Laser Ablation of a Nonlesional Cingulate Gyrus Epileptogenic Zone Using Robotic-Assisted Stereotactic EEG Localization: A Case Report

Upadhyayula, Pavan S.; Rennert, Robert C.; Hoshide, Reid; Sattar, Shifteh; Gonda, David

doi:10.1159/000496155

Cited by 4 publications

(4 citation statements)

References 25 publications

(24 reference statements)

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“…To the best of our knowledge, there have been only case reports on nonlesional cingulate LITT. 18,19 In our series, the 3 patients (cases 7-9) with only left cingulate seizure onset had favorable seizure outcome (Engel class I-III) following cingulate LITT. The patient (case 2) with both left cingulate and insular seizure onsets who underwent both left insular and cingulate LITT achieved Engel class IB outcome.…”

Section: Key Resultsmentioning

confidence: 56%

Intracranial EEG and laser interstitial thermal therapy in MRI-negative insular and/or cingulate epilepsy: case series

Gireesh

Lee

Skinner

et al. 2021

Journal of Neurosurgery

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OBJECTIVE The goal of this study was to assess the success rate and complications of stereo-electroencephalogra-phy (sEEG) and laser interstitial thermal therapy (LITT) in the treatment of nonlesional refractory epilepsy in cingulate and insular cortex. METHODS The authors retrospectively analyzed the treatment response in 9 successive patients who underwent insular or cingulate LITT for nonlesional refractory epilepsy at their center between 2011 and 2019. Localization of seizures was based on inpatient video-EEG monitoring, neuropsychological testing, 3-T MRI, PET scan, magnetoencephalography scan, and/or ictal SPECT scan. Eight patients underwent sEEG, and 1 patient had implantation of both sEEG electrodes and subdural grids for localization of epileptogenic zones. LITT was performed in 5 insular cases (4 left and 1 right) and 3 cingulate cases (all left-sided). One patient also underwent both insular and cingulate LITT on the left side. All of the patients who underwent insular LITT as well as 2 of the 3 who underwent cingulate LITT were right-hand dominant. The patient who underwent insular plus cingulate LITT was also right-hand dominant. RESULTS Following LITT, 67% of the patients were seizure free (Engel class I) at follow-up (mean 1.35 years, range 0.6–2.8 years). All patients responded favorably to treatment (Engel class I–III). Two patients developed small intracranial hemorrhages during the sEEG implantation that did not require surgical management. One patient developed a large intracranial hemorrhage during an insular LITT procedure that did require surgical management. That patient experienced aphasia, incoordination, and hemiparesis, which resolved with inpatient rehabilitation. No permanent neurological deficits were noted in any of the patients at last follow-up. Neuropsychological status was stable in this cohort before and after LITT. CONCLUSIONS sEEG can be safely used to localize seizures originating from insular and cingulate cortex. LITT can successfully treat seizures arising from these deep-seated structures. The insula and cingulum should be evaluated more frequently for seizure onset zones.

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Section: Key Resultsmentioning

confidence: 56%

Intracranial EEG and laser interstitial thermal therapy in MRI-negative insular and/or cingulate epilepsy: case series

Gireesh

Lee

Skinner

et al. 2021

Journal of Neurosurgery

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“…The search yielded 30 articles reporting on 76 patients with epilepsy arising from the anterior cingulate and 6 cases from the anterior midcingulate cortex were identified. 4,7–34 The localization of the epilepsy within the ACC or aMCC was confirmed by the lack of seizure recurrence after epilepsy surgery in all but six cases. 12,16,17,19,23,32 In the remaining cases, this localization was suggested by the presence of a lesion within the ACC or aMCC and semiology and nuclear medicine studies that were consistent.…”

Section: Resultsmentioning

confidence: 79%

“…An aura is present in more than half the patients and is most frequently emotional or interoceptive, often presenting with fear. Seizures tend to manifest with 14 Normal Anterior frontal N/A Qiao et al 28 L ACC lesion Left cingulate and frontal(ipsilateral) Cingulate Sun et al 33 Normal Contralateral SFG Ipsilateral multifocal Sun et al 33 Normal Ipsilateral insula operculum Cingulate Sun et al 33 Normal Ipsilateral MFG Cingulate Sun et al 33 Normal Ipsilateral ACC Ipsilateral frontal Sun et al 33 Normal Bilateral lateral temporal Nonlocalizable Sun et al 33 Normal Ipsilateral mesial temporal Ipsilateral multifocal Sun et al 33 Normal Contralateral mesial temporal Cingulate 1 frontal Sun et al 33 Normal Ipsilateral opercular Cingulate 1 frontal Upadhyayula et al 31 Normal Bilateral: R 90% SFG 10% L FOp 1 superior insula Normal ACC, anterior cingulate cortex; FOp, frontal operculum; MEG, magnetoencephalography; MFG, middle frontal gyrus; PET, positron emission tomography; SFG, superior frontal gyrus.…”

Section: Discussionmentioning

confidence: 99%

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Anterior Cingulate Epilepsy: A Review

Pana

Nguyen

2023

Journal of Clinical Neurophysiology

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Summary: In this review, the semiology, and characteristics of noninvasive investigations suggestive of anterior cingulate and anterior midcingulate epilepsy are detailed by the authors. The clinical presentation is representative of a recently recognized rostrocaudal gradient of functional connectivity with seizures of the anterior cingulate cortex manifesting emotional and interoceptive aura followed by a hyperkinetic or complex motor seizures. The few reports of anterior midcingulate epilepsy show a trend toward a higher proportion of sensory auras and premotor semiology. Ictal pouting, vocalizations, and, in particular, laughter are strong indicators of epilepsy arising or spreading to this region. Although scalp EEG was traditionally thought to provide little information, the data provided in this review demonstrate that most patients will have abnormalities over the frontal or frontotemporal regions. Frontotemporal abnormalities at least interictally provide valuable information regarding lateralization. The etiology of epilepsy arising from the anterior cingulate region seems to be most frequently secondary to focal cortical dysplasia (FCD), followed by neoplasms and vascular lesions, particularly cavernomas, although one cannot rule out a publication bias. Findings of nuclear medicine imaging is seldomly reported but both positron emission tomography and ictal single-photon computed tomography can identify the generator or the network often showing abnormalities extending to the frontal regions. The few available magnetoencephalography (MEG) studies reveal mixed results, sometimes providing false lateralization of the focus. Anterior cingulate epilepsy is difficult to recognize, but the features summarized in this review should prompt suspicion in clinical practice.

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Magnetic Resonance Imaging-Guided Laser Interstitial Thermal Therapy for Epilepsy: Systematic Review of Technique, Indications, and Outcomes

2020

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BACKGROUND For patients with focal drug-resistant epilepsy (DRE), surgical resection of the epileptogenic zone (EZ) may offer seizure freedom and benefits for quality of life. Yet, concerns remain regarding invasiveness, morbidity, and neurocognitive side effects. Magnetic resonance-guided laser interstitial thermal therapy (MRgLITT) has emerged as a less invasive option for stereotactic ablation rather than resection of the EZ. OBJECTIVE To provide an introduction to MRgLITT for epilepsy, including historical development, surgical technique, and role in therapy. METHODS The development of MRgLITT is briefly recounted. A systematic review identified reported techniques and indication-specific outcomes of MRgLITT for DRE in human studies regardless of sample size or follow-up duration. Potential advantages and disadvantages compared to available alternatives for each indication are assessed in an unstructured review. RESULTS Techniques and outcomes are reported for mesial temporal lobe epilepsy, hypothalamic hamartoma, focal cortical dysplasia, nonlesional epilepsy, tuberous sclerosis, periventricular nodular heterotopia, cerebral cavernous malformations, poststroke epilepsy, temporal encephalocele, and corpus callosotomy. CONCLUSION MRgLITT offers access to foci virtually anywhere in the brain with minimal disruption of the overlying cortex and white matter, promising fewer neurological side effects and less surgical morbidity and pain. Compared to other ablative techniques, MRgLITT offers immediate, discrete lesions with real-time monitoring of temperature beyond the fiber tip for damage estimates and off-target injury prevention. Applications of MRgLITT for epilepsy are growing rapidly and, although more evidence of safety and efficacy is needed, there are potential advantages for some patients.

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Laser Ablation of a Nonlesional Cingulate Gyrus Epileptogenic Zone Using Robotic-Assisted Stereotactic EEG Localization: A Case Report

Cited by 4 publications

References 25 publications

Intracranial EEG and laser interstitial thermal therapy in MRI-negative insular and/or cingulate epilepsy: case series

Intracranial EEG and laser interstitial thermal therapy in MRI-negative insular and/or cingulate epilepsy: case series

Anterior Cingulate Epilepsy: A Review

Magnetic Resonance Imaging-Guided Laser Interstitial Thermal Therapy for Epilepsy: Systematic Review of Technique, Indications, and Outcomes

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