Schizencephaly and intractable epilepsy: an FDG-PET study

Background: To assess the role of 2-deoxy-2(18F)-fluoro-D-glucose positron emission tomography (FDG-PET) scans in the comprehensive evaluation and surgical decision-making in patients with schizencephaly. Methods: We evaluated 11 patients (8M) with schizencephaly (mean follow-up: 4.5 years), including detailed clinical, MRI, FDG-PET, EEG, surgical and neuropathology data. Results: Eight patients had unilateral and three had bilateral clefts on MRI. Mean age at seizure onset was 20 months, with seizure being frequent in 10 and rare in one. Multiple seizure types were noted, with complex partial seizures being the most common (n=8) followed by infantile spasms (n=6). FDG-PET showed larger area of involvement than MRI in all the patients which corresponded better with the electrophysiological changes. Five patients (with unilateral disease on MRI) underwent epilepsy surgery (4 hemispherectomy and 1 multilobar resection). Two patients with focal defect on MRI underwent hemispherectomy due to larger area of abnormality revealed by FDG-PET. One patient was excluded from the surgery due to bilateral abnormalities on FDG PET. Six patients (4 with surgery) were seizure-free at last follow-up (average seizure-free duration: 70 months). One patient who underwent hemispherectomy due to apparently unilateral disease on both video-EEG and MRI but having bilateral abnormality on PET continued to have seizures. ACTH treatment had only a brief (1 month to 1 year) or no response in the six infantile spasms patients. Conclusions: FDG-PET typically shows a much larger area of involvement than MRI thus supplementing MRI in defining the full extent of malformation and assessing the functional integrity of the contralateral hemisphere. FDG-PET may prove to be a useful tool to aid in surgical decision-making and predicting surgical outcome, as patients with contralateral abnormality on FDG-PET may have poor surgical outcomes. When the malformation is unilateral with an intact contralateral hemisphere, surgery (usually hemispherectomy) may be curative of the epilepsy.

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The surgical outcome of decompression alone versus decompression with limited fusion for degenerative lumbar scoliosis

Journal of Neurosurgery Spine ◽

10.3171/2018.1.spine17879 ◽

2018 ◽

Vol 29 (3) ◽

pp. 259-264 ◽

Cited By ~ 6

Author(s):

Kenji Masuda ◽

Takayuki Higashi ◽

Katsutaka Yamada ◽

Tatsuhiro Sekiya ◽

Tomoyuki Saito

Keyword(s):

Decision Making ◽

Cobb Angle ◽

Japanese Orthopaedic Association ◽

Spinal Instability ◽

Degenerative Lumbar Scoliosis ◽

Surgical Decision ◽

Lumbar Scoliosis ◽

Radiological Parameters ◽

Surgical Decision Making

OBJECTIVEThe aim of this study was to assess the usefulness of radiological parameters for surgical decision-making in patients with degenerative lumbar scoliosis (DLS) by comparing the clinical and radiological results after decompression or decompression and fusion surgery.METHODSThe authors prospectively planned surgical treatment for 298 patients with degenerative lumbar disease between September 2005 and March 2013. The surgical method used at their institution to address intervertebral instability is precisely defined based on radiological parameters. Among 64 patients with a Cobb angle ranging from 10° to 25°, 57 patients who underwent follow-up for more than 2 years postoperatively were evaluated. These patients were divided into 2 groups: those in the decompression group underwent decompression alone (n = 25), and those in the fusion group underwent decompression and short segmental fusion (n = 32). Surgical outcomes were reviewed, including preoperative and postoperative Cobb angles, lumbar lordosis based on radiological parameters, and Japanese Orthopaedic Association (JOA) scores.RESULTSThe JOA scores of the decompression group and fusion group improved from 5.9 ± 1.6 to 10.0 ± 2.8 and from 7.2 ± 2.0 to 11.3 ± 2.8, respectively, which was not significantly different between the groups. At the final follow-up, the postoperative Cobb angle in the decompression group changed from 14° ± 2.9° to 14.3° ± 6.4° and remained stable, while the Cobb angle in the fusion group decreased from 14.8° ± 4.0° to 10.0° ± 8.5° after surgery.CONCLUSIONSThe patients in both groups demonstrated improved JOA scores and preserved Cobb angles after surgery. The improvement in JOA scores and preservation of Cobb angles in both groups show that the evaluation of spinal instability using radiological parameters is appropriate for surgical decision-making.

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Role of sciatic nerve stiffness in surgical decision making and follow up in patients with deep gluteal syndrome

10.1101/390120 ◽

2018 ◽

Cited By ~ 1

Author(s):

Sava Stajic ◽

Aleksandar Vojvodic ◽

Luis Perez Carro ◽

Jelena Mihailovic ◽

Milos Gasic ◽

...

Keyword(s):

Decision Making ◽

Sciatic Nerve ◽

Knee Flexion ◽

Acoustic Radiation Force Impulse ◽

Stiffness Ratio ◽

Surgical Decision ◽

Strain Elastography ◽

Deep Gluteal Syndrome ◽

Surgical Decision Making

AbstractThe study shows the relevance of sciatic nerve stiffness assessed by strain elastography using ARFI (Acoustic Radiation Force Impulse) for surgical decision making and the follow up of patients with deep gluteal syndrome (DGS). The research focuses on nerve stiffness associated with knee movements in order to determine the degree of nerve entrapment. Neurological examination, MRI of pelvis and electromyography (EMG) were performed as well. The sciatic nerve was scanned by ARFI (strain) elastography during knee movements in patients with DGS (143). In 54 patients surgical treatment was indicated, while 24 of them underwent surgery. The results were based on tissue response to ARFI by color elastogram and stiffness ratio. Diameters of the sciatic nerve in patients with DGS during knee flexion were statistically significantly lower than during extension movement (p<0.01). In patients with DGS (in ones without indication and the ones scheduled for surgery) sciatic nerve stiffness ratio was significantly increased (p<0.01) during knee flexion. Patients scheduled for surgery confirmed increased sciatic nerve stiffness during knee movements, compared with those without indications for surgery (p<0.05). Sciatic nerve recovery after surgery by diameter and stiffness ratio was marked (r=0.881). The correlation between MRI and EMG findings and ARFI nerve stiffness values in patients scheduled for surgery was high (r=0.963). The overall specificity of method was 93.5%, sensitivity was 88.9% with accuracy of 90.6%. ARFI elastography (by strain) is a diagnostic procedure based on nerve stiffness assessment and a useful tool in decision making for surgery and the follow up.

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Routinely Performed Serial Follow-Up Imaging in Asymptomatic Patients With Multiple Cerebral Cavernous Malformations Has No Influence on Surgical Decision Making

Frontiers in Neurology ◽

10.3389/fneur.2018.00848 ◽

2018 ◽

Vol 9 ◽

Cited By ~ 4

Author(s):

Julia Velz ◽

Martin Nikolaus Stienen ◽

Marian Christoph Neidert ◽

Yang Yang ◽

Luca Regli ◽

...

Keyword(s):

Decision Making ◽

Cerebral Cavernous Malformations ◽

Cavernous Malformations ◽

Surgical Decision ◽

Asymptomatic Patients ◽

Surgical Decision Making

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Surgical decision making in temporal lobe epilepsy: A comparison of [18F]FDG-PET, MRI, and EEG

Epilepsy & Behavior ◽

10.1016/j.yebeh.2011.06.022 ◽

2011 ◽

Vol 22 (2) ◽

pp. 293-297 ◽

Cited By ~ 24

Author(s):

Aaron F. Struck ◽

Lance T. Hall ◽

John M. Floberg ◽

Scott B. Perlman ◽

Douglas A. Dulli

Keyword(s):

Decision Making ◽

Temporal Lobe Epilepsy ◽

Temporal Lobe ◽

Fdg Pet ◽

Surgical Decision ◽

18F Fdg ◽

Surgical Decision Making

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Does F-18 FDG-PET substantially alter the surgical decision-making in drug-resistant partial epilepsy?

Epilepsy & Behavior ◽

10.1016/j.yebeh.2015.07.004 ◽

2015 ◽

Vol 51 ◽

pp. 133-139 ◽

Cited By ~ 5

Author(s):

Ramshekhar N. Menon ◽

Ashalatha Radhakrishnan ◽

Ramanathapuram Parameswaran ◽

Bejoy Thomas ◽

Chandrashekharan Kesavadas ◽

...

Keyword(s):

Decision Making ◽

Fdg Pet ◽

Partial Epilepsy ◽

Drug Resistant ◽

Surgical Decision ◽

Surgical Decision Making

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18F-FDG PET-CT after Neoadjuvant Chemoradiotherapy in Esophageal Cancer Patients to Optimize Surgical Decision Making

PLoS ONE ◽

10.1371/journal.pone.0133690 ◽

2015 ◽

Vol 10 (11) ◽

pp. e0133690 ◽

Cited By ~ 12

Author(s):

Maarten C. J. Anderegg ◽

Elisabeth J. de Groof ◽

Suzanne S. Gisbertz ◽

Roel J. Bennink ◽

Sjoerd M. Lagarde ◽

...

Keyword(s):

Decision Making ◽

Esophageal Cancer ◽

Cancer Patients ◽

Fdg Pet ◽

Neoadjuvant Chemoradiotherapy ◽

Surgical Decision ◽

Pet Ct ◽

18F Fdg ◽

Fdg Pet Ct ◽

Surgical Decision Making

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18f-fdg Pet/mr in Focal Epilepsy: a New Step for Improving the Detection of Epileptogenic Lesions

10.21203/rs.3.rs-254510/v1 ◽

2021 ◽

Author(s):

Anthime FLAUS ◽

Charles MELLERIO ◽

Sebastian RODRIGO ◽

Vincent BRULON ◽

Vincent LEBON ◽

...

Keyword(s):

Decision Making ◽

Fdg Pet ◽

Visual Analysis ◽

Focal Epilepsy ◽

Drug Resistant ◽

Surgical Decision ◽

Promising Tool ◽

Drug Resistant Epilepsy ◽

Additional Value ◽

Surgical Decision Making

Abstract Purpose: Hybrid PET/MR is a promising tool in focal drug-resistant epilepsy, however the additional value for the detection of epileptogenic lesions and surgical decision-making remains to be established.Methods: We retrospectively compared 18F-FDG PET/MR images with those obtained by a previous 18F-FDG PET co-registered with MRI (PET+MR) in 25 consecutive patients (16 females, 13-60 year-old) investigated for focal drug-resistant epilepsy. Visual analysis was performed by two readers blinded from imaging modalities, asked to assess the technical characteristics (co-registration, quality of images), confidence in results, location of PET abnormalities and presence of a structural lesion on MRI. The clinical impact on surgical strategy and outcome was assessed independently.Results: The location of epilepsy was temporal in 9 patients and extra-temporal in 16 others. MRI was initially considered negative in 21 of them. PET alone demonstrated metabolic abnormalities in 19 cases (76%), and the co-registration with MRI allowed the detection of 4 additional structural lesions. PET/MR was considered better performing than PET+MR in 56% of patients. The increase in sensitivity was 13% and new structural lesions (mainly focal cortical dysplasias) were detected in 6 patients (24%). Change of surgical decision-making was substantial for 40% of patients, consisting in avoiding invasive monitoring in 6 patients and modifying the planning in 4 others. Seizure-free outcome was obtained in 13/14 patients who underwent a cortical resection.Conclusion: Hybrid PET/MR improves the detection of epileptogenic lesions, allowing to optimize the presurgical work-up and to increase the proportion of successful surgery even in the more complex cases.

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Management of idiopathic pediatric syringohydromyelia

Journal of Neurosurgery Pediatrics ◽

10.3171/2015.3.peds14433 ◽

2015 ◽

Vol 16 (4) ◽

pp. 452-457 ◽

Cited By ~ 8

Author(s):

Analiz Rodriguez ◽

Elizabeth N. Kuhn ◽

Aravind Somasundaram ◽

Daniel E. Couture

Keyword(s):

Decision Making ◽

Clinical Course ◽

Inclusion Criteria ◽

Single Institution ◽

Surgical Decision ◽

Spinal Imaging ◽

Spinal Mri ◽

Surgical Decision Making ◽

Median Maximum

OBJECT Syringohydromyelia is frequently identified on spinal imaging. The literature provides little guidance to decision making regarding the need for follow-up or treatment. The purpose of this study was to review the authors' experience in managing pediatric syringohydromyelia of unknown cause. METHODS A single-institution retrospective review of all cases involving pediatric patients who underwent spinal MRI from 2002 to 2012 was conducted. Patients with idiopathic syringohydromyelia (IS) were identified and categorized into 2 subgroups: uncomplicated idiopathic syrinx and IS associated with scoliosis. Clinical and radiological course were analyzed. RESULTS Ninety-eight patients (50 female, 48 male) met the inclusion criteria. Median age at diagnosis of syrinx was 11.9 years. Median maximum syrinx size was 2 mm (range 0.5–17 mm) and spanned 5 vertebral levels (range 1–20 vertebral levels). Thirty-seven patients had scoliosis. The most common presenting complaint was back pain (26%). Clinical follow-up was available for 78 patients (80%), with a median follow-up of 20.5 months (range 1–143 months). A neurological deficit existed at presentation in 36% of the patients; this was either stable or improved at last follow-up in 64% of cases. Radiological follow-up was available for 38 patients (39%), with a median duration of 13 months (range 2–83 months). There was no change in syrinx size in 76% of patients, while 16% had a decrease and 8% had an increase in syrinx size. Thirty-six patients had both clinical and radiological follow-up. There was concordance between clinical and radiological course in 14 patients (39%), with 11 patients (31%) showing no change and 3 patients (8%) showing clinical and radiological improvement. No patients had concurrent deterioration in clinical and radiological course. One patient with scoliosis and muscular dystrophy underwent direct surgical treatment of the syrinx and subsequently had a deteriorated clinical course and decreased syrinx size. CONCLUSIONS There remains a paucity of data regarding the management of pediatric IS. IS in association with scoliosis can complicate neurosurgical decision making. There was no concordance between radiological syrinx size increase and clinical deterioration in this cohort, indicating that surgical decision making should reflect clinical course as opposed to radiological course.

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