Bilateral occipital dysplasia, seizure identification, and ablation: a novel surgical technique

Clarke, Dave; Tindall, Kristi; Lee, Mark; Patel, Bhairav

doi:10.1684/epd.2014.0658

Cited by 51 publications

(20 citation statements)

References 15 publications

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“…There are only a few reports on using SLA for lesional, extratemporal epilepsy. Pathologies include periventricular nodular heterotopia, 11,29 focal cortical dysplasia, 3,6,11,23 tuberous sclerosis, 5 cavernous malformations, 24 and encephalomalacia. 19 Reports on treating nonlesional extratemporal epilepsy with SLA are mostly restricted to insular epilepsy.…”

Section: Discussionmentioning

confidence: 99%

Stereotactic laser ablation for nonlesional cingulate epilepsy: case report

Marashly¹,

Loman

Lew

2018

Journal of Neurosurgery: Pediatrics

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Stereotactic laser ablation (SLA) is being increasingly used to treat refractory focal epilepsy, especially mesial temporal lobe epilepsy. However, emerging evidence suggests it can be used for extratemporal lobe epilepsy as well.The authors report the case of a 17-year-old male who presented with refractory nocturnal seizures characterized by bilateral arms stiffening or rhythmic jerking lasting several seconds. Semiology suggested an epileptogenic zone close to one of the supplementary sensory motor areas. Electroencephalography showed seizures arising from the central region without consistent lateralization. Brain imaging showed no abnormality. An invasive evaluation using bilateral stereoelectroencephalography (SEEG) was utilized in 2 steps, first to establish the laterality of seizures, and second to further cover the mesial cingulate region of the right hemisphere. Seizures arose from the middle portion of the right cingulate gyrus. Extraoperative electrical mapping revealed that the seizure onset zone was adjacent to eloquent motor areas. SLA targeting the right midcingulate gyrus was performed. The patient has remained seizure free since immediately after the procedure with no postoperative deficits (follow-up of 17 months).This case highlights the utility of SEEG in evaluating difficult-to-localize, focal epilepsy. It also demonstrates that the use of SLA can be extended to nonlesional, extratemporal epilepsies.

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Section: Discussionmentioning

confidence: 99%

Stereotactic laser ablation for nonlesional cingulate epilepsy: case report

Marashly¹,

Loman

Lew

2018

Journal of Neurosurgery: Pediatrics

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“…Seizure freedom was achieved 9 months after an ATL and amygdalohippocampotomy. A third patient, discussed by Clarke et al 15 received MRgLITT for the treatment of bilateral occipital dysplasia with PVHs extending from the periventricular region to the occipital lobe, surrounded by eloquent cortex. The proximity of eloquent cortex to the lesion ruled out the use of open resection.…”

Section: Cortical Ablationsmentioning

confidence: 99%

Laser interstitial thermal therapy for the treatment of epilepsy: evidence to date

Shukla¹,

Ho²,

Pendharkar³

et al. 2017

NDT

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Medically intractable epilepsy is associated with increased morbidity and mortality. For those with focal epilepsy and correlated electrophysiological or radiographic features, open surgical resection can achieve high rates of seizure control, but can be associated with neurologic deficits and cognitive effects. Recent innovations have allowed for more minimally invasive methods of surgical seizure control such as magnetic resonance-guided laser interstitial therapy (MRgLITT). MRgLITT achieves the goal of ablating seizure foci while preserving neuropsycho-logical function and offering real-time feedback and monitoring of tissue ablation. This review summarizes the utilization of MRgLITT for mesial temporal lobe epilepsy and other seizure disorders. Overall, the efficacy of MRgLITT is comparable to that of open surgery and offers a less invasive approach in patients with significantly less morbidity.

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“…Laser ablation of periventricular nodular heterotopias (PVH) has been reported in four patients (124–126). Among the three patients with reported follow-up data, one achieved seizure freedom with medication adjustment at 12 months (125), one was seizure free after 8 months (126), and one achieved seizure freedom with subsequent temporal lobectomy and amygdalohippocampectomy (125).…”

Section: Clinical Outcomes Using Commercial Mriglittmentioning

confidence: 99%

“…Among the three patients with reported follow-up data, one achieved seizure freedom with medication adjustment at 12 months (125), one was seizure free after 8 months (126), and one achieved seizure freedom with subsequent temporal lobectomy and amygdalohippocampectomy (125). Nevertheless, PVHs are surgically difficult to access, and laser ablation provides a useful tool for their treatment in the instances where the PVH, rather than the overlying cortex, is determined to be involved in the seizure onset zone.…”

Section: Clinical Outcomes Using Commercial Mriglittmentioning

confidence: 99%

“…In one case, the location was in the posterior frontal region on the dominant side, and the PVH was involved at onset; the patient became seizure free with ablation of the PVH alone, without complication (125). In another case, there were bilateral onsets from PVHs that extended from the periventricular region into the occipital lobes, surrounded by cortical tissue activated by visual fMRI and by optic radiation fibers, as determined by diffusion tensor imaging (126). Laser ablation allowed focal destruction of the PVH bilaterally, with temperature monitoring of surrounding tissue at risk, and the patient became seizure free without visual deficits on field testing.…”

Section: Clinical Outcomes Using Commercial Mriglittmentioning

confidence: 99%

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Stereotactic Laser Ablation for Medically Intractable Epilepsy: The Next Generation of Minimally Invasive Epilepsy Surgery

LaRiviere

Gross

2016

Front. Surg.

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Epilepsy is a common, disabling illness that is refractory to medical treatment in approximately one-third of patients, particularly among those with mesial temporal lobe epilepsy. While standard open mesial temporal resection is effective, achieving seizure freedom in most patients, efforts to develop safer, minimally invasive techniques have been underway for over half a century. Stereotactic ablative techniques, in particular, radiofrequency (RF) ablation, were first developed in the 1960s, with refinements in the 1990s with the advent of modern computed tomography and magnetic resonance-based imaging. In the past 5 years, the most recent techniques have used MRI-guided laser interstitial thermotherapy (LITT), the development of which began in the 1980s, saw refinements in MRI thermal imaging through the 1990s, and was initially used primarily for the treatment of intracranial and extracranial tumors. The present review describes the original stereotactic ablation trials, followed by modern imaging-guided RF ablation series for mesial temporal lobe epilepsy. The developments of LITT and MRI thermometry are then discussed. Finally, the two currently available MRI-guided LITT systems are reviewed for their role in the treatment of mesial temporal lobe and other medically refractory epilepsies.

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Bilateral occipital dysplasia, seizure identification, and ablation: a novel surgical technique

Cited by 51 publications

References 15 publications

Stereotactic laser ablation for nonlesional cingulate epilepsy: case report

Stereotactic laser ablation for nonlesional cingulate epilepsy: case report

Laser interstitial thermal therapy for the treatment of epilepsy: evidence to date

Stereotactic Laser Ablation for Medically Intractable Epilepsy: The Next Generation of Minimally Invasive Epilepsy Surgery

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