1
|
Hines K, Hughes LP, Franco D, Sharan AD, Wu C. Exoscope improves visualization and extent of hippocampal resection in temporal lobectomy. Acta Neurochir (Wien) 2023; 165:259-263. [PMID: 36346514 PMCID: PMC9641305 DOI: 10.1007/s00701-022-05405-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 10/23/2022] [Indexed: 11/11/2022]
Abstract
INTRODUCTION Anterior temporal lobectomy (ATL) is a safe and well-validated procedure in the treatment of temporal lobe epilepsy (TLE), but is a challenging technique to master and still confers a risk of morbidity and mortality due to the complex anatomy of the mesial temporal lobe structures. Automated robotic 3D exoscopes have been developed to address limitations traditionally associated with microscopic visualization, allowing for ergonomic, high-definition 3D visualization with hands-free control of the robot. Given the potential advantages of using such a system for visualization of complex anatomy seen during mesial structure resection in ATL, this group sought to investigate impact on the percentage of hippocampal resection in both exoscope and microscope guided procedures. METHODS We conducted a retrospective analysis of 20 consecutive patients undergoing standard ATL for treatment of medically refractory TLE at our institution. Using pre-operative and post-operative imaging, the coronal plane cuts in which either the head, body, or tail of the hippocampus appeared were counted. The number of cuts in which the hippocampus appeared were multiplied by slice thickness to estimate hippocampal length. RESULTS Mean percentage of hippocampal resection was 61.1 (SD 13.1) and 76.5 (SD 6.5) for microscope and exoscope visualization, respectively (p = 0.0037). CONCLUSION Use of exoscope for mesial resection during ATL has provided good visualization for those in the operating room and the potential for a safe increase in hippocampal resection in our series. Further investigation of its applications should be evaluated to see if it will improve outcomes.
Collapse
Affiliation(s)
- Kevin Hines
- Department of Neurological Surgery, Thomas Jefferson University, 909 Walnut St., 3rd Floor, PA, 19107, Philadelphia, USA.
| | - Liam P Hughes
- Department of Neurological Surgery, Thomas Jefferson University, 909 Walnut St., 3rd Floor, PA, 19107, Philadelphia, USA
| | - Daniel Franco
- Department of Neurological Surgery, Thomas Jefferson University, 909 Walnut St., 3rd Floor, PA, 19107, Philadelphia, USA
| | - Ashwini D Sharan
- Department of Neurological Surgery, Thomas Jefferson University, 909 Walnut St., 3rd Floor, PA, 19107, Philadelphia, USA
| | - Chengyuan Wu
- Department of Neurological Surgery, Thomas Jefferson University, 909 Walnut St., 3rd Floor, PA, 19107, Philadelphia, USA
| |
Collapse
|
2
|
Patil AA, de Joya J. Minimally invasive surgical techniques in patients with intractable epilepsy with CT-guided stereotactic cryoablation as a superior alternative: a systematic review. EGYPTIAN JOURNAL OF NEUROSURGERY 2022. [DOI: 10.1186/s41984-022-00174-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Abstract
Background
Stereotactic cryoablation is a minimally invasive surgical technique that has been used to treat disorders of the brain in the past; however, in current practice, it is primarily used for the treatment of liver, kidney, lung, prostate, and breast neoplasms. In this paper, currently used surgical methods to treat medically refractory seizure disorder are reviewed, and a case is made for the use of stereotactic cryoablation.
Main body
Anterior temporal lobectomy is the gold standard for temporal. There are also several variations of this procedure. Since this is a resective surgery, it can result in neurological defects. To obviate this problem, minimally invasive surgical techniques such as radio frequency ablation and laser interstitial thermal therapy are currently being used for intracranial targets. Cryoablation offers certain advantages over thermal ablations. Cryoablation studies in brain, renal, breast, and other neoplasms have shown that cryoablation has superior abilities to monitor the ablation zone in real time via computerized tomography imaging and also has the capability to create lesions of both smaller and larger sizes. This allows for safer and more effective tumor destruction.
Short conclusion
Based on the review, the authors conclude that further investigation of the use of stereotactic cryoablation in patients with medically intractable epilepsy is needed.
Collapse
|
3
|
Joudi Mashhad M, Harati H, Parooie F, Salarzaei M. Epilepsy surgery for refractory seizures: a systematic review and meta-analysis in different complications. THE EGYPTIAN JOURNAL OF NEUROLOGY, PSYCHIATRY AND NEUROSURGERY 2020. [DOI: 10.1186/s41983-020-00168-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Nearly one-third of epilepsy patients are refractory/resistant to medical treatment. Developments made in surgical techniques have significantly increased the effectiveness and safety of these techniques, as such techniques have been demonstrated to improve seizure control/freedom outcomes.
Objectives
The aim of this systematic review and meta-analysis was to evaluate the complications of epilepsy surgery.
Patient and methods
The searches were conducted by three independent researchers to find the relevant studies published from January 1, 2009, until the end of January 6, 2019. For English published statistical studies, all studies conducted on epileptic patients who have undergone epilepsy surgery were included.
Statistical analysis
A meta-analysis was conducted in the STATA14 statistical software.
Results
A total of 6735 patients with epilepsy who had undergone the epilepsy surgery were studied. The overall prevalence of complications was 5%. The prevalence of major and minor complications was 5.4% and 3.2% respectively. The prevalence of complications related to the temporal epilepsy surgery and the extra-temporal epilepsy surgery based on 3 studies was 7.9% and 8.2 % respectively. The frequency of neurological and surgical complications after epilepsy surgery was 4.4% and 4.1% respectively.
Conclusion
The overall rate of complications caused by epilepsy surgery was reasonably low (5%), implying that epilepsy surgery especially temporal lobe resection can be safe preferably when performed by an experienced surgeon.
Collapse
|
4
|
Milovanović JR, Janković SM, Milovanović D, Ružić Zečević D, Folić M, Kostić M, Ranković G, Stefanović S. Contemporary surgical management of drug-resistant focal epilepsy. Expert Rev Neurother 2019; 20:23-40. [DOI: 10.1080/14737175.2020.1676733] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
| | | | - Dragan Milovanović
- Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
| | | | - Marko Folić
- Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
| | - Marina Kostić
- Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
| | - Goran Ranković
- Medical Faculty, University of Pristina, Kosovska Mitrovica, Serbia
| | - Srđan Stefanović
- Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
| |
Collapse
|
5
|
Yang H, Shan W, Zhu F, Yu T, Fan J, Guo A, Li F, Yang X, Wang Q. C-Fos mapping and EEG characteristics of multiple mice brain regions in pentylenetetrazol-induced seizure mice model. Neurol Res 2019; 41:749-761. [PMID: 31038018 DOI: 10.1080/01616412.2019.1610839] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Purpose: To confirm different local brain activities characterized in pentylenetetrazol (PTZ)-induced seizure model. Methods: we induced seizure response by a single dose of PTZ injection (45 mg/kg, i.p.). Local activity was recorded in different brain regions by EEG in time and c-Fos staining at different time points (0.5 h, 1 h, 2 h, 4 h) after PTZ treatment. Results: EEG recordings showed distinctive features of activation in different brain areas. With the aggravation of behavioral manifestations of seizures, the frequency and amplitude of the discharges on EEG were increasing gradually. The epileptic response on EEG immediately ended after reaching the maximum stage of seizures, followed by a short period of suppression. The labeling of c-Fos was enhanced in the medial prefrontal cortex, the piriform cortex, the amygdala, hippocampal CA1, CA3 and dentate gyrus, but inapparent in the striatum. The most potent changes in c-Fos were observed in cortex, amygdala nuclei, and dentate gyrus. EEG and c-Fos immunolabeling in neuronal activation showed discrepancies in the striatum. For each brain region, the maximum c-Fos labeling was observed at 2 h after injection and diminished at 4 h. The level of c-Fos immunoreactivity was even lower than the control group, which was accompanied by increased labeling of parvalbumin neurons (PVNs). Conclusions: These findings validated PTZ-induced seizure as a seizure model with a specific spatial-temporal profile. Neuronal activity was enhanced and then subsequently inhibited during seizure evolution. Abbreviations: AEDs: anti-epileptic drugs; AF: Alexa Fluor; CA1: Cornu Ammonis area 1; CA3: Cornu Ammonis area 3; DAB, 3: 3P-diaminobenzidine; DAPI: 4',6-diamidino-2-phenylindole; DG: dentate gyrus; EEG: electroencephalogram; GABA: gamma-aminobutyric acid; IEG: immediate early gene; mPFC: medial prefrontal cortex; NAc: nucleus accumbens; PB: phosphate buffer; PBS: phosphate buffered saline; PBST: phosphate buffered saline with Tween; PFA, paraformaldehyde; PTZ: pentylenetetrazol; PVN: parvalbumin neuron; ROI: regions of interest; SE: status epilepticus.
Collapse
Affiliation(s)
- Huajun Yang
- a Department of Neurology, Beijing Tiantan Hospital, Capital Medical University , Beijing , P.R.China.,b Beijing Institute for Brain Disorders , Beijing , P.R.China.,c National Center for Clinical Medicine of Neurological Diseases , Beijing , P.R.China
| | - Wei Shan
- a Department of Neurology, Beijing Tiantan Hospital, Capital Medical University , Beijing , P.R.China.,b Beijing Institute for Brain Disorders , Beijing , P.R.China.,c National Center for Clinical Medicine of Neurological Diseases , Beijing , P.R.China
| | - Fei Zhu
- a Department of Neurology, Beijing Tiantan Hospital, Capital Medical University , Beijing , P.R.China.,b Beijing Institute for Brain Disorders , Beijing , P.R.China.,c National Center for Clinical Medicine of Neurological Diseases , Beijing , P.R.China
| | - Tingting Yu
- a Department of Neurology, Beijing Tiantan Hospital, Capital Medical University , Beijing , P.R.China.,b Beijing Institute for Brain Disorders , Beijing , P.R.China.,c National Center for Clinical Medicine of Neurological Diseases , Beijing , P.R.China
| | - Jingjing Fan
- a Department of Neurology, Beijing Tiantan Hospital, Capital Medical University , Beijing , P.R.China.,b Beijing Institute for Brain Disorders , Beijing , P.R.China.,c National Center for Clinical Medicine of Neurological Diseases , Beijing , P.R.China
| | - Anchen Guo
- b Beijing Institute for Brain Disorders , Beijing , P.R.China.,c National Center for Clinical Medicine of Neurological Diseases , Beijing , P.R.China
| | - Fei Li
- d Beijing institute of pharmacology and toxicology , Beijing , P.R.China
| | - Xiaofeng Yang
- b Beijing Institute for Brain Disorders , Beijing , P.R.China
| | - Qun Wang
- a Department of Neurology, Beijing Tiantan Hospital, Capital Medical University , Beijing , P.R.China.,b Beijing Institute for Brain Disorders , Beijing , P.R.China.,c National Center for Clinical Medicine of Neurological Diseases , Beijing , P.R.China
| |
Collapse
|