Operculoinsular cortectomy for refractory epilepsy. Part 1: Is it effective?

2020 ◽  
Vol 133 (4) ◽  
pp. 950-959
Author(s):  
Alain Bouthillier ◽  
Alexander G. Weil ◽  
Laurence Martineau ◽  
Laurent Létourneau-Guillon ◽  
Dang Khoa Nguyen
Keyword(s):  
Surgical Treatment ◽  
Frontal Lobe ◽  
Seizure Control ◽  
Refractory Epilepsy ◽  
Seizure Outcome ◽  
Seizure Freedom ◽  
Invasive Monitoring ◽  
Seizure Semiology ◽  
Intracranial Electrodes

OBJECTIVEPatients with refractory epilepsy of operculoinsular origin are often denied potentially effective surgical treatment with operculoinsular cortectomy (also termed operculoinsulectomy) because of feared complications and the paucity of surgical series with a significant number of cases documenting seizure control outcome. The goal of this study was to document seizure control outcome after operculoinsular cortectomy in a group of patients investigated and treated by an epilepsy team with 20 years of experience with this specific technique.METHODSClinical, imaging, surgical, and seizure control outcome data of all patients who underwent surgery for refractory epilepsy requiring an operculoinsular cortectomy were retrospectively reviewed. Tumors and progressive encephalitis cases were excluded. Descriptive and uni- and multivariate analyses were done to determine seizure control outcome and predictors.RESULTSForty-three patients with 44 operculoinsular cortectomies were studied. Kaplan-Meier estimates of complete seizure freedom (first seizure recurrence excluding auras) for years 0.5, 1, 2, and 5 were 70.2%, 70.2%, 65.0%, and 65.0%, respectively. With patients with more than 1 year of follow-up, seizure control outcome Engel class I was achieved in 76.9% (mean follow-up duration 5.8 years; range 1.25–20 years). With multivariate analysis, unfavorable seizure outcome predictors were frontal lobe–like seizure semiology, shorter duration of epilepsy, and the use of intracranial electrodes for invasive monitoring. Suspected causes of recurrent seizures were sparing of the language cortex part of the focus, subtotal resection of cortical dysplasia/polymicrogyria, bilateral epilepsy, and residual epileptic cortex with normal preoperative MRI studies (insula, frontal lobe, posterior parieto-temporal, orbitofrontal).CONCLUSIONSThe surgical treatment of operculoinsular refractory epilepsy is as effective as epilepsy surgeries in other brain areas. These patients should be referred to centers with appropriate experience. A frontal lobe–like seizure semiology should command more sampling with invasive monitoring. Recordings with intracranial electrodes are not always required if the noninvasive investigation is conclusive. The complete resection of the epileptic zone is crucial to achieve good seizure control outcome.

scholarly journals Periinsular anterior quadrantotomy: technical note

2018 ◽  
Vol 21 (2) ◽  
pp. 124-132 ◽  
Author(s):  
Giulia Cossu ◽  
Sebastien Lebon ◽  
Margitta Seeck ◽  
Etienne Pralong ◽  
Mahmoud Messerer ◽  
...  
Keyword(s):  
Frontal Lobe ◽  
Refractory Epilepsy ◽  
Focal Cortical Dysplasia ◽  
Seizure Outcome ◽  
Illustrative Case ◽  
Neural Pathways ◽  
Functional Neuroanatomy ◽  
The Right ◽  
Epileptogenic Foci

Refractory frontal lobe epilepsy has been traditionally treated through a frontal lobectomy. A disconnective technique may allow similar seizure outcomes while avoiding the complications associated with large brain resections. The aim of this study was to describe a new technique of selective disconnection of the frontal lobe that can be performed in cases of refractory epilepsy due to epileptogenic foci involving 1 frontal lobe (anterior to the motor cortex), with preservation of motor function. In addition to the description of the technique, an illustrative case is also presented.This disconnective procedure is divided into 4 steps: the suprainsular window, the anterior callosotomy, the intrafrontal disconnection, and the frontobasal disconnection. The functional neuroanatomy is analyzed in detail for each step of the surgery. It is important to perform cortical and subcortical electrophysiological mapping to guide this disconnective procedure and identify eloquent cortices and intact neural pathways.The authors describe the case of a 9-year-old boy who presented with refractory epilepsy due to epileptogenic foci localized to the right frontal lobe. MRI confirmed the presence of a focal cortical dysplasia of the right frontal lobe. A periinsular anterior quadrant disconnection (quadrantotomy) was performed. The postoperative period was uneventful, and the patient was in Engel seizure outcome Class I at the 3-year follow-up. A significant cognitive gain was observed during follow-up.Periinsular anterior quadrantotomy may thus represent a safe technique to efficiently treat refractory epilepsy when epileptogenic foci are localized to 1 frontal lobe while preserving residual motor functions.

scholarly journals Predictive Factors of Surgical Outcome in Frontal Lobe Epilepsy Explored with Stereoelectroencephalography

Neurosurgery ◽  
2017 ◽  
Vol 83 (2) ◽  
pp. 217-225 ◽  
Author(s):  
Francesca Bonini ◽  
Aileen McGonigal ◽  
Didier Scavarda ◽  
Romain Carron ◽  
Jean Régis ◽  
...  
Keyword(s):  
Frontal Lobe ◽  
Surgical Resection ◽  
Complete Resection ◽  
Conditional Inference ◽  
Prognostic Indicators ◽  
Frontal Lobe Epilepsy ◽  
Seizure Outcome ◽  
Seizure Freedom ◽  
Epileptogenic Zone

Abstract BACKGROUND Resective surgery established treatment for pharmacoresistant frontal lobe epilepsy (FLE), but seizure outcome and prognostic indicators are poorly characterized and vary between studies. OBJECTIVE To study long-term seizure outcome and identify prognostic factors. METHODS We retrospectively analyzed 42 FLE patients having undergone surgical resection, mostly preceded by invasive recordings with stereoelectroencephalography (SEEG). Postsurgical outcome up to 10-yr follow-up and prognostic indicators were analyzed using Kaplan–Meier analysis and multivariate and conditional inference procedures. RESULTS At the time of last follow-up, 57.1% of patients were seizure-free. The estimated chance of seizure freedom was 67% (95% confidence interval [CI]: 54-83) at 6 mo, 59% (95% CI: 46-76) at 1 yr, 53% (95% CI: 40-71) at 2 yr, and 46% (95% CI: 32-66) at 5 yr. Most relapses (83%) occurred within the first 12 mo. Multivariate analysis showed that completeness of resection of the epileptogenic zone (EZ) as defined by SEEG was the main predictor of seizure outcome. According to conditional inference trees, in patients with complete resection of the EZ, focal cortical dysplasia as etiology and focal EZ were positive prognostic indicators. No difference in outcome was found in patients with positive vs negative magnetic resonance imaging. CONCLUSION Surgical resection in drug-resistant FLE can be a successful therapeutic approach, even in the absence of neuroradiologically visible lesions. SEEG may be highly useful in both nonlesional and lesional FLE cases, because complete resection of the EZ as defined by SEEG is associated with better prognosis.

scholarly journals Seizure control after radiosurgery for cerebral arteriovenous malformations: a 25-year experience

2019 ◽  
Vol 131 (6) ◽  
pp. 1763-1772
Author(s):  
Ajay Niranjan ◽  
Ahmed Kashkoush ◽  
Hideyuki Kano ◽  
Edward A. Monaco ◽  
John C. Flickinger ◽  
...  
Keyword(s):  
Seizure Frequency ◽  
Arteriovenous Malformations ◽  
Seizure Control ◽  
Venous Drainage ◽  
Seizure Outcome ◽  
Seizure Freedom ◽  
Impaired Awareness ◽  
Free Status

OBJECTIVESeizures are the second-most common presenting symptom in patients with lobar arteriovenous malformations (AVMs). However, few studies have assessed the long-term effect of stereotactic radiosurgery (SRS) on seizure control. The authors of this study assess the outcome of SRS for these patients to identify prognostic factors associated with seizure control.METHODSPatients with AVM who presented with a history of seizure and underwent SRS at the authors’ institution between 1987 and 2012 were retrospectively assessed. The total cohort included 155 patients with a mean follow-up of 86 months (range 6–295 months). Primary outcomes assessed were seizure frequency, antiepileptic drug regimen, and seizure freedom for 6 months prior to last follow-up.RESULTSSeizure-free status was achieved in 108 patients (70%), with an additional 23 patients (15%) reporting improved seizure frequency as compared to their pre-SRS status. The median time to seizure-free status was estimated to be 12 months (95% CI 0–27 months) as evaluated via Kaplan-Meier survival analysis. The mean seizure frequency prior to SRS was 14.2 (95% CI 5.4–23.1) episodes per year. Although not all patients tried, the proportion of patients successfully weaned off all antiepileptic drugs was 18% (28/155 patients). On multivariate logistic regression, focal impaired awareness seizure type (also known as complex partial seizures) and superficial venous drainage were significantly associated with a decreased odds ratio for seizure-free status at last follow-up (OR 0.37 [95% CI 0.15–0.92] for focal impaired awareness seizures; OR 0.36 [95% CI 0.16–0.81] for superficial venous drainage). The effects of superficial venous drainage on seizure outcome were nonsignificant when excluding patients with < 2 years of follow-up. AVM obliteration did not correlate with long-term seizure freedom (p = 0.202, chi-square test).CONCLUSIONSThis study suggests that SRS improves long-term seizure control and increases the likelihood of being medication free, independently of AVM obliteration. Patients with focal impaired awareness seizures were less likely to obtain long-term seizure relief.

Predictors of seizure freedom after resection of supratentorial low-grade gliomas

2011 ◽  
Vol 115 (2) ◽  
pp. 240-244 ◽  
Author(s):  
Dario J. Englot ◽  
Mitchel S. Berger ◽  
Nicholas M. Barbaro ◽  
Edward F. Chang
Keyword(s):  
Seizure Control ◽  
Critical Factor ◽  
Gross Total Resection ◽  
Subtotal Resection ◽  
Seizure Outcome ◽  
Seizure Freedom ◽  
Low Grade ◽  
Total Resection ◽  
Low Grade Gliomas ◽  
Seizure Semiology

Object Seizures are the most frequent presenting symptom in patients with low-grade gliomas (LGGs), and significantly influence quality of life if they are uncontrolled. Achieving freedom from seizures is of utmost importance in surgical planning, but the factors associated with seizure control remain incompletely understood. Methods The authors performed a systematic literature review of seizure outcomes after resection of LGGs causing seizures, examining 773 patients across 20 published series. Rates of seizure freedom were stratified across 7 variables: patient age, tumor location, preoperative seizure control with medication, seizure semiology, epilepsy duration, extent of resection, and the use of intraoperative electrocorticography (ECoG). Results Gross-total resection was most predictive of complete seizure freedom, when compared with subtotal resection (OR 3.41, 95% CI 2.36–4.93). Other predictors of seizure freedom included preoperative seizure control on antiepileptic medication (OR 2.12, 95% CI 1.33–3.38) and duration of seizures of ≤ 1 year (OR 1.85, 95% CI 1.22–2.79). Patients with simple partial seizure semiology achieved seizure freedom less often than those with complex partial, generalized, or mixed seizure types (OR 0.46, 95% CI 0.26–0.80). No significant differences in seizure outcome were observed between adults versus children, patients with temporal lobe versus extratemporal tumors, or with the use of intraoperative ECoG. Conclusions Seizure control is one of the most important considerations in planning surgery for low-grade brain tumors. Gross-total resection is a critical factor in achieving seizure freedom.

scholarly journals The Impact of Lesional Factors on Seizure Outcome Following Lesionectomy as a Surgical Management of Extratemporal Epilepsy, Case Series from a Developing Country and Review of Literature.

2021 ◽  
Author(s):  
Amr Ali Hasanain ◽  
Mohamed Sawan ◽  
Ahmed Mohamed Ali
Keyword(s):  
Focal Epilepsy ◽  
Focal Lesion ◽  
Seizure Outcome ◽  
Seizure Freedom ◽  
Low Grade ◽  
Epileptogenic Zone ◽  
Seizure Semiology ◽  
Radiological Data ◽  
The Impact

Abstract BACKGROUNDExtratemporal lesional epilepsy can be managed with various surgical techniques such as simple lesionectomy or more extensive resections, all of which aim at targeting the epileptogenic zone which is the key for achieving a favorable outcome. This study aimed at evaluating the effectiveness of lesionectomy in the treatment of extra-temporal epilepsy associated with a lesion on radiological imaging, and to show the effect of lesional factors on seizure outcome including the anatomical location, the relation to cerebral parenchyma, the extent of surgical excision and the histopathological nature of the lesion.METHODSA prospective study on 20 patients presenting with focal epilepsy, or focal epilepsy with secondary generalized seizures with evidence of focal lesion in an extratemporal location on MRI. Lesionectomy was done and we used the Engel’s classification for seizure outcome.RESULTSLesions were mostly tumors (85 %). The frontal lobe is the most frequent locations (60 %). Low-grade glioma represented 35 % while meningioma represented 45 % of all lesions (both intra-axial and extra-axial). Four patients were lost during follow up (mean 23.31 months). For the remaining 16 patients, 13 cases were tumors (81.25%). Lesionectomy achieved seizure freedom in 68.75 %.CONCLUSIONSIn a country with limited resources, lesionectomy is a valid technique for epilepsy surgery as long as the radiological data and the seizure semiology are concordant. Total lesionectomy provides good seizure control when the clinical and radiological data are concordant with seizure semiology, in particular with tumor-related epilepsy. A study comparing postoperative seizure outcome between intra-axial and extra-axial lesions on a larger scale and with a longer follow up period is recommended.

Predictors of seizure freedom in the surgical treatment of supratentorial cavernous malformations

2011 ◽  
Vol 115 (6) ◽  
pp. 1169-1174 ◽  
Author(s):  
Dario J. Englot ◽  
Seunggu J. Han ◽  
Michael T. Lawton ◽  
Edward F. Chang
Keyword(s):  
Surgical Treatment ◽  
Refractory Epilepsy ◽  
Gross Total Resection ◽  
Prognostic Indicators ◽  
Seizure Outcome ◽  
Seizure Freedom ◽  
Total Resection ◽  
Cavernous Malformations ◽  
Postoperative Seizure ◽  
Medically Refractory Epilepsy

Object Seizures are the most common presenting symptom of supratentorial cerebral cavernous malformations (CCMs) and progress to medically refractory epilepsy in 40% of patients. Predictors of seizure freedom in the resection of CCMs are incompletely understood. Methods The authors systematically reviewed the published literature on seizure freedom following the resection of supratentorial CCMs in patients presenting with seizures. Seizure outcomes were stratified across 12 potential prognostic variables. A total of 1226 patients with supratentorial CCMs causing seizures were identified across 31 predominantly retrospective studies; 361 patients had medically refractory epilepsy. Results Seventy-five percent of the patients were seizure free after microsurgical lesion removal, whereas 25% continued to have seizures. All patients had had preoperative seizures and > 6 months of postoperative follow-up. Modifiable predictors of postoperative seizure freedom included gross-total resection (OR 36.6, 95% CI 8.5–157.5) and surgery within 1 year of symptom onset (OR 1.83, 95% CI 1.30–2.58). Additional prognostic indicators of a favorable outcome were a CCM size < 1.5 cm (OR 15.4, 95% CI 5.2–45.4), the absence of multiple CCMs (OR 2.02, 95% CI 1.13–3.60), medically controlled seizures (OR 2.38, 95% CI 1.29–4.39), and the lack of secondarily generalized seizures (OR 3.33, 95% CI 2.09–5.30). Other factors, including extended resection of the hemosiderin ring, were not significantly predictive. Conclusions In the surgical treatment of supratentorial CCMs, gross-total resection and early operative intervention may improve seizure outcome. While surgery should not be considered the first-line treatment for CCM-related epilepsy, it is important to understand the variables associated with seizure freedom in CCM resection given the considerable morbidity and diminished quality of life associated with epilepsy.

Psychiatric and psychosocial morbidity 1 year after epilepsy surgery

2020 ◽  
pp. 1-8
Author(s):  
S. Patel ◽  
M. Clancy ◽  
H. Barry ◽  
N. Quigley ◽  
M. Clarke ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Surgical Treatment ◽  
Epilepsy Surgery ◽  
Refractory Epilepsy ◽  
Post Surgery ◽  
Axis I ◽  
Patients With Epilepsy ◽  
The Impact

Abstract Objectives: There is a high rate of psychiatric comorbidity in patients with epilepsy. However, the impact of surgical treatment of refractory epilepsy on psychopathology remains under investigation. We aimed to examine the impact of epilepsy surgery on psychopathology and quality of life at 1-year post-surgery in a population of patients with epilepsy refractory to medication. Methods: This study initially assessed 48 patients with refractory epilepsy using the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I), the Hospital Anxiety and Depression Scale (HADS) and the Quality of Life in Epilepsy Inventory 89 (QOLIE-89) on admission to an Epilepsy Monitoring Unit (EMU) as part of their pre-surgical assessment. These patients were again assessed using the SCID-I, QOLIE-89 and HADS at 1-year follow-up post-surgery. Results: There was a significant reduction in psychopathology, particularly psychosis, following surgery at 1-year follow-up (p < 0.021). There were no new cases of de novo psychosis and surgery was also associated with a significant improvement in the quality of life scores (p < 0.001). Conclusions: This study demonstrates the impact of epilepsy surgery on psychopathology and quality of life in a patient population with refractory surgery. The presence of a psychiatric illness should not be a barrier to access surgical treatment.

scholarly journals The influence of lesion volume, perilesion resection volume, and completeness of resection on seizure outcome after resective epilepsy surgery for cortical dysplasia in children

2015 ◽  
Vol 15 (6) ◽  
pp. 644-650 ◽  
Author(s):  
Chima O. Oluigbo ◽  
Jichuan Wang ◽  
Matthew T. Whitehead ◽  
Suresh Magge ◽  
John S. Myseros ◽  
...  
Keyword(s):  
Epilepsy Surgery ◽  
Seizure Control ◽  
Brain Mri ◽  
Age At Onset ◽  
Cortical Dysplasia ◽  
Complete Resection ◽  
Seizure Outcome ◽  
Seizure Freedom ◽  
Lesion Volume ◽  
Resection Volume

OBJECT Focal cortical dysplasia (FCD) is one of the most common causes of intractable epilepsy leading to surgery in children. The predictors of seizure freedom after surgical management for FCD are still unclear. The objective of this study was to perform a volumetric analysis of factors shown on the preresection and postresection brain MRI scans of patients who had undergone resective epilepsy surgery for cortical dysplasia and to determine the influence of these factors on seizure outcome. METHODS The authors reviewed the medical records and brain images of 43 consecutive patients with focal MRI-documented abnormalities and a pathological diagnosis of FCD who had undergone surgical treatment for refractory epilepsy. Preoperative lesion volume and postoperative resection volume were calculated by manual segmentation using OsiriX PRO software. RESULTS Forty-three patients underwent first-time surgery for resection of an FCD. The age range of these patients at the time of surgery ranged from 2 months to 21.8 years (mean age 7.3 years). The median duration of follow-up was 20 months. The mean age at onset was 31.6 months (range 1 day to 168 months). Complete resection of the area of an FCD, as adjudged from the postoperative brain MR images, was significantly associated with seizure control (p = 0.0005). The odds of having good seizure control among those who underwent complete resection were about 6 times higher than those among the patients who did not undergo complete resection. Seizure control was not significantly associated with lesion volume (p = 0.46) or perilesion resection volume (p = 0.86). CONCLUSIONS The completeness of FCD resection in children is a significant predictor of seizure freedom. Neither lesion volume nor the further resection of perilesional tissue is predictive of seizure freedom.

Surgical outcomes in children with bottom-of-sulcus dysplasia and drug-resistant epilepsy: a retrospective cohort study

2021 ◽  
pp. 1-11
Author(s):  
Puneet Jain ◽  
Ayako Ochi ◽  
Carter McInnis ◽  
Hiroshi Otsubo ◽  
O. Carter Snead ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Medical Records ◽  
Focal Cortical Dysplasia ◽  
Seizure Freedom ◽  
Language Mapping ◽  
Resective Surgery ◽  
Histological Data ◽  
Drug Resistant Epilepsy ◽  
Video Eeg

OBJECTIVE Bottom-of-sulcus dysplasia (BOSD) is challenging to identify radiologically. The aim of this study was to explore seizure outcomes after resective surgery or MR-guided laser interstitial thermal therapy (MRgLITT) in children with BOSD. METHODS Children with radiologically defined BOSD who underwent resective surgery or MRgLITT, with at least 1 year of follow-up were included. Clinical, radiological, neurophysiological, and histological data were extracted from medical records. Invasive video EEG (IVEEG) was used to evaluate the ictal onset zone or motor/language mapping, wherever appropriate. Histology of MRI-visible BOSD, including the overlying and adjacent cortex, was also evaluated. RESULTS Forty-one children with BOSD underwent surgical treatment. The lesion was initially overlooked on MRI in 20 patients (48.8%). Of 34 patients who underwent IVEEG and who had available ictal data, the ictal onset zone extended beyond the MRI-visible BOSD in 23 patients (67.6%). Surgical treatment included lesionectomy (24 patients), extended lesionectomy (12 patients), lobectomy (1 patient), and ablation of BOSD (4 patients). The pathology in 37 patients who underwent resection showed focal cortical dysplasia type IIB and type IIA in 21 (53.8%) and 16 patients (41%), respectively. Seizure freedom was achieved in 32 patients (78.1%) after a mean follow-up of 4.3 years. CONCLUSIONS Seizure outcomes after resective surgery or MRgLITT in children with BOSD were generally favorable. The authors found that the neurophysiological abnormality and pathology often extended beyond the MRI-visible BOSD.

scholarly journals Rasmussen Encephalitis: longterm outcome after surgery

2010 ◽  
Vol 16 (2) ◽  
pp. 59-63 ◽  
Author(s):  
Vera C. Terra ◽  
Helio R. Machado ◽  
Ricardo dos Santos Oliveira ◽  
Luciano N Serafini ◽  
Cecília Souza-Oliveira ◽  
...  
Keyword(s):  
Epilepsy Surgery ◽  
Language Impairment ◽  
Seizure Control ◽  
Demographic Data ◽  
Intractable Epilepsy ◽  
Seizure Outcome ◽  
Rasmussen Encephalitis ◽  
Eeg Abnormalities ◽  
Clonic Seizures

BACKGROUND AND PURPOSE: Rasmussen Encephalitis (RE) is characterized by intractable epilepsy, progressive hemiparesis and unilateral hemispheric atrophy. The progression of the symptoms usually occurs within months to few years. Antiepileptic drugs are usually not effective to control disease progression and epilepsy surgery in the form of hemispheric disconnection has been considered the treatment of choice. This work describes the clinical and electrographic analyses, as well as the post-operative evolution of patients with RE. PATIENTS AND METHODS: This work includes all the patients with RE evaluated from January 1995 to January 2008 by the Ribeirão Preto Epilepsy Surgery Program (CIREP) considering demographic data, interictal and ictal electroencephalographic (EEG) findings; anatomo-pathological findings and clinical outcome. RESULTS: Twenty-five patients were evaluated, thirteen were female. Mean age of epilepsy onset was 4.4±2.0 years. There were no differences between patients with slow and fast evolution with respect to age of epilepsy onset (p=0.79), age at surgery (p=0.24), duration of epilepsy (0.06), and follow-up (p=0.40). There were no correlations between the presence of bilateral EEG abnormalities or the absence of spikes and post-operative seizure outcome (p=0.06). Twenty-three patients underwent surgery. The mean follow-up was 75.3 months. Eleven patients had total seizure control. Twelve individuals persisted with seizures consisting of mild facial jerks (6 patients), occasional hemigeneralized tonic-clonic seizures (3 patients), and frequent tonic-clonic seizures (3 patients). Mental and language impairment was observed in 15 and 12 patients, after surgery, respectively. CONCLUSIONS: This retrospective study reported the clinical and electrographic analysis, as well as the evolution of 23 patients with RE. Fourteen patients achieved satisfactory seizure control, three patients had partial response to surgery, and five patients had maintenance of the pre-operative condition. All patients with left side involvement presented with some language and cognitive disturbance.

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