scholarly journals Localization of musicogenic epilepsy to Heschl’s gyrus and superior temporal plane: case report

2018 ◽  
Vol 129 (1) ◽  
pp. 157-164 ◽  
Author(s):  
Yasunori Nagahama ◽  
Christopher K. Kovach ◽  
Michael Ciliberto ◽  
Charuta Joshi ◽  
Ariane E. Rhone ◽  
...  
Keyword(s):  
Temporal Lobe ◽  
Electrode Placement ◽  
Seizure Focus ◽  
Depth Electrodes ◽  
Heschl’S Gyrus ◽  
Depth Electrode ◽  
Seizure Onset Zone ◽  
Temporal Structures ◽  
Heschl's Gyrus ◽  
Musicogenic Epilepsy

Musicogenic epilepsy (ME) is an extremely rare form of the disorder that is provoked by listening to or playing music, and it has been localized to the temporal lobe. The number of reported cases of ME in which intracranial electroencephalography (iEEG) has been used for seizure focus localization is extremely small, especially with coverage of the superior temporal plane (STP) and specifically, Heschl’s gyrus (HG). The authors describe the case of a 17-year-old boy with a history of medically intractable ME who underwent iEEG monitoring that involved significant frontotemporal coverage as well as coverage of the STP with an HG depth electrode anteriorly and a planum temporale depth electrode posteriorly. Five seizures occurred during the monitoring period, and a seizure onset zone was localized to HG and the STP. The patient subsequently underwent right temporal neocortical resection, involving the STP and including HG, with preservation of the mesial temporal structures. The patient remains seizure free 1 year postoperatively. To the authors’ knowledge, this is the first reported case of ME in which the seizure focus has been localized to HG and the STP with iEEG monitoring. The authors review the literature on iEEG findings in ME, explain their approach to HG depth electrode placement, and discuss the utility of STP depth electrodes in temporal lobe epilepsy.

Functional Connections Between Auditory Cortex on Heschl's Gyrus and on the Lateral Superior Temporal Gyrus in Humans

2003 ◽  
Vol 90 (6) ◽  
pp. 3750-3763 ◽  
Author(s):  
John F. Brugge ◽  
Igor O. Volkov ◽  
P. Charles Garell ◽  
Richard A. Reale ◽  
Matthew A. Howard
Keyword(s):  
Lateral Surface ◽  
Superior Temporal Gyrus ◽  
Constant Current ◽  
Functional Connections ◽  
Depth Electrodes ◽  
Heschl’S Gyrus ◽  
Heschl's Gyrus ◽  
Auditory Field ◽  
Stimulus Site ◽  
Stimulation Of

Functional connections between auditory fields on Heschl's gyrus (HG) and the acoustically responsive posterior lateral superior temporal gyrus (field PLST) were studied using electrical stimulation and recording methods in patients undergoing diagnosis and treatment of intractable epilepsy. Averaged auditory (click-train) evoked potentials were recorded from multicontact subdural recording arrays chronically implanted over the lateral surface of the superior temporal gyrus (STG) and from modified depth electrodes inserted into HG. Biphasic electrical pulses (bipolar, constant current, 0.2 ms) were delivered to HG sites while recording from the electrode array over acoustically responsive STG cortex. Stimulation of sites along the mediolateral extent of HG resulted in complex waveforms distributed over posterolateral STG. These areas overlapped each other and field PLST. For any given HG stimulus site, the morphology of the electrically evoked waveform varied across the STG map. A characteristic waveform was recorded at the site of maximal amplitude of response to stimulation of mesial HG [presumed primary auditory field (AI)]. Latency measurements suggest that the earliest evoked wave resulted from activation of connections within the cortex. Waveforms changed with changes in rate of electrical HG stimulation or with shifts in the HG stimulus site. Data suggest widespread convergence and divergence of input from HG to posterior STG. Evidence is presented for a reciprocal functional projection, from posterolateral STG to HG. Results indicate that in humans there is a processing stream from AI on mesial HG to an associational auditory field (PLST) on the lateral surface of the superior temporal gyrus.

scholarly journals Medically resistant pediatric insular-opercular/perisylvian epilepsy. Part 1: invasive monitoring using the parasagittal transinsular apex depth electrode

2016 ◽  
Vol 18 (5) ◽  
pp. 511-522 ◽  
Author(s):  
Alexander G. Weil ◽  
Aria Fallah ◽  
Evan C. Lewis ◽  
Sanjiv Bhatia
Keyword(s):  
Epilepsy Surgery ◽  
Electrode Placement ◽  
Epileptogenic Zone ◽  
Drug Resistant ◽  
Depth Electrodes ◽  
Depth Electrode ◽  
Age At Surgery ◽  
Feasible Alternative ◽  
The Mean ◽  
Drug Resistant Epilepsy

OBJECTIVE Insular lobe epilepsy (ILE) is an under-recognized cause of extratemporal epilepsy and explains some epilepsy surgery failures in children with drug-resistant epilepsy. The diagnosis of ILE usually requires invasive investigation with insular sampling; however, the location of the insula below the opercula and the dense middle cerebral artery vasculature renders its sampling challenging. Several techniques have been described, ranging from open direct placement of orthogonal subpial depth and strip electrodes through a craniotomy to frame-based stereotactic placement of orthogonal or oblique electrodes using stereo-electroencephalography principles. The authors describe an alternative method for sampling the insula, which involves placing insular depth electrodes along the long axis of the insula through the insular apex following dissection of the sylvian fissure in conjunction with subdural electrodes over the lateral hemispheric/opercular region. The authors report the feasibility, advantages, disadvantages, and role of this approach in investigating pediatric insular-opercular refractory epilepsy. METHODS The authors performed a retrospective analysis of all children (< 18 years old) who underwent invasive intracranial studies involving the insula between 2002 and 2015. RESULTS Eleven patients were included in the study (5 boys). The mean age at surgery was 7.6 years (range 0.5–16 years). All patients had drug-resistant epilepsy as defined by the International League Against Epilepsy and underwent comprehensive noninvasive epilepsy surgery workup. Intracranial monitoring was performed in all patients using 1 parasagittal insular electrode (1 patient had 2 electrodes) in addition to subdural grids and strips tailored to the suspected epileptogenic zone. In 10 patients, extraoperative monitoring was used; in 1 patient, intraoperative electrocorticography was used alone without extraoperative monitoring. The mean number of insular contacts was 6.8 (range 4–8), and the mean number of fronto-parieto-temporal hemispheric contacts was 61.7 (range 40–92). There were no complications related to placement of these depth electrodes. All 11 patients underwent subsequent resective surgery involving the insula. CONCLUSIONS Parasagittal transinsular apex depth electrode placement is a feasible alternative to orthogonally placed open or oblique-placed stereotactic methodologies. This method is safe and best suited for suspected unilateral cases with a possible extensive insular-opercular epileptogenic zone.

Robotic Navigated Laser Craniotomy for Depth Electrode Implantation in Epilepsy Surgery: A Cadaver Lab Study

2020 ◽  
Author(s):  
Karl Roessler ◽  
Fabian Winter ◽  
Tobias Wilken ◽  
Ekaterina Pataraia ◽  
Magdalena Mueller-Gerbl ◽  
...  
Keyword(s):  
Laser Beam ◽  
Epilepsy Surgery ◽  
Entry Point ◽  
Occipital Bone ◽  
Electrode Placement ◽  
Target Point ◽  
Twist Drill ◽  
Electrode Implantation ◽  
Depth Electrodes ◽  
Depth Electrode

Abstract Objective Depth electrode implantation for invasive monitoring in epilepsy surgery has become a standard procedure. We describe a new frameless stereotactic intervention using robot-guided laser beam for making precise bone channels for depth electrode placement. Methods A laboratory investigation on a head cadaver specimen was performed using a CT scan planning of depth electrodes in various positions. Precise bone channels were made by a navigated robot-driven laser beam (erbium:yttrium aluminum garnet [Er:YAG], 2.94-μm wavelength,) instead of twist drill holes. Entry point and target point precision was calculated using postimplantation CT scans and comparison to the preoperative trajectory plan. Results Frontal, parietal, and occipital bone channels for bolt implantation were made. The occipital bone channel had an angulation of more than 60 degrees to the surface. Bolts and depth electrodes were implanted solely guided by the trajectory given by the precise bone channels. The mean depth electrode length was 45.5 mm. Entry point deviation was 0.73 mm (±0.66 mm SD) and target point deviation was 2.0 mm (±0.64 mm SD). Bone channel laser time was ∼30 seconds per channel. Altogether, the implantation time was ∼10 to 15 minutes per electrode. Conclusion Navigated robot-assisted laser for making precise bone channels for depth electrode implantation in epilepsy surgery is a promising new, exact and straightforward implantation technique and may have many advantages over twist drill hole implantation.

Surgical management of epilepsy using epidural recordings to localize the seizure focus

1984 ◽  
Vol 60 (3) ◽  
pp. 457-466 ◽  
Author(s):  
Sidney Goldring ◽  
Erik M. Gregorie
Keyword(s):  
Temporal Lobe ◽  
Focal Epilepsy ◽  
Temporal Lobectomy ◽  
Epileptogenic Focus ◽  
Electrode Arrays ◽  
Content Type ◽  
Seizure Focus ◽  
Depth Electrodes ◽  
Sensory Evoked ◽  
Fine Print

✓ One hundred patients with focal epilepsy (44 were children) were evaluated with extraoperative electrocorticography via epidural electrode arrays. Localization of the epileptogenic focus was derived predominantly from recordings made during spontaneously occurring seizures. All resection procedures were carried out under general anesthesia. During anesthesia, the recording of sensory evoked responses made it possible to readily identify the sensorimotor region. Of the 100 patients, 72 underwent resection of an epileptogenic focus, and 33 of these were children. Those who did not have a resection either exhibited a diffuse seizure focus, failed to show an electrical seizure discharge in association with the clinical seizure, failed to have a seizure during the period of monitoring, or failed to exhibit conclusive changes for identifying a focus in the interictal record. Fifty-seven patients (29 children and 28 adults) who had a resection have been followed for between 1 and 12 years. Eighteen (62%) of the 29 children and 18 (64%) of the 28 adults enjoyed a good result. Twenty of the 100 patients reported here had temporal lobe epilepsy. They were candidates for recordings with depth electrodes to identify their focus, but they were evaluated instead with epidural recordings; the method is described. In 15 of them, a unilateral focus was identified and they underwent an anterior temporal lobectomy. Pathological changes were found in every case and, in 11 patients, the epidural recordings distinguished between a medial and a lateral focus. Ten of these patients have been followed for 9 months to 3½ years, and seven have had a good result. The observations suggest that epidural electrodes may be used in lieu of depth electrodes for identifying the symptomatic temporal lobe.

scholarly journals Stereotactic electroencephalography with temporal grid and mesial temporal depth electrode coverage: does technique of depth electrode placement affect outcome?

2010 ◽  
Vol 113 (1) ◽  
pp. 32-38 ◽  
Author(s):  
Jamie J. Van Gompel ◽  
Fredric B. Meyer ◽  
W. Richard Marsh ◽  
Kendall H. Lee ◽  
Gregory A. Worrell
Keyword(s):  
Temporal Lobe ◽  
Middle Temporal Gyrus ◽  
Electrode Implantation ◽  
Middle Temporal ◽  
Contact Depth ◽  
Depth Electrodes ◽  
Depth Electrode ◽  
Group A ◽  
Group B ◽  
Seizure Localization

Object Intracranial monitoring for temporal lobe seizure localization to differentiate neocortical from mesial temporal onset seizures requires both neocortical subdural grids and hippocampal depth electrode implantation. There are 2 basic techniques for hippocampal depth electrode implantation. This first technique uses a stereotactically guided 8-contact depth electrode directed along the long axis of the hippocampus to the amygdala via an occipital bur hole. The second technique involves direct placement of 2 or 3 4-contact depth electrodes perpendicular to the temporal lobe through the middle temporal gyrus and overlying subdural grid. The purpose of this study was to determine whether one technique was superior to the other by examining monitoring success and complications. Methods Between 1997 and 2005, 41 patients underwent invasive seizure monitoring with both temporal subdural grids and depth electrodes placed in 2 ways. Patients in Group A underwent the first technique, and patients in Group B underwent the second technique. Results Group A consisted of 26 patients and Group B 15 patients. There were no statistically significant differences between Groups A and B regarding demographics, monitoring duration, seizure localization, or outcome (Engel classification). There was a statistically significant difference at the point in time at which these techniques were used: Group A represented more patients earlier in the series than Group B (p < 0.05). The complication rate attributable to the grids and depth electrodes was 0% in each group. It was more likely that the depth electrodes were placed through the grid if there was a prior resection and the patient was undergoing a new evaluation (p < 0.05). Furthermore, Group A procedures took significantly longer than Group B procedures. Conclusions In this patient series, there was no difference in efficacy of monitoring, complications, or outcome between hippocampal depth electrodes placed laterally through temporal grids or using an occipital bur hole stereotactic approach. Placement of the depth electrodes perpendicularly through the grids and middle temporal gyrus is technically more practical because multiple head positions and redraping are unnecessary, resulting in shorter operative times with comparable results.

A new instrument for improved accuracy of stereotactic depth electrode placement

1996 ◽  
Vol 85 (2) ◽  
pp. 357-358 ◽  
Author(s):  
Richard D. Ashpole ◽  
Gavin C. A. Fabinyi ◽  
Milos Vosmansky
Keyword(s):  
Simple Device ◽  
Electrode Placement ◽  
Content Type ◽  
Depth Electrodes ◽  
Depth Electrode ◽  
New Instrument ◽  
Improved Accuracy ◽  
Fine Print

✓ A disadvantage of stereotactic placement of flexible depth electrodes is the risk of inaccurate positioning as a result of electrode movement when the introducer is withdrawn. A simple device that virtually eliminates this error is described.

Subdural Electrodes for Seizure Focus Localization

Neurosurgery ◽  
1986 ◽  
Vol 19 (1) ◽  
pp. 73-81 ◽  
Author(s):  
Thomas J. Rosenbaum ◽  
Kenneth D. Laxer ◽  
Michael Vessely ◽  
W. Brewster Smith
Keyword(s):  
Electrode Placement ◽  
Surgical Decision ◽  
Electrode Implantation ◽  
Seizure Focus ◽  
Seizure Disorders ◽  
Depth Electrodes ◽  
Subdural Electrode ◽  
Focus Localization ◽  
Significant Addition ◽  
Made In

Abstract Fifty patients with medically refractory partial seizure disorders have undergone subdural electrode placement for seizure focus localization. Standard scalp telemetry recordings of ictal events had failed to demonstrate accurately the site of seizure onset, and these patients were considered candidates for telemetry with intracerebral depth electrodes. Excellent recordings of interictal and ictal events were obtained, and localization of the epileptogenic focus was derived from recordings made during spontaneously occurring seizures. Electrocorticograms were monitored for up to 21 days. The recordings enabled a surgical decision to be made in 43 of 50 cases (86%). Thirty patients have subsequently undergone cortical excision of their foci with good results. Subdural electrode recordings are a significant addition to the armamentarium of the neurosurgeon attempting to localize surgical seizure foci, offering a low morbidity procedure as an alternative to depth electrode implantation.

scholarly journals Coding of Repetitive Transients by Auditory Cortex on Heschl's Gyrus

2009 ◽  
Vol 102 (4) ◽  
pp. 2358-2374 ◽  
Author(s):  
John F. Brugge ◽  
Kirill V. Nourski ◽  
Hiroyuki Oya ◽  
Richard A. Reale ◽  
Hiroto Kawasaki ◽  
...  
Keyword(s):  
Auditory Cortex ◽  
Intractable Epilepsy ◽  
Primate Species ◽  
Frequency Following Response ◽  
Depth Electrodes ◽  
Heschl’S Gyrus ◽  
Long Latency ◽  
Surgical Evaluation ◽  
Latency Response ◽  
Heschl's Gyrus

The capacity of auditory cortex on Heschl's gyrus (HG) to encode repetitive transients was studied in human patients undergoing surgical evaluation for medically intractable epilepsy. Multicontact depth electrodes were chronically implanted in gray matter of HG. Bilaterally presented stimuli were click trains varying in rate from 4 to 200 Hz. Averaged evoked potentials (AEPs) and event-related band power (ERBP), computed from responses at each of 14 recording sites, identified two auditory fields. A core field, which occupies posteromedial HG, was characterized by a robust polyphasic AEP on which could be superimposed a frequency following response (FFR). The FFR was prominent at click rates below ∼50 Hz, decreased rapidly as click rate was increased, but could reliably be detected at click rates as high as 200 Hz. These data are strikingly similar to those obtained by others in the monkey under essentially the same stimulus conditions, indicating that mechanisms underlying temporal processing in the auditory core may be highly conserved across primate species. ERBP, which reflects increases or decreases of both phase-locked and non–phase-locked power within given frequency bands, showed stimulus-related increases in gamma band frequencies as high as 250 Hz. The AEPs recorded in a belt field anterolateral to the core were typically of low amplitude, showing little or no evidence of short-latency waves or an FFR, even at the lowest click rates used. The non–phase-locked component of the response extracted from the ERBP showed a robust, long-latency response occurring here in response to the highest click rates in the series.

scholarly journals The comparative study of invasive electroencephalography modalities in temporal lobe epilepsy

2021 ◽  
Vol 23 (3) ◽  
pp. 14-22
Author(s):  
V. M. Dzhafarov ◽  
A. B. Dmitriev ◽  
N. P. Denisova ◽  
D. A. Rzaev
Keyword(s):  
Temporal Lobe Epilepsy ◽  
Temporal Lobe ◽  
Focal Epilepsy ◽  
Epileptogenic Zone ◽  
Foramen Ovale ◽  
Seizure Onset ◽  
Depth Electrodes ◽  
Seizure Onset Zone ◽  
Temporal Lobe Seizures ◽  
Mesial Temporal Lobe

Introduction. Invasive video-EEG monitoring (invasive EEG) is indicated in patients with refractory focal epilepsy while localization of the epileptogenic zone is unclear. Methods of invasive EEG in different groups of patients demonstrate variable results.Objective: to analyse the results of invasive EEG via subdural and depth electrodes in patients with refractory temporal lobe epilepsy with mesial temporal lobe seizures.Materials and methods. The series of 37 patients who underwent invasive EEG from 2013 to 2020 was retrospectively analysed. The study includes primary adult patients with structural refractory focal epilepsy with mesial temporal lobe seizures without tumor and vascular pathology. Patients were divided onto 3 groups: 1) with foramen ovale electrodes 2) subdural strip electrodes and 3) combination of subdural strips and depths electrodes. The results of anteromedial temporal lobectomy after 6 months were classified according to Engel scale.Results. A group with foramen ovale electrodes included 7 patients, subdural strips – 23, combination – 7. The seizure onset zone was detected in 36 (97 %) cases. Serious complications were observed in 2 (29 %) cases in the group with foramen ovale electrodes. The mean follow-up in 23 (76 %) patients after resective surgery was 28.3 months. Favourable results (Engel I, II) were observed in 4 (80 %) patients with foramen ovale electrodes, in 8 (67 %) patients with subdural electrodes, in 6 (100 %) with combination. Unfavourable results (Engel III, IV) were noted in 1 (20 %) patient with foramen ovale electrode, in 4 (33 %) patients with subdural strips.Conclusion. All the presented modalities of invasive EEG are effective for localizing of seizure onset zone in this category of patients. Foramen ovale electrode using may be limited due to increased risk of complications.

scholarly journals A novel miniature robotic device for frameless implantation of depth electrodes in refractory epilepsy

2017 ◽  
Vol 126 (5) ◽  
pp. 1622-1628 ◽  
Author(s):  
Christian Dorfer ◽  
Georgi Minchev ◽  
Thomas Czech ◽  
Harald Stefanits ◽  
Martha Feucht ◽  
...  
Keyword(s):  
Surgical Navigation ◽  
Phantom Study ◽  
Entry Point ◽  
Electrode Placement ◽  
Robotic Device ◽  
Robot Assisted ◽  
Skull Model ◽  
Depth Electrodes ◽  
Depth Electrode ◽  
Superficial Wound

OBJECTIVEThe authors' group recently published a novel technique for a navigation-guided frameless stereotactic approach for the placement of depth electrodes in epilepsy patients. To improve the accuracy of the trajectory and enhance the procedural workflow, the authors implemented the iSys1 miniature robotic device in the present study into this routine.METHODSAs a first step, a preclinical phantom study was performed using a human skull model, and the accuracy and timing between 5 electrodes implanted with the manual technique and 5 with the aid of the robot were compared. After this phantom study showed an increased accuracy with robot-assisted electrode placement and confirmed the robot's ability to maintain stability despite the rotational forces and the leverage effect from drilling and screwing, patients were enrolled and analyzed for robot-assisted depth electrode placement at the authors' institution from January 2014 to December 2015. All procedures were performed with the S7 Surgical Navigation System with Synergy Cranial software and the iSys1 miniature robotic device.RESULTSNinety-three electrodes were implanted in 16 patients (median age 33 years, range 3–55 years; 9 females, 7 males). The authors saw a significant increase in accuracy compared with their manual technique, with a median deviation from the planned entry and target points of 1.3 mm (range 0.1–3.4 mm) and 1.5 mm (range 0.3–6.7 mm), respectively. For the last 5 patients (31 electrodes) of this series the authors modified their technique in placing a guide for implantation of depth electrodes (GIDE) on the bone and saw a significant further increase in the accuracy at the entry point to 1.18 ± 0.5 mm (mean ± SD) compared with 1.54 ± 0.8 mm for the first 11 patients (p = 0.021). The median length of the trajectories was 45.4 mm (range 19–102.6 mm). The mean duration of depth electrode placement from the start of trajectory alignment to fixation of the electrode was 15.7 minutes (range 8.5–26.6 minutes), which was significantly faster than with the manual technique. In 12 patients, depth electrode placement was combined with subdural electrode placement. The procedure was well tolerated in all patients. The authors did not encounter any case of hemorrhage or neurological deficit related to the electrode placement. In 1 patient with a psoriasis vulgaris, a superficial wound infection was encountered. Adequate physiological recordings were obtained from all electrodes. No additional electrodes had to be implanted because of misplacement.CONCLUSIONSThe iSys1 robotic device is a versatile and easy to use tool for frameless implantation of depth electrodes for the treatment of epilepsy. It increased the accuracy of the authors' manual technique by 60% at the entry point and over 30% at the target. It further enhanced and expedited the authors' procedural workflow.

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