions can be avoided and interventions close to eloquent brain areas become possible. We describe the history and rationale of laser neurosurgery as well as the two available SLT systems (Visualase® and NeuroBlate®; CE marks pending). Both systems are coupled with magnetic resonance imaging (MRI) and MR thermometry, thereby increasing patient safety. We report the published clinical experiences with SLT in epilepsy surgery (altogether approximately 200 cases) with respect to complications, brain structural alterations, seizure outcome, neuropsychological findings and treatment costs. The rate of seizure-free patients seems to be slightly lower than for resection surgery. Due to the inadequate quality of studies, the neuropsychological superiority of SLT has not yet been unambiguously demonstrated.
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Muzumdar D, Patil M, Goel A, Ravat S, Sawant N, Shah U. Mesial temporal lobe epilepsy – An overview of surgical techniques. Int J Surg 2016; 36:411-419. [DOI: 10.1016/j.ijsu.2016.10.027] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Revised: 10/16/2016] [Accepted: 10/18/2016] [Indexed: 12/29/2022]
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Ramos-Perdigués S, Baillés E, Mané A, Carreño M, Donaire A, Rumia J, Bargalló N, Boget T, Setoain X, Valdes M, Pintor L. A prospective study contrasting the psychiatric outcome in drug-resistant epilepsy between patients who underwent surgery and a control group. Epilepsia 2016; 57:1680-1690. [PMID: 27562413 DOI: 10.1111/epi.13497] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/18/2016] [Indexed: 12/01/2022]
Abstract
OBJECTIVE Psychiatric morbidity in drug-resistant epilepsy is frequent and has a negative influence on quality of life. Surgery is proven to be the best therapeutic alternative for treating seizures. However, it is inconclusive with the current evidence whether surgery, per se, is a risk factor or promotes amelioration of psychiatric disorders. Until now, most studies have been cross-sectional with small or heterogeneous groups. In addition, the few prospective studies did not have an identical control group. The present study aims to clarify the role of surgery in psychopathologic alterations. METHODS We analyzed, through a prospective case-control study, the psychopathologic outcomes of patients with drug-resistant epilepsy, comparing those who underwent surgery and those who continued with pharmacologic treatment due to not being suitable for surgery. The assessments were performed during presurgical evaluation and 6 months after surgery. We studied psychiatric changes for each group, compared differences between groups, and also analyzed de novo and remission cases. Finally, we determined associated factors for postsurgical psychiatric disturbances. RESULTS The surgical group experienced a significant decrease in psychopathologic alterations in comparison with the control group. In addition, distress perception of surgical patients also improved, whereas it did not decrease in the control group. Patients who underwent surgery presented a decrease in depressive and anxiety symptoms, whereas the nonsurgical group increased its anxiety levels. De novo disturbances that appeared after surgery were less frequent than in nonsurgical patients. We observed significant favorable outcomes considering de novo versus remission cases for anxiety, depression, and total symptoms only in the surgical group. The two main predictors for psychiatric disorders after surgery were presurgical psychiatric functioning and surgery. SIGNIFICANCE Provides evidence that surgery improves psychiatric functioning in drug-resistant epilepsy through a prospective controlled study.
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Affiliation(s)
| | - Eva Baillés
- Department of Experimental and Health Sciences, University Pompeu Fabra, Barcelona, Spain.,Autonomous University of Barcelona, Barcelona, Spain
| | - Anna Mané
- Institute of Neuropsychiatry and Addictions, Parc de Salut Mar and Foundation IMIM, Barcelona, Spain.,Center for Biomedical Research in Mental Health Network (CIBERSAM), Barcelona, Spain
| | - Mar Carreño
- Clinical Institute of Neurosciences, Hospital Clinic of Barcelona, Barcelona, Spain.,Epilepsy Unit, Hospital Clinic of Barcelona, Barcelona, Spain.,Biomedical Research Institute August Pi i Sunyer (IDIBAPS), Hospital Clínic of Barcelona, Barcelona, Spain
| | - Antonio Donaire
- Clinical Institute of Neurosciences, Hospital Clinic of Barcelona, Barcelona, Spain.,Epilepsy Unit, Hospital Clinic of Barcelona, Barcelona, Spain.,Biomedical Research Institute August Pi i Sunyer (IDIBAPS), Hospital Clínic of Barcelona, Barcelona, Spain
| | - Jordi Rumia
- Clinical Institute of Neurosciences, Hospital Clinic of Barcelona, Barcelona, Spain.,Epilepsy Unit, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Nuria Bargalló
- Clinical Institute of Neurosciences, Hospital Clinic of Barcelona, Barcelona, Spain.,Epilepsy Unit, Hospital Clinic of Barcelona, Barcelona, Spain.,Biomedical Research Institute August Pi i Sunyer (IDIBAPS), Hospital Clínic of Barcelona, Barcelona, Spain
| | - Teresa Boget
- Clinical Institute of Neurosciences, Hospital Clinic of Barcelona, Barcelona, Spain.,Epilepsy Unit, Hospital Clinic of Barcelona, Barcelona, Spain.,Biomedical Research Institute August Pi i Sunyer (IDIBAPS), Hospital Clínic of Barcelona, Barcelona, Spain
| | - Xavier Setoain
- Clinical Institute of Neurosciences, Hospital Clinic of Barcelona, Barcelona, Spain.,Epilepsy Unit, Hospital Clinic of Barcelona, Barcelona, Spain.,Biomedical Research Institute August Pi i Sunyer (IDIBAPS), Hospital Clínic of Barcelona, Barcelona, Spain
| | - Manuel Valdes
- Clinical Institute of Neurosciences, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Luís Pintor
- Clinical Institute of Neurosciences, Hospital Clinic of Barcelona, Barcelona, Spain.,Epilepsy Unit, Hospital Clinic of Barcelona, Barcelona, Spain.,Biomedical Research Institute August Pi i Sunyer (IDIBAPS), Hospital Clínic of Barcelona, Barcelona, Spain
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Zhu XC, Wang HF, Jiang T, Lu H, Tan MS, Tan CC, Tan L, Tan L, Yu JT. Effect of CR1 Genetic Variants on Cerebrospinal Fluid and Neuroimaging Biomarkers in Healthy, Mild Cognitive Impairment and Alzheimer's Disease Cohorts. Mol Neurobiol 2016; 54:551-562. [DOI: 10.1007/s12035-015-9638-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Accepted: 12/15/2015] [Indexed: 12/20/2022]
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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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Ronsoni MF, Remor AP, Lopes MW, Hohl A, Troncoso IHZ, Leal RB, Boos GL, Kondageski C, Nunes JC, Linhares MN, Lin K, Latini AS, Walz R. Mitochondrial Respiration Chain Enzymatic Activities in the Human Brain: Methodological Implications for Tissue Sampling and Storage. Neurochem Res 2015; 41:880-91. [PMID: 26586405 DOI: 10.1007/s11064-015-1769-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2015] [Revised: 10/12/2015] [Accepted: 11/11/2015] [Indexed: 12/25/2022]
Abstract
Mitochondrial respiratory chain complexes enzymatic (MRCCE) activities were successfully evaluated in frozen brain samples. Epilepsy surgery offers an ethical opportunity to study human brain tissue surgically removed to treat drug resistant epilepsies. Epilepsy surgeries are done with hemodynamic and laboratory parameters to maintain physiology, but there are no studies analyzing the association among these parameters and MRCCE activities in the human brain tissue. We determined the intra-operative parameters independently associated with MRCCE activities in middle temporal neocortex (Cx), amygdala (AMY) and head of hippocampus (HIP) samples of patients (n = 23) who underwent temporal lobectomy using multiple linear regressions. MRCCE activities in Cx, AMY and HIP are differentially associated to trans-operative mean arterial blood pressure, O2 saturation, hemoglobin, and anesthesia duration to time of tissue sampling. The time-course between the last seizure occurrence and tissue sampling as well as the sample storage to biochemical assessments were also associated with enzyme activities. Linear regression models including these variables explain 13-17 % of MRCCE activities and show a moderate to strong effect (r = 0.37-0.82). Intraoperative hemodynamic and laboratory parameters as well as the time from last seizure to tissue sampling and storage time are associated with MRCCE activities in human samples from the Cx, AMYG and HIP. Careful control of these parameters is required to minimize confounding biases in studies using human brain samples collected from elective neurosurgery.
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Affiliation(s)
- Marcelo Fernando Ronsoni
- Centro de Neurociências Aplicadas, Hospital Universitário (HU), Universidade Federal de Santa Catarina (UFSC), Florianópolis, SC, Brazil
| | - Aline Pertile Remor
- Laboratório de Bioenergética e Estresse Oxidativo, Departamento de Bioquímica, Universidade Federal de Santa Catarina (UFSC), Florianópolis, SC, Brazil
| | - Mark William Lopes
- Laboratório de Transdução de Sinal no Sistema Nervoso Central, Departamento de Bioquímica, Universidade Federal de Santa Catarina (UFSC), Florianópolis, SC, Brazil
| | - Alexandre Hohl
- Centro de Neurociências Aplicadas, Hospital Universitário (HU), Universidade Federal de Santa Catarina (UFSC), Florianópolis, SC, Brazil
| | - Iris H Z Troncoso
- Centro de Neurociências Aplicadas, Hospital Universitário (HU), Universidade Federal de Santa Catarina (UFSC), Florianópolis, SC, Brazil
| | - Rodrigo Bainy Leal
- Centro de Neurociências Aplicadas, Hospital Universitário (HU), Universidade Federal de Santa Catarina (UFSC), Florianópolis, SC, Brazil.,Laboratório de Transdução de Sinal no Sistema Nervoso Central, Departamento de Bioquímica, Universidade Federal de Santa Catarina (UFSC), Florianópolis, SC, Brazil
| | - Gustavo Luchi Boos
- Centro de Ensino e Treinamento Integrado de Anestesiologia, Hospital Governador Celso Ramos (HGCR), Florianópolis, SC, Brazil
| | - Charles Kondageski
- Centro de Neurociências Aplicadas, Hospital Universitário (HU), Universidade Federal de Santa Catarina (UFSC), Florianópolis, SC, Brazil.,Divisão de Neurocirurgia, Departamento de Cirurgia, Hospital Universitário (HU), Universidade Federal de Santa Catarina (UFSC), Florianópolis, SC, Brazil
| | - Jean Costa Nunes
- Centro de Neurociências Aplicadas, Hospital Universitário (HU), Universidade Federal de Santa Catarina (UFSC), Florianópolis, SC, Brazil.,Laboratório de Neuropatologia, Serviço de Patologia, Hospital Universitário (HU), Universidade Federal de Santa Catarina (UFSC), Florianópolis, SC, Brazil
| | - Marcelo Neves Linhares
- Centro de Neurociências Aplicadas, Hospital Universitário (HU), Universidade Federal de Santa Catarina (UFSC), Florianópolis, SC, Brazil.,Serviço de Cirurgia de Epilepsia, Hospital Governador Celso Ramos (HGCR), Florianópolis, SC, Brazil
| | - Kátia Lin
- Centro de Neurociências Aplicadas, Hospital Universitário (HU), Universidade Federal de Santa Catarina (UFSC), Florianópolis, SC, Brazil.,Serviço de Neurologia, Departamento de Clínica Médica, Hospital Universitário, 3 andar, Universidade Federal de Santa Catarina (UFSC), Florianópolis, SC, 88.040-970, Brazil
| | - Alexandra Susana Latini
- Centro de Neurociências Aplicadas, Hospital Universitário (HU), Universidade Federal de Santa Catarina (UFSC), Florianópolis, SC, Brazil.,Laboratório de Bioenergética e Estresse Oxidativo, Departamento de Bioquímica, Universidade Federal de Santa Catarina (UFSC), Florianópolis, SC, Brazil
| | - Roger Walz
- Centro de Neurociências Aplicadas, Hospital Universitário (HU), Universidade Federal de Santa Catarina (UFSC), Florianópolis, SC, Brazil. .,Serviço de Neurologia, Departamento de Clínica Médica, Hospital Universitário, 3 andar, Universidade Federal de Santa Catarina (UFSC), Florianópolis, SC, 88.040-970, Brazil.
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Boucher O, Dagenais E, Bouthillier A, Nguyen DK, Rouleau I. Different effects of anterior temporal lobectomy and selective amygdalohippocampectomy on verbal memory performance of patients with epilepsy. Epilepsy Behav 2015; 52:230-5. [PMID: 26469799 DOI: 10.1016/j.yebeh.2015.09.012] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Revised: 09/12/2015] [Accepted: 09/12/2015] [Indexed: 11/30/2022]
Abstract
The advantage of selective amygdalohippocampectomy (SAH) over anterior temporal lobectomy (ATL) for the treatment of temporal lobe epilepsy (TLE) remains controversial. Because ATL is more extensive and involves the lateral and medial parts of the temporal lobe, it may be predicted that its impact on memory is more important than SAH, which involves resection of medial temporal structures only. However, several studies do not support this assumption. Possible explanations include task-specific factors such as the extent of semantic and syntactic information to be memorized and failure to control for main confounders. We compared preoperative vs. postoperative memory performance in 13 patients with SAH with 26 patients who underwent ATL matched on side of surgery, IQ, age at seizure onset, and age at surgery. Memory function was assessed using the Logical Memory subtest from the Wechsler Memory Scales - 3rd edition (LM-WMS), the Rey Auditory Verbal Learning Test (RAVLT), the Digit Span subtest from the Wechsler Adult Intelligence Scale, and the Rey-Osterrieth Complex Figure Test. Repeated measures analyses of variance revealed opposite effects of SAH and ATL on the two verbal learning memory tests. On the immediate recall trial of the LM-WMS, performance deteriorated after ATL in comparison with that after SAH. By contrast, on the delayed recognition trial of the RAVLT, performance deteriorated after SAH compared with that after ATL. However, additional analyses revealed that the latter finding was only observed when surgery was conducted in the right hemisphere. No interaction effects were found on other memory outcomes. The results are congruent with the view that tasks involving rich semantic content and syntactical structure are more sensitive to the effects of lateral temporal cortex resection as compared with mesiotemporal resection. The findings highlight the importance of task selection in the assessment of memory in patients undergoing TLE surgery.
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Affiliation(s)
- Olivier Boucher
- Centre de recherche en neuropsychologie et cognition (CERNEC), Département de Psychologie, Université de Montréal, Canada
| | | | - Alain Bouthillier
- Centre hospitalier de l'Université de Montréal - Hôpital Notre-Dame, Canada
| | - Dang Khoa Nguyen
- Centre hospitalier de l'Université de Montréal - Hôpital Notre-Dame, Canada
| | - Isabelle Rouleau
- Département de Psychologie, Université du Québec à Montréal, Canada; Centre hospitalier de l'Université de Montréal - Hôpital Notre-Dame, Canada.
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36
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Hamasaki T, Hirai T, Yamada K, Kuratsu JI. An in vivo morphometry study on the standard transsylvian trajectory for mesial temporal lobe epilepsy surgery. SPRINGERPLUS 2015; 4:406. [PMID: 26266077 PMCID: PMC4529845 DOI: 10.1186/s40064-015-1198-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Accepted: 07/29/2015] [Indexed: 11/24/2022]
Abstract
A safe and appropriate surgical approach to the medial temporal structure is a prerequisite to perform surgeries for temporal lobe epilepsy. We used in vivo morphometry to identify the standard direction for entry into the inferior horn of the lateral ventricle via the Sylvian fissure: an important initial step in performing transsylvian selective amygdalohippocampectomy. 3D magnetic resonance images obtained from 28 patients without intra-parenchymal lesions were re-oriented to demonstrate all points in the Talairach space of the brain. The limen insulae and the midpoint between the hippocampal sulcus and the innominate sulcus on the coronal slice through the posterior edge of the amygdala were defined as the start and target points, respectively. We evaluated the direction of the vector between these two points and its validity in the brain of 12 patients with temporal lobe epilepsy. The direction of the mean approach vector was 52.4° posteriorly and 16.2° inferiorly. The mean approach vector on the axial plane showed the approximate parallelism with the sphenoid ridge in individual cases. The computer simulation revealed that our average approach vector correctly entered the inferior horn of the lateral ventricle in all temporal lobe epilepsy brains. In vivo morphometry may contribute to the further development of safe and minimally-invasive neurosurgical procedures.
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Affiliation(s)
- Tadashi Hamasaki
- Department of Neurosurgery, Kumamoto University Medical School, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556 Japan
| | - Toshinori Hirai
- Department of Neurosurgery, Kumamoto University Medical School, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556 Japan ; Department of Diagnostic Radiology, Kumamoto University Medical School, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556 Japan ; Department of Radiology, Faculty of Medicine, University of Miyazaki, 5200 Kiyotake, Miyazaki, 889-1692 Japan
| | - Kazumichi Yamada
- Department of Neurosurgery, Kumamoto University Medical School, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556 Japan
| | - Jun-Ichi Kuratsu
- Department of Neurosurgery, Kumamoto University Medical School, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556 Japan
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Uda T, Morino M, Minami N, Matsumoto T, Uchida T, Kamei T. Abnormal discharges from the temporal neocortex after selective amygdalohippocampectomy and seizure outcomes. J Clin Neurosci 2015; 22:1797-801. [PMID: 26256064 DOI: 10.1016/j.jocn.2015.03.063] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2015] [Revised: 03/17/2015] [Accepted: 03/18/2015] [Indexed: 11/28/2022]
Abstract
The present study examined the relationship between residual discharges from the temporal neocortex postoperatively and seizure outcomes, in mesial temporal lobe epilepsy (MTLE) patients with hippocampal sclerosis (HS) who were treated with selective amygdalohippocampectomy (SelAH). Abnormal discharges from the temporal neocortex are often observed and remain postoperatively. However, no recommendations have been made regarding whether additional procedures to eliminate these discharges should be performed for seizure relief. We retrospectively analyzed 28 patients with unilateral MTLE and HS, who underwent transsylvian SelAH. The mean follow-up period was 29 months (range: 16-49). In the pre- and postresection states, electrocorticography (ECoG) was recorded for the temporal base and lateral temporal cortex. The extent of resection was not influenced by the results of the preresection ECoG. Even if residual abnormal discharges were identified on the temporal neocortex, no additional procedures were undertaken to eliminate these abnormalities. The postresection spike counts were examined to determine the postresective alterations in spike count, and the frequency of residual spike count. The seizure outcomes were evaluated in all patients using the Engel classification. The postoperative seizure-free rate was 92.9%. No significant correlations were seen between a decreasing spike count and seizure outcomes (p=0.9259), or between the absence of residual spikes and seizure outcomes (p=1.000). Residual spikes at the temporal neocortex do not appear to influence seizure outcomes. Only mesial temporal structures should be removed, and additional procedures to eliminate residual spikes are not required.
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Affiliation(s)
- Takehiro Uda
- Department of Neurosurgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi, Abeno-ku, Osaka 545-8585, Japan; Department of Neurosurgery, Tokyo Metropolitan Neurological Hospital, Tokyo, Japan.
| | - Michiharu Morino
- Department of Neurosurgery, Tokyo Metropolitan Neurological Hospital, Tokyo, Japan
| | - Noriaki Minami
- Department of Neurosurgery, Tokyo Metropolitan Neurological Hospital, Tokyo, Japan
| | - Takahiro Matsumoto
- Department of Neurosurgery, Tokyo Metropolitan Neurological Hospital, Tokyo, Japan
| | - Tatsuya Uchida
- Department of Neurosurgery, Tokyo Metropolitan Neurological Hospital, Tokyo, Japan
| | - Takamasa Kamei
- Department of Neurosurgery, Tokyo Metropolitan Neurological Hospital, Tokyo, Japan
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38
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Na M, Liu Y, Shi C, Gao W, Ge H, Wang Y, Wang H, Long Y, Shen H, Shi C, Lin Z. Prognostic value of CA4/DG volumetry with 3T magnetic resonance imaging on postoperative outcome of epilepsy patients with dentate gyrus pathology. Epilepsy Res 2014; 108:1315-25. [DOI: 10.1016/j.eplepsyres.2014.06.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2013] [Revised: 05/21/2014] [Accepted: 06/13/2014] [Indexed: 02/04/2023]
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39
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Shah AK, Mittal S. Invasive electroencephalography monitoring: Indications and presurgical planning. Ann Indian Acad Neurol 2014; 17:S89-94. [PMID: 24791095 PMCID: PMC4001224 DOI: 10.4103/0972-2327.128668] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2013] [Revised: 12/01/2013] [Accepted: 12/01/2013] [Indexed: 11/24/2022] Open
Abstract
Electroencephalography (EEG) remains a “gold standard” for defining seizures; hence identification of epileptogenic zone for surgical treatment of epilepsy requires precise electrographic localization of the seizures. Routine scalp EEG recording is not sufficient in many instances, such as extratemporal lobe epilepsy or non-lesional temporal lobe epilepsy. In these individuals EEG recording from proximity of the seizure focus is necessary, which can be achieved by placing electrodes on the surface or in the substance of the brain. As this process requires invasive procedures (usually necessitating surgical intervention) EEG obtained via these electrodes is defined as invasive electroencephalography (iEEG). As only limited areas of the brain can be covered by these electrodes in an individual, precise targeting of the presumed seizure onset location is crucial. The presurgical planning includes where to place electrodes, which type of the electrodes to choose and planned duration of the intracranial recording. Though there are general principles that guide such endeavor, each center does it slightly differently depending upon the various technologies available to them and expertise and preferences of the epilepsy surgery team. Here we describe our approach to iEEG recording. We briefly describe the background, types of iEEG recording and rationale for each, various electrode types, and scenarios where iEEG might be useful. We also describe planning of iEEG recording once the need has been established as well as our decision making process of deciding about location of electrode placement, type of electrodes to use, length of recording, choice of arrays, mapping of eloquent cortex and finally surgical planning and decisions.
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Affiliation(s)
- Aashit K Shah
- Department of Neurology, Detroit, Michigan, USA ; Department of Neurosurgery, Wayne State University, Detroit, Michigan, USA
| | - Sandeep Mittal
- Department of Neurosurgery, Wayne State University, Detroit, Michigan, USA ; Detroit Medical Center, Detroit, Michigan, USA ; Karmanos Cancer Institute, Detroit, Michigan, USA
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40
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Clinico-pathological factors influencing surgical outcome in drug resistant epilepsy secondary to mesial temporal sclerosis. J Neurol Sci 2014; 340:183-90. [DOI: 10.1016/j.jns.2014.03.026] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2013] [Revised: 03/11/2014] [Accepted: 03/12/2014] [Indexed: 11/20/2022]
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41
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Martens T, Merkel M, Holst B, Brückner K, Lindenau M, Stodieck S, Fiehler J, Westphal M, Heese O. Vascular events after transsylvian selective amygdalohippocampectomy and impact on epilepsy outcome. Epilepsia 2014; 55:763-769. [DOI: 10.1111/epi.12556] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/07/2014] [Indexed: 11/30/2022]
Affiliation(s)
- Tobias Martens
- Department of Neurological Surgery; University Medical Center Hamburg-Eppendorf; Hamburg Germany
| | - Matthias Merkel
- Department of Neurology and Epileptology; Epilepsy Center Hamburg-Alsterdorf; Hamburg Germany
| | - Brigitte Holst
- Department of Neuroradiology; University Medical Center Hamburg-Eppendorf; Hamburg Germany
| | - Katja Brückner
- Department of Neurology and Epileptology; Epilepsy Center Hamburg-Alsterdorf; Hamburg Germany
| | - Matthias Lindenau
- Department of Neurology and Epileptology; Epilepsy Center Hamburg-Alsterdorf; Hamburg Germany
| | - Stefan Stodieck
- Department of Neurology and Epileptology; Epilepsy Center Hamburg-Alsterdorf; Hamburg Germany
| | - Jens Fiehler
- Department of Neuroradiology; University Medical Center Hamburg-Eppendorf; Hamburg Germany
| | - Manfred Westphal
- Department of Neurological Surgery; University Medical Center Hamburg-Eppendorf; Hamburg Germany
| | - Oliver Heese
- Department of Neurological Surgery; University Medical Center Hamburg-Eppendorf; Hamburg Germany
- Department of Neurosurgery; HELIOS Medical Center Schwerin; Schwerin Germany
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Englot DJ, Chang EF. Rates and predictors of seizure freedom in resective epilepsy surgery: an update. Neurosurg Rev 2014; 37:389-404; discussion 404-5. [PMID: 24497269 DOI: 10.1007/s10143-014-0527-9] [Citation(s) in RCA: 116] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2013] [Revised: 10/26/2013] [Accepted: 10/27/2013] [Indexed: 12/26/2022]
Abstract
Epilepsy is a debilitating neurological disorder affecting approximately 1 % of the world's population. Drug-resistant focal epilepsies are potentially surgically remediable. Although epilepsy surgery is dramatically underutilized among medically refractory patients, there is an expanding collection of evidence supporting its efficacy which may soon compel a paradigm shift. Of note is that a recent randomized controlled trial demonstrated that early resection leads to considerably better seizure outcomes than continued medical therapy in patients with pharmacoresistant temporal lobe epilepsy. In the present review, we provide a timely update of seizure freedom rates and predictors in resective epilepsy surgery, organized by the distinct pathological entities most commonly observed. Class I evidence, meta-analyses, and individual observational case series are considered, including the experiences of both our institution and others. Overall, resective epilepsy surgery leads to seizure freedom in approximately two thirds of patients with intractable temporal lobe epilepsy and about one half of individuals with focal neocortical epilepsy, although only the former observation is supported by class I evidence. Two common modifiable predictors of postoperative seizure freedom are early operative intervention and, in the case of a discrete lesion, gross total resection. Evidence-based practice guidelines recommend that epilepsy patients who continue to have seizures after trialing two or more medication regimens should be referred to a comprehensive epilepsy center for multidisciplinary evaluation, including surgical consideration.
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Affiliation(s)
- Dario J Englot
- UCSF Comprehensive Epilepsy Center, University of California, San Francisco, CA, USA,
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