Posts Tagged ‘epilepsy surgery’
Ahead of Print: MRI-negative Extratemporal Epilepsy
Background: Surgery is an important therapeutic option in patients with medically refractory epilepsy. The combination of an extratemporal epileptic focus and non-lesional MRI was often believed to portend a poor outcome.
Objective: To investigate the outcome and analyze potential prognostic predictors in patients without lesions on MRI who underwent extratemporal resections.
Methods: Clinical, presurgical evaluation, invasive monitoring, and postoperative data of patients with high resolution MRI that was initially reported as non-lesional were reviewed. Patients were re-classified as MRI-positive if an MRI abnormality related to the epilepsy was revealed at the multidisciplinary pre-surgical patient management conference, or as MRI-negative if imaging remained normal or revealed incidental findings.
Free Editor Choice with CME: SEEG Methodology, Safety, and Accuracy
Background: Stereoelectroencephalography (SEEG) methodology, originally developed by Talairach and Bancaud, is progressively gaining popularity for the presurgical invasive evaluation of drug-resistant epilepsies.
Objective: To describe recent SEEG methodological implementations carried out in our center, to evaluate safety, and to analyze in vivo application accuracy in a consecutive series of 500 procedures with a total of 6496 implanted electrodes.
Methods: Four hundred nineteen procedures were performed with the traditional 2-step surgical workflow, which was modified for the subsequent 81 procedures. The new workflow entailed acquisition of brain 3-dimensional angiography and magnetic resonance imaging in frameless and markerless conditions, advanced multimodal planning, and robot-assisted implantation. Quantitative analysis for in vivo entry point and target point localization error was performed on a sub–data set of 118 procedures (1567 electrodes).
Ahead of Print: Anchoring Depth Electrodes for Bedside Removal
Background: Intracranial depth electrodes for epilepsy are easily dislodged during long-term monitoring unless adequately anchored, but a technique is not available that is both secure and allows for easy explantation without reopening the incision.
Objective: To describe a convenient and inexpensive method for anchoring depth electrodes that prevents migration and incidental pullout, while allowing for electrode removal at the bedside.
Methods: An easily breakable suture (e.g. monocryl) is tied around both the depth electrode and a heavy nylon suture and anchored to a hole at the edge of the burr hole; the tails of both are together tunneled percutaneously. The ‘break-away’ monocryl suture effectively anchors the electrode for as long as needed. At the completion of the intracranial EEG session, the two tails of the nylon suture are pulled to break their encompassing monocryl anchor suture, thus freeing the depth electrode for easy removal.
Ahead of Print: Cingulate Gyrus Epilepsy Surgery
Background: Epilepsy surgery involving the cingulate gyrus has been mostly presented as case reports, and larger series with long-term follow up are not published yet.
Objective: To report our experience with focal epilepsy arising from the cingulate gyrus and surrounding structures and its surgical treatment.
Methods: 22 patients (mean age 36, range 12-63) with a mean seizure history of 23 years (range 2-52) were retrospectively analyzed. We report pre-surgical diagnostics, surgical strategy, and post-operative follow up concerning functional morbidity and seizures (mean follow-up 86 months, range 25-174).
Ahead of Print: Characterization of the Supplementary Motor Area Syndromeand Seizure Outcome Following Medial Frontal Lobe Resections in Pediatric Epilepsy Surgery
Full article access for Neurosurgery subscribers at Neurosurgery-Online.com.
BACKGROUND: In adults, resection of the medial frontal lobe has been shown to result in Supplementary Motor Area (SMA)syndrome, a disorder characterized by transient motor impairment. Studies examining the development of SMA syndrome in children, however, are wanting.
OBJECTIVE: To characterize the development of SMAsyndrome and analyze seizure outcomesfollowing surgery in the medial frontal lobe for medically intractable epilepsy.
METHODS: Thirty-nine patients with medically intractable epilepsy who underwent surgery in the medial frontal lobewere retrospectively reviewed. The progression of neurological impairment and seizure outcome following surgery was recorded, and the extent of cortex resected was analyzed.
