Endoscope-assisted posterior quadrant disconnection plus corpus callosotomy: case report

2021 ◽  
pp. 1-5
Author(s):  
Melissa A. LoPresti ◽  
Kathryn Wagner ◽  
Sandi Lam
Keyword(s):  
Refractory Epilepsy ◽  
Intractable Epilepsy ◽  
Surgical Approaches ◽  
Seizure Freedom ◽  
Significant Morbidity ◽  
Corpus Callosotomy ◽  
Posterior Quadrant ◽  
Epilepsy Treatment ◽  
Keyhole Approach ◽  
Medically Refractory Epilepsy

Intractable epilepsy impacts many children. Surgically resective and palliative treatments have developed to increase seizure freedom or palliate the seizure burden in those with medically refractory epilepsy. However, surgical epilepsy treatment can confer significant morbidity and death. Endoscope-assisted surgical approaches may be helpful in reducing the morbidity related to traditional open surgical approaches while allowing for good visualization of surgical targets. Here, the authors report a case utilizing an endoscope-assisted keyhole approach to perform a posterior quadrantectomy and corpus callosotomy, achieving the surgical goals of disconnection and reducing the need for large craniotomy exposure. They present the case of a 17-year-old male with medically refractory epilepsy treated with endoscope-assisted posterior quadrantectomy and corpus callosotomy through two mini-craniotomies to achieve a functional disconnection. To the authors’ knowledge, this is the first reported case of an endoscope-assisted approach for a posterior quadrantectomy for surgical epilepsy treatment in an adult or a pediatric patient. The case is reported to highlight the technical nuances and benefits of this approach in select patients as well as the expansion of applications of endoscope-assisted epilepsy surgery.

Medial Temporal Encephalocele and Medically Intractable Epilepsy: A Tailored Inferior Temporal Lobectomy and Case Report

2019 ◽  
Vol 18 (1) ◽  
pp. E19-E22 ◽  
Author(s):  
Anthony L Mikula ◽  
Karim ReFaey ◽  
Sanjeet S Grewal ◽  
Jeffrey W Britton ◽  
Jamie J Van Gompel
Keyword(s):  
Case Report ◽  
Temporal Lobe ◽  
Refractory Epilepsy ◽  
Statistical Parametric Mapping ◽  
Intractable Epilepsy ◽  
Middle Cranial Fossa ◽  
Temporal Lobectomy ◽  
Seizure Freedom ◽  
Temporal Region ◽  
Medically Refractory Epilepsy

AbstractBACKGROUND AND IMPORTANCETemporal lobe encephaloceles are increasingly recognized as a potential cause of medically refractory epilepsy and surgical treatment has proven effective. Resection of the encephalocele and associated cortex is often sufficient to provide seizure control. However, it is difficult to determine the extent of adjacent temporal lobe that should be resected. We present a case report and our technique of a tailored inferior temporal pole resection.CLINICAL PRESENTATIONA 32-yr-old man with an 11-yr history of medically refractory epilepsy. Prolonged electroencephalography (EEG) revealed frequent left and rare right frontotemporal sharp waves. Numerous seizures were captured with EEG, all of which originated from the left temporal region. Statistical parametric mapping (SPM) subtraction ictal–interictal SPECT coregistered with magnetic resonance imaging (MRI) (SISCOM) demonstrated ictal hyperperfusion in the anterior left temporal lobe. MRI showed 2 encephaloceles in the left anterior temporal lobe with the accompanying bony defects in the floor of the middle cranial fossa apparent on the computed tomography scan. The patient underwent left temporal craniotomy with intraoperative electrocorticography, resection of the encephaloceles, and a tailored inferior temporal lobectomy (IFTL) and repair of the middle fossa defects. At 7 mo follow up he reported seizure-freedom since surgery.CONCLUSIONResection of temporal encephalocele and adjacent cortex is safe and effective procedure for select patients with medically refractory epilepsy. This video demonstrates our technique which provides a more standardized approach to the resection.

Using a Robotic-Assisted Approach for Stereotactic Laser Ablation Corpus Callosotomy: A Technical Report

2021 ◽  
pp. 1-6
Author(s):  
Timothy H. Ung ◽  
Lora Kahn ◽  
Lisa Hirt ◽  
Gregoire Chatain ◽  
Elizabeth Humes ◽  
...  
Keyword(s):  
Refractory Epilepsy ◽  
Intractable Epilepsy ◽  
Volumetric Analysis ◽  
Corpus Callosotomy ◽  
Robotic Assisted ◽  
Clinical Presentations ◽  
Technical Report ◽  
Stereotactic Guidance ◽  
Atonic Seizures ◽  
Medically Refractory Epilepsy

<b><i>Background:</i></b> Corpus callosotomy for medically intractable epilepsy is an effective ablative procedure traditionally achieved using either standard open craniotomy or with less-invasive approaches. Advances in robotic-assisted stereotactic guidance for neurosurgery can be applied for LITT for corpus callosotomy. <b><i>Clinical Presentations:</i></b> Two patients were included in this study. One was a 25-year-old female patient with extensive bi-hemispheric malformations of cortical development and medically refractory epilepsy, and the other was an 18-year-old male with medically refractory epilepsy and atonic seizures, who underwent a complete corpus callosotomy using robotic-assisted stereotactic guidance for LITT. <b><i>Results:</i></b> Both patients underwent successful intended corpus callosotomy with volumetric analysis demonstrating a length disconnection of 74% and a volume disconnection of 55% for patient 1 and a length disconnection of 83% and a volume disconnection of 33% for patient 2. Postoperatively, both patients had clinical reductions in seizure. <b><i>Conclusion:</i></b> Our experience demonstrates that robotic guidance systems can safely and effectively be adapted for minimally invasive LITT corpus callosotomy.

A historical cohort of temporal lobe surgery for medically refractory epilepsy: a systematic review and meta-analysis to guide future nonrandomized controlled trial studies

2020 ◽  
Vol 133 (1) ◽  
pp. 71-78 ◽  
Author(s):  
Anthony T. Lee ◽  
John F. Burke ◽  
Pranathi Chunduru ◽  
Annette M. Molinaro ◽  
Robert Knowlton ◽  
...  
Keyword(s):  
Systematic Review ◽  
Temporal Lobe ◽  
Epilepsy Surgery ◽  
Refractory Epilepsy ◽  
Meta Analysis ◽  
Small Sample ◽  
Seizure Freedom ◽  
Level I ◽  
Study Designs ◽  
Medically Refractory Epilepsy

OBJECTIVERecent trials for temporal lobe epilepsy (TLE) highlight the challenges of investigating surgical outcomes using randomized controlled trials (RCTs). Although several reviews have examined seizure-freedom outcomes from existing data, there is a need for an overall seizure-freedom rate estimated from level I data as investigators consider other methods besides RCTs to study outcomes related to new surgical interventions.METHODSThe authors performed a systematic review and meta-analysis of the 3 RCTs of TLE in adults and report an overall surgical seizure-freedom rate (Engel class I) composed of level I data. An overall seizure-freedom rate was also collected from level II data (prospective cohort studies) for validation. Eligible studies were identified by filtering a published Cochrane meta-analysis of epilepsy surgery for RCTs and prospective studies, and supplemented by searching indexed terms in MEDLINE (January 1, 2012–April 1, 2018). Retrospective studies were excluded to minimize heterogeneity in patient selection and reporting bias. Data extraction was independently reverified and pooled using a fixed-effects model. The primary outcome was overall seizure freedom following surgery. The historical benchmark was applied in a noninferiority study design to compare its power to a single-study cohort.RESULTSThe overall rate of seizure freedom from level I data was 72.4% (55/76 patients, 3 RCTs), which was nearly identical to the overall seizure-freedom rate of 71.7% (1325/1849 patients, 18 studies) from prospective cohorts (z = 0.134, p = 0.89; z-test). Seizure-freedom rates from level I and II studies were consistent over the years of publication (R2< 0.01, p = 0.73). Surgery resulted in markedly improved seizure-free outcomes compared to medical management (RR 10.82, 95% CI 3.93–29.84, p < 0.01; 2 RCTs). Noninferiority study designs in which the historical benchmark was used had significantly higher power at all difference margins compared to using a single cohort alone (p < 0.001, Bonferroni’s multiple comparison test).CONCLUSIONSThe overall rate of seizure freedom for temporal lobe surgery is approximately 70% for medically refractory epilepsy. The small sample size of the RCT cohort underscores the need to move beyond standard RCTs for epilepsy surgery. This historical seizure-freedom rate may serve as a useful benchmark to guide future study designs for new surgical treatments for refractory TLE.

scholarly journals Robot-assisted stereoelectroencephalography in children

2019 ◽  
Vol 23 (3) ◽  
pp. 288-296 ◽  
Author(s):  
Robert A. McGovern ◽  
Elia Pestana Knight ◽  
Ajay Gupta ◽  
Ahsan N. V. Moosa ◽  
Elaine Wyllie ◽  
...  
Keyword(s):  
Proportional Hazards Model ◽  
Refractory Epilepsy ◽  
Cox Proportional Hazards Model ◽  
Older Age ◽  
Hospital Length Of Stay ◽  
Seizure Freedom ◽  
Epileptogenic Zone ◽  
Robot Assisted ◽  
Resective Surgery ◽  
Medically Refractory Epilepsy

OBJECTIVEThe goal in the study was to describe the clinical outcomes associated with robot-assisted stereoelectroencephalography (SEEG) in children.METHODSThe authors performed a retrospective, single-center study in consecutive children with medically refractory epilepsy who were undergoing robot-assisted SEEG. Kaplan-Meier survival analysis was used to calculate the probability of seizure freedom. Both univariate and multivariate methods were used to analyze the preoperative and operative factors associated with seizure freedom.RESULTSFifty-seven children underwent a total of 64 robot-assisted procedures. The patients’ mean age was 12 years, an average of 6.4 antiepileptic drugs (AEDs) per patient had failed prior to implantation, and in 56% of the patients the disease was considered nonlesional. On average, children had 12.4 electrodes placed per implantation, with an implantation time of 9.6 minutes per electrode and a 10-day postoperative stay. SEEG analysis yielded a definable epileptogenic zone in 51 (89%) patients; 42 (74%) patients underwent surgery, half of whom were seizure free at last follow-up, 19.6 months from resection. In a multivariate generalized linear model, resective surgery, older age, and shorter SEEG-related hospital length of stay were associated with seizure freedom. In a Cox proportional hazards model including only the children who underwent resective surgery, older age was the only significant factor associated with seizure freedom. Complications related to bleeding were the major contributors to morbidity. One patient (1.5%) had a symptomatic hemorrhage resulting in a permanent neurological deficit.CONCLUSIONSThe authors report one of the largest pediatric-specific SEEG series demonstrating that the modern surgical management of medically refractory epilepsy in children can lead to seizure freedom in many patients, while also highlighting the challenges posed by this difficult patient population.

Corpus callosotomy in multistage epilepsy surgery in the pediatric population

2011 ◽  
Vol 7 (2) ◽  
pp. 189-200 ◽  
Author(s):  
Jessica S. Lin ◽  
Sean M. Lew ◽  
Charles J. Marcuccilli ◽  
Wade M. Mueller ◽  
Anne E. Matthews ◽  
...  
Keyword(s):  
Epilepsy Surgery ◽  
Refractory Epilepsy ◽  
Initial Step ◽  
Electrode Placement ◽  
Invasive Monitoring ◽  
Eeg Monitoring ◽  
Corpus Callosotomy ◽  
Epileptiform Discharges ◽  
Select Group ◽  
Medically Refractory Epilepsy

Object The object of this study was to evaluate surgical outcome in a select group of patients with medically refractory epilepsy who had undergone corpus callosotomy combined with bilateral subdural electroencephalography (EEG) electrode placement as the initial step in multistage epilepsy surgery. Methods A retrospective chart review of 18 children (ages 3.5–18 years) with medically refractory symptomatic generalized or localization-related epilepsy was undertaken. A corpus callosotomy with subdural bihemispheric EEG electrode placement was performed as the initial step in multistage epilepsy surgery. All of the patients had tonic and atonic seizures; 6 patients also experienced complex partial seizures. All of the patients had frequent generalized epileptiform discharges as well as multifocal independent epileptiform discharges on surface EEG monitoring. Most of the patients (94%) had either normal (44%) MR imaging studies of the brain or bihemispheric abnormalities (50%). One patient had a suspected unilateral lesion (prominent sylvian fissure). Results Of the 18 patients who underwent corpus callosotomy and placement of subdural strips and grids, 12 progressed to further resection based on localizing data obtained during invasive EEG monitoring. The mean patient age was 10.9 years. The duration of invasive monitoring ranged from 3 to 14 days, and the follow-up ranged from 6 to 70 months (mean 35 months). Six (50%) of the 12 patients who had undergone resection had an excellent outcome (Engel Class I or II). There were no permanent neurological deficits or deaths. Conclusions The addition of invasive monitoring for patients undergoing corpus callosotomy for medically refractory epilepsy may lead to the localization of surgically amenable seizure foci, targeted resections, and improved seizure outcomes in a select group of patients typically believed to be candidates for palliative surgery alone.

scholarly journals Retrospective analysis of open surgical versus laser interstitial thermal therapy callosotomy in pediatric patients with refractory epilepsy

2021 ◽  
pp. 1-9
Author(s):  
James P. Caruso ◽  
M. Burhan Janjua ◽  
Alison Dolce ◽  
Angela V. Price
Keyword(s):  
Blood Loss ◽  
Retrospective Analysis ◽  
Pediatric Patients ◽  
Refractory Epilepsy ◽  
Thermal Therapy ◽  
Efficacy And Safety ◽  
Corpus Callosotomy ◽  
Laser Interstitial Thermal Therapy ◽  
Medically Refractory Epilepsy

OBJECTIVECorpus callosotomy remains an established surgical treatment for certain types of medically refractory epilepsy in pediatric patients. While the traditional surgical approach is often well tolerated, the advent of MR-guided laser interstitial thermal therapy (LITT) provides a new opportunity to ablate the callosal body in a minimally invasive fashion and minimize the risks associated with an open interhemispheric approach. However, the literature is sparse regarding the comparative efficacy and safety profiles of open corpus callosotomy (OCC) and LITT callosotomy. To this end, the authors present a novel retrospective analysis comparing the efficacy and safety of these methods.METHODSPatients who underwent OCC and LITT callosotomy during the period from 2005 to 2018 were included in a single-center retrospective analysis. Patient demographic and procedural variables were collected, including length of stay, procedural blood loss, corticosteroid requirements, postsurgical complications, and postoperative disposition. Pre- and postoperative seizure frequency (according to seizure type) were recorded.RESULTSIn total, 19 patients, who underwent 24 interventions (16 OCC and 8 LITT), were included in the analysis. The mean follow-up durations for the OCC and LITT cohorts were 83.5 months and 12.3 months, respectively. Both groups experienced reduced frequencies of seizure and drop attack frequency postoperatively. Additionally, LITT callosotomy was associated with a significant decrease in estimated blood loss and decreased length of pediatric ICU stay, with a trend of shorter length of hospitalization.CONCLUSIONSLonger-term follow-up and a larger population are required to further delineate the comparative efficacies of LITT callosotomy and OCC for the treatment of pediatric medically refractory epilepsy. However, the authors’ data demonstrate that LITT shows promise as a safe and effective alternative to OCC.

scholarly journals Continuing Burden of Refractory Epilepsy

2020 ◽  
pp. 106002802094805
Author(s):  
Marnie T. Janson ◽  
Jacquelyn L. Bainbridge
Keyword(s):  
Refractory Epilepsy ◽  
Neurological Diseases ◽  
Intractable Epilepsy ◽  
Premature Death ◽  
Additional Benefit ◽  
Drug Resistant ◽  
Psychological Consequences ◽  
Epilepsy Treatment ◽  
Patients With Epilepsy

Epilepsy is one of the most common neurological diseases, and uncontrolled seizures remain a significant problem for one-third of patients with epilepsy on drug therapy. Ongoing seizures affect the morbidity and mortality of patients with epilepsy. Premature death is up to 3 times higher in those with epilepsy than in the general population. Quality of life is affected by refractory epilepsy with physical, social, and psychological consequences. Patients may be stigmatized by society, institutions, and their own shame surrounding seizures. Questions remain on how to treat refractory epilepsy, also called drug-resistant, pharmacoresistant, or intractable epilepsy. Cenobamate, a novel antiseizure medication, may provide additional benefit for refractory epilepsy treatment.

P.020 Septo-optic dysplasia plus manifesting with medically refractory epilepsy

2016 ◽  
Vol 43 (S2) ◽  
pp. S26-S26
Author(s):  
MO Al.Khateeb ◽  
S Mirsattari ◽  
D Diosy ◽  
R McLachlan
Keyword(s):  
Refractory Epilepsy ◽  
Intractable Epilepsy ◽  
Nerve Stimulator ◽  
Vagus Nerve Stimulator ◽  
Malformation Of Cortical Development ◽  
Functional Hemispherectomy ◽  
London Health ◽  
Epilepsy Monitoring ◽  
Video Eeg ◽  
Medically Refractory Epilepsy

Background: Septo-Optic Dysplasia is a rare disorder with developmental malformations that was first reported by De Morsier.SOD associated with refractory epilepsy has not been well studied. We report six cases with SOD in patients with malformation of cortical development(MCD) and medically refractory epilepsy that underwent video-EEG telemetry. Methods: Six cases of SOD plus were admitted to the Epilepsy Monitoring Unit at London Health Sciences Centre because of medically refractory epilepsy. Functional hemispherectomy in one patient resulted in significant reduction of her seizures while insertion of a vagus nerve stimulator was not successful in controlling seizures in another patient. Right temporal resection for one patient resulted in about 60% reduction in her seizures. The remaining three patients were not surgical candidates and they remained on antiepileptic drugs. Results: MCD was present in 4/6 patients. Bilateral optic nerve hypoplasia was found in 50% of the patients. EEG was abnormal in all cases(6/6).Intractable epilepsy was found in 6/6 patients. Conclusions: SOD plus was associated with medically refractory epilepsy.

Outcomes After Anterior or Complete Corpus Callosotomy in Children

Neurosurgery ◽  
2013 ◽  
Vol 74 (1) ◽  
pp. 17-28 ◽  
Author(s):  
Aimen S. Kasasbeh ◽  
Matthew D. Smyth ◽  
Karen Steger-May ◽  
Laleh Jalilian ◽  
Mary Bertrand ◽  
...  
Keyword(s):  
Seizure Control ◽  
Refractory Epilepsy ◽  
Single Stage ◽  
Seizure Onset ◽  
Corpus Callosotomy ◽  
Second Stage ◽  
Operative Complications ◽  
Pediatric Patient Population ◽  
Medically Refractory Epilepsy ◽  
Surgical Option

Abstract BACKGROUND: Corpus callosotomy (CC) is a valuable palliative surgical option for children with medically refractory epilepsy due to generalized or multifocal cortical seizure onset. OBJECTIVE: To investigate the extent of CC resulting in optimal seizure control in a pediatric patient population and to evaluate the modification of seizure profile after various CC approaches. METHODS: The records of 58 children (3–22 years of age at the time of surgery) with medically refractory epilepsy who underwent CC between 1995 and 2011 were retrospectively reviewed. RESULTS: Anterior two thirds callosotomy resulted in resolution of absence (P = .03) and astatic (P = .03) seizures, whereas anterior two thirds callosotomy followed by second-stage completion resulted in resolution of generalized tonic-clonic (GTC) (P = .03), astatic (P = .005), and myoclonic (P = .03) seizures in addition to a trend toward resolution of absence seizures (P = .08). Single-stage upfront complete callosotomy resulted in resolution of absence (P = .002), astatic (P &lt; .0001), myoclonic (P = .007), and complex partial (P = .008) seizures in addition to a trend toward resolution of GTC (P = .06). In comparing a composite of subjects who underwent anterior two thirds callosotomy alone or 2-stage complete callosotomy before the second stage to complete the callosotomy with subjects who underwent upfront complete CC, a more favorable outcome was found in those with the upfront complete CC (P = .02). CONCLUSION: Single-stage upfront complete callosotomy is effective in relieving a broader spectrum of seizure types than anterior two thirds callosotomy or 2-stage complete callosotomy in children. The advantages of single-stage complete callosotomy must be weighed against the potentially higher risk of neurological and operative complications.

scholarly journals Thirty-day postoperative morbidity and mortality after temporal lobectomy for medically refractory epilepsy

2018 ◽  
Vol 128 (4) ◽  
pp. 1158-1164 ◽  
Author(s):  
Panagiotis Kerezoudis ◽  
Brandon McCutcheon ◽  
Meghan E. Murphy ◽  
Kenan R. Rajjoub ◽  
Daniel Ubl ◽  
...  
Keyword(s):  
Mortality Rate ◽  
Length Of Stay ◽  
Refractory Epilepsy ◽  
Significant Risk ◽  
Intractable Epilepsy ◽  
Major Complication ◽  
Morbidity And Mortality ◽  
Temporal Lobectomy ◽  
National Database ◽  
Medically Refractory Epilepsy

OBJECTIVETemporal lobectomy is a well-established treatment modality for the management of medically refractory epilepsy in appropriately selected patients. The aim of this study was to assess 30-day morbidity and mortality after temporal lobectomy in cases registered in a national database.METHODSA retrospective cohort analysis was conducted using a multiinstitutional surgical registry compiled between 2006 and 2014. The authors identified patients who underwent anterior temporal lobectomy and/or amygdalohippocampectomy for a primary diagnosis of intractable epilepsy. Univariate and multivariable analyses with regard to patient demographics, comorbidities, operative characteristics, and 30-day outcomes were applied.RESULTSA total of 216 patients were included in the study. The median age was 38 years and 46% of patients were male. The median length of stay was 3 days and the 30-day mortality rate was 1.4%. Fourteen patients (6.5%) developed at least one major complication. Return to the operating room was observed in 7 patients (3.2%). Readmission within 30 days and discharge to a location other than home were available for 2011–2014 (n = 155) and occurred in 11% and 10.3% of patients, respectively. Multivariable regression analysis revealed that increasing age was an independent predictor of discharge disposition other than home and that male sex was a significant risk factor for the development of a major complication. Interestingly, the presence of the attending neurosurgeon and a resident during the procedure was significantly associated with decreased odds of prolonged length of stay (i.e., > 75th percentile [5 days]) and discharge to a location other than home.CONCLUSIONSUsing a multiinstitutional surgical registry, 30-day outcome data after temporal lobectomy for medically intractable epilepsy demonstrates a mortality rate of 1.4%, a major complication rate of 6.5%, and a readmission rate of 11%. Temporal lobectomy is an extremely effective therapy for seizures originating there—however, surgical intervention must be weighed against its morbidity and mortality outcomes.

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