How technology is driving the landscape of epilepsy surgery

Abstract

This article emphasizes the role of the technological progress in changing the landscape of epilepsy surgery and provides a critical appraisal of robotic applications, laser interstitial thermal therapy, intraoperative imaging, wireless recording, new neuromodulation techniques, and high-intensity focused ultrasound. Specifically, (a) it relativizes the current hype in using robots for stereo-electroencephalography (SEEG) to increase the accuracy of depth electrode placement and save operating time; (b) discusses the drawback of laser interstitial thermal therapy (LITT) when it comes to the need for adequate histopathologic specimen and the fact that the concept of stereotactic disconnection is not new; (c) addresses the ratio between the benefits and expenditure of using intraoperative magnetic resonance imaging (MRI), that is, the high technical and personnel expertise needed that might restrict its use to centers with a high case load, including those unrelated to epilepsy; (d) soberly reviews the advantages, disadvantages, and future potentials of neuromodulation techniques with special emphasis on the differences between closed and open-loop systems; and (e) provides a critical outlook on the clinical implications of focused ultrasound, wireless recording, and multipurpose electrodes that are already on the horizon. This outlook shows that although current ultrasonic systems do have some limitations in delivering the acoustic energy, further advance of this technique may lead to novel treatment paradigms. Furthermore, it highlights that new data streams from multipurpose electrodes and wireless transmission of intracranial recordings will become available soon once some critical developments will be achieved such as electrode fidelity, data processing and storage, heat conduction as well as rechargeable technology. A better understanding of modern epilepsy surgery will help to demystify epilepsy surgery for the patients and the treating physicians and thereby reduce the surgical treatment gap. K E Y W O R D Sepilepsy surgery, high-intensity focused ultrasound, intraoperative MRI, laser ablation, neuromodulation, robots 842 |

Neurosurgical Approaches to Brain Tissue Harvesting for the Establishment of Cell Cultures in Neural Experimental Cell Models

“…In adults, however, tissue is usually more stable as it is collected during resections and biopsies, and it reaches the laboratory much more quickly. Because adult brain tissue is readily available and abundant due to the greater number of surgeries than neonatal sources, it is the preferred tissue source for experimentation [34,[46][47][48][49]. In our clinical department, the tissue transport time is up to 20 min.…”

“…The use of new technological achievements and the number of invasive procedures in medicine are increasing [48,49]. With the advent of new technological capabilities that support the development of neuroendoscopic and neuronavigational techniques and instruments, surgeries are also becoming less invasive for patients [101].…”

Neurochirurgische Operationsmöglichkeiten bei posteriorer Epilepsie

“…Auch im Falle von umschriebenen therapierefraktären epileptogenen okzipitalen oder parietalen Läsionen wie LEATs, FCDs, vaskuläre Pathologien (AVMs, Ka- Intraoperativ können mithilfe der Neuronavigation [7] in weiterer Folge Läsionsausmaß und Mapping-Daten der eloquenten Areale auf den intraoperativen Situs übertragen werden und die vorgeplanten Resektionsgrenzen für die Läsionektomie definiert werden (maßgeschneiderte Läsionektomie). Mit intraoperativer MR-Bildgebung [7] oder intraoperativem Ultraschall [8] lässt sich in weiterer Folge das Ausmaß der Resektion überprüfen und ermöglicht im Falle von Rest-oder Sattelitenläsionen die Vervollständigung der Resektion innerhalb der gleichen Narkose (intraoperative Second-Look-Surgery) und erspart dem Patienten einen neuerlichen Eingriff bzw. das Schicksal, nicht anfallsfrei zu werden.…”

“…Durch die Einführung neuer Techniken in der Epilepsiechirurgie wie Laserablation oder fokussierter Ultraschall stehen noch mehr minimal-invasive oder perkutane Verfahren zur Verfügung, die für die Zerstörung von Läsionen oder eine Diskonnektion genützt werden können. Damit sind neue Operationsverfahren für die Anwendung für posteriore Epilepsien zu erwarten [8].…”

Covid, AI, and Robotics—A Neurologist's Perspective

“…Robotic frameless neurosurgery has exponentially cut down the time employed to completing the procedure and also minimizing the contact between the surgeon and the patient as well as with the other support staff. Robotic stereotactic surgery has become a routine in many affluent north American hospitals with excellent results and in fact with improved accuracy (Dorfer et al, 2020 ).…”