Image-Guided Robotic Radiosurgery for the Treatment of Drug-Refractory Epilepsy

2020 ◽  
pp. 565-577
Author(s):  
Pantaleo Romanelli ◽  
Alfredo Conti
Keyword(s):  
Refractory Epilepsy ◽  
Image Guided ◽  
Robotic Radiosurgery ◽  
Drug Refractory Epilepsy

Letter to the Editor. Is arterial spin labeling relevant in MRI-negative drug-refractory epilepsy?

2021 ◽  
Vol 28 (2) ◽  
pp. 245
Author(s):  
Raghu Samala ◽  
Ramesh Doddamani ◽  
Manjari Tripathi ◽  
P. Sarat Chandra
Keyword(s):  
Arterial Spin Labeling ◽  
Refractory Epilepsy ◽  
Spin Labeling ◽  
Letter To The Editor ◽  
Drug Refractory Epilepsy

scholarly journals Epilepsy in children with perinatal arterial ischemic stroke

2021 ◽  
Author(s):  
Fabienne Kühne ◽  
Alexander Jungbluth ◽  
Joanna Schneider ◽  
Christoph Bührer ◽  
Christine Prager ◽  
...  
Keyword(s):  
Cerebral Palsy ◽  
Ischemic Stroke ◽  
Neonatal Period ◽  
Refractory Epilepsy ◽  
Late Onset ◽  
Cognitive Outcome ◽  
Response To Treatment ◽  
Arterial Ischemic Stroke ◽  
Structural Epilepsy ◽  
Drug Refractory Epilepsy

Purpose: Perinatal ischemic stroke (PIS) is a frequent cause for perinatal brain structure defects resulting in epilepsy, cerebral palsy and disability. Since the severity of symptoms is variable, the aim of this study was to evaluate the outcome of children with PIS and seizures/epilepsy to aid parental counseling and therapy decisions. Material: We studied retrospectively patients with arterial PIS and structural epilepsy or seizures in the newborn treated at a single center in 2000-2019. Specifically, signs and symptoms of cerebral palsy (CP), developmental and motor delay, epilepsy and thrombophilia were assessed. Results: From the identified 69 individuals with arterial PIS, we only included the 50 patients (64% male) who had structural epilepsy at the time of investigation or previously in their medical history.The mean age of the included patients was 7.1 years (range 0.08-22) at last consultation. Infarct localisation was predominantly unilateral (86%), left sided (58%) and affecting the middle cerebral artery (94%). Genetic thrombophilia was identified in 52% of the patients examined with genetic testing. More than half of the individuals had CP (52%), and 38.5% had a cognitive outcome below average. First seizures occurred in the neonatal period in 58% of patients and developed into drug-refractory epilepsy in 24.1%. Children with late-onset of epilepsy were twice as likely to develop drug-refractory epilepsy (52.4%). Discussion: Our study shows that patients with PIS and seizures as common sequela often also develop CP. Children with later onset of epilepsy have a worse outcome. Patients with seizure onset in the neonatal period and reccuring seizures have a good response to treatment. Therefore, early diagnosis, follow-up examination and adequate therapy are important. Most children need intensive physiotherapy and speech therapy; however, participation in life is usually age-appropriate.

scholarly journals Neuronavigation as a Tool for Pre-Surgical Planning in Refractory Epilepsy Surgery

2019 ◽  
Vol 5 (2) ◽  
pp. 01-10
Author(s):  
Carlos Valencia Calderón
Keyword(s):  
Epilepsy Surgery ◽  
Surgical Planning ◽  
Refractory Epilepsy ◽  
Surgical Experience ◽  
Surgical Time ◽  
Cross Sectional ◽  
Guided Surgery ◽  
Image Guided ◽  
Eloquent Areas ◽  
High Incidence

Summary Epilepsy is one of the most frequent chronic neurological pathologies, with high incidence and prevalence worldwide. A third of these patients are resistant to treatment, which is known as refractory epilepsy. Most of these patients suffer epilepsy secondary to epileptogenic lesions, where the surgery is the only treatment that could cure epilepsy. The goal of epilepsy surgery is to remove the epileptogenic area with preservation of eloquent areas, and here the surgical experience, the neuroimaging technology and the availability of image-guided surgery systems known as a neuronavigator plays a key role. Objectives: To demonstrate the usefulness of neuronavigation in pre-surgical planning and in the surgery of refractory epilepsy. Method: A cross-sectional and analytical descriptive study was conducted based on 47 surgeries performed (12 resective, 32 palliative and 3 diagnostic) in patients with refractory epilepsy and mean age of 9.93 years (SD 4.1). In 27 patients (57.44%) the neuronavigator was used. In the group of patients operated with neuronavigation, the surgical time decreased by 47.17 minutes (p = 0.022), the amount of bleeding by 111.41 milliliters (p = 0.011) and the days of hospitalization by 6.68 days (p = 0.005), compared with the group operated without neuronavigation. Complications in the neuronavigation group were 29.63% compared to 65% in the group operated without neuronavigation (p = 0.034). Conclusions: In our series, the use of the neuronavigator in the planning and development of the surgery had a significant impact by reducing the amount of bleeding lost, the surgical time, the days of hospitalization, and the post-surgical complications.

Clinical spectrum of pediatric drug refractory epilepsy secondary to parieto-occipital gliosis

2021 ◽  
pp. 106804
Author(s):  
Somdattaa Ray ◽  
Raghavendra Kenchaiah ◽  
Ajay Asranna ◽  
Hansashree Padmanabha ◽  
Karthik Kulanthaivelu ◽  
...  
Keyword(s):  
Refractory Epilepsy ◽  
Clinical Spectrum ◽  
Pediatric Drug ◽  
Drug Refractory Epilepsy

Treatment planning for image-guided robotic radiosurgery

2005 ◽  
pp. 131-137
Author(s):  
Rhea Tombropoulos ◽  
Achim Schweikard ◽  
Jean-Claude Latombe ◽  
John R. Adler
Keyword(s):  
Treatment Planning ◽  
Image Guided ◽  
Robotic Radiosurgery

STN–PPTg circuits and REM sleep dysfunction in drug-refractory epilepsy

2015 ◽  
Vol 51 ◽  
pp. 277-280 ◽  
Author(s):  
Ai-Jun Xu ◽  
Tao-Tao Liu ◽  
Zhi-Gang He ◽  
Qing-Xiong Hong ◽  
Hong-Bing Xiang
Keyword(s):  
Rem Sleep ◽  
Refractory Epilepsy ◽  
Sleep Dysfunction ◽  
Drug Refractory Epilepsy

scholarly journals Image-Guided Robotic Radiosurgery for Trigeminal Neuralgia

Neurosurgery ◽  
2017 ◽  
Vol 83 (5) ◽  
pp. 1023-1030 ◽  
Author(s):  
Pantaleo Romanelli ◽  
Alfredo Conti ◽  
Livia Bianchi ◽  
Achille Bergantin ◽  
Anna Martinotti ◽  
...  
Keyword(s):  
Trigeminal Neuralgia ◽  
Trigeminal Nerve ◽  
Pain Control ◽  
Target Volume ◽  
Image Guided ◽  
Single Center Experience ◽  
Robotic Radiosurgery ◽  
Sensory Disturbances ◽  
Prescription Dose

Abstract BACKGROUND Frameless, non-isocentric irradiation of an extended segment of the trigeminal nerve introduces new concepts in stereotactic radiosurgery for medically resistant trigeminal neuralgia (TN). OBJECTIVE To report the results of the largest single-center experience about image-guided robotic radiosurgery for TN. METHODS A cohort of 138 patients treated with CyberKnife® (Accuray Incorporated, Sunnyvale, California) radiosurgery with a minimum follow-up of 36 mo were recruited. Pain relief, medications, sensory disturbances, rate and time of pain recurrence were prospectively analyzed. RESULTS Median follow-up was 52.4 mo; median dose 75 Gy; median target length 5.7-mm; median target volume 40 mm³; median prescription dose 60 Gy (80% isodose line). Actuarial pain control rate (Barrow Neurological Institute [BNI] class I-IIIa) at 6, 12, 24, and 36 mo were 93.5%, 85.8%, 79.7%, and 76%, respectively. Overall, 33 patients (24%) required a second treatment. Overall, 18.1% developed sensory disturbances after 16.4 ± 8.7 mo. One patient (0.7%) developed BNI grade IV dysfunction; 6 (4.3%) developed BNI grade III (somewhat bothersome) hypoesthesia after retreatment; BNI grade II (not bothersome) hypoesthesia was reported by 18 patients (11 after retreatment). Shorter nerve length (<6 mm vs 6 mm), smaller nerve volume (<30 mm3 vs >30 mm3), and lower prescription dose (<58 vs >58 Gy) were associated with treatment failure (P = .01, P = .02, P = .03, respectively). Re-irradiation independently predicted sensory disturbance (P < .001). CONCLUSION Targeting a 6-mm segment of the trigeminal nerve with a prescribed dose of 60 Gy appears safe and effective. Persistent pain control was achieved in most patients with acceptable risk of sensory complications, which were typically found after re-irradiation.

Development of a Streamlined, Non-invasive Robotic Radiosurgery Method for Treatment of Uveal Melanoma

2008 ◽  
Vol 7 (5) ◽  
pp. 369-373 ◽  
Author(s):  
Alexander Muacevic ◽  
Martin Nentwich ◽  
Berndt Wowra ◽  
Sibylle Staerk ◽  
Anselm Kampik ◽  
...  
Keyword(s):  
Uveal Melanoma ◽  
Treatment Plan ◽  
Three Dimensional ◽  
Ct Scanning ◽  
Single Session ◽  
Image Guided ◽  
Robotic Radiosurgery ◽  
Retrobulbar Anaesthesia ◽  
Treat All

To analyze the feasibility and safety of frameless, image-guided robotic radiosurgery against uveal melanoma, we developed a streamlined procedure that is completed within 3 hours under retrobulbar anesthesia without immobilization. Twenty patients (10 men and 10 women) with medium (3–5-mm prominence) and large (>5-mm prominence) unilateral uveal melanomas were treated with a frameless robotic radiosurgery system. Median age was 61 years (range 32–78 years). All patients underwent a single-session procedure beginning with retrobulbar anaesthesia, followed by computerized tomography (CT) scanning that was used in the generation of a treatment plan, and then the delivery of a radiosurgical tumor dose between 18 and 22 Gy to the 70% isodose line. Three-dimensional treatment planning was aimed at securing the optical lens and the optic disc as much as possible. Follow-up occurred at 3, 6, 12, and 18 months after the radiosurgery with clinical, ultrasound, and CT studies. We were able to treat all patients in the frameless setup within 3 hours. In five patients with lateral and dorsal tumors, the dose to the optic lens could be kept below 2 Gy. The clinical response was evaluated for the first seven patients treated with a follow-up of at least 6 months. No local recurrences occurred with any of the clinically evaluated patients for a mean 13-month follow-up (range 6–22 months). Maximum median apical tumor height according to standardized A-scan ultrasound evaluations decreased from 7.7 to 5.6 mm (p < 0.1). The median reflectivity increased from 41% to 70% (p < 0.01). None of the patients developed a secondary glaucoma during the short-term follow-up period. Frameless, single-session, image-guided robotic radiosurgery is a feasible, safe and comfortable treatment option for patients with uveal melanoma. Longer follow-up and analysis of a larger patient series is required for definitive clinical recommendations.

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