Morbidity in epilepsy surgery: an experience based on 2449 epilepsy surgery procedures from a single institution

Tanrıverdi, Taner; Ajlan, Abdulrazag; Poulin, Nicole; Olivier, André

doi:10.3171/2009.8.jns08338

Cited by 131 publications

(120 citation statements)

References 43 publications

(130 reference statements)

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“…Overall, the morbidity and mortality rates (< 1%) in our series are also comparable to similar values reported in the literature. 4,11,21,31 To address this issue moving forward, we are optimistic that current developments including the introduction of robotic stereotaxy and improved imaging techniques (i.e., 3D digital subtraction angiography and/ or double-dose Gd-enhanced MRI, among others) will allow for more accurate and safer placement of SEEG electrodes to avoid vascular and other critical structures, as has been previously reported. 4,9 …”

Section: Seeg Experience At Cleveland Clinic and Comparison With The mentioning

confidence: 99%

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The stereotactic approach for mapping epileptic networks: a prospective study of 200 patients

Serletis

Bulacio

Bingaman

et al. 2014

JNS

153

117

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Object Stereoelectroencephalography (SEEG) is a methodology that permits accurate 3D in vivo electroclinical recordings of epileptiform activity. Among other general indications for invasive intracranial electroencephalography (EEG) monitoring, its advantages include access to deep cortical structures, its ability to localize the epileptogenic zone when subdural grids have failed to do so, and its utility in the context of possible multifocal seizure onsets with the need for bihemispheric explorations. In this context, the authors present a brief historical overview of the technique and report on their experience with 2 SEEG techniques (conventional Leksell frame-based stereotaxy and frameless stereotaxy under robotic guidance) for the purpose of invasively monitoring difficult-to-localize refractory focal epilepsy. Methods Over a period of 4 years, the authors prospectively identified 200 patients with refractory epilepsy who collectively underwent 2663 tailored SEEG electrode implantations for invasive intracranial EEG monitoring and extraoperative mapping. The first 122 patients underwent conventional Leksell frame-based SEEG electrode placement; the remaining 78 patients underwent frameless stereotaxy under robotic guidance, following acquisition of a stereotactic ROSA robotic device at the authors' institution. Electrodes were placed according to a preimplantation hypothesis of the presumed epileptogenic zone, based on a standardized preoperative workup including video-EEG monitoring, MRI, PET, ictal SPECT, and neuropsychological assessment. Demographic features, seizure semiology, number and location of implanted SEEG electrodes, and location of the epileptogenic zone were recorded and analyzed for all patients. For patients undergoing subsequent craniotomy for resection, the type of resection and procedure-related complications were prospectively recorded. These results were analyzed and correlated with pathological diagnosis and postoperative seizure outcomes. Results The epileptogenic zone was confirmed by SEEG in 154 patients (77%), of which 134 (87%) underwent subsequent craniotomy for epileptogenic zone resection. Within this cohort, 90 patients had a minimum follow-up of at least 12 months; therein, 61 patients (67.8%) remained seizure free, with an average follow-up period of 2.4 years. The most common pathological diagnosis was focal cortical dysplasia Type I (55 patients, 61.1%). Per electrode, the surgical complications included wound infection (0.08%), hemorrhagic complications (0.08%), and a transient neurological deficit (0.04%) in a total of 5 patients (2.5%). One patient (0.5%) ultimately died due to intracerebral hematoma directly ensuing from SEEG electrode placement. Conclusions Based on these results, SEEG methodology is safe, reliable, and effective. It is associated with minimal morbidity and mortality, and serves as a practical, minimally invasive approach to extraoperative localization of the epileptogenic zone in patients with refractory epilepsy.

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Section: Seeg Experience At Cleveland Clinic and Comparison With The mentioning

confidence: 99%

“…To date, SEEG is gaining in popularity, and although it has been extensively used in Europe (namely in France and Italy), it has more recently found its way to North America. 22,31 …”

Section: 171822mentioning

confidence: 99%

The stereotactic approach for mapping epileptic networks: a prospective study of 200 patients

Serletis

Bulacio

Bingaman

et al. 2014

JNS

153

117

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“…3,13,14,16,18 Differences in surgical techniques, pathology, and categorization make these results difficult to compare. Complications are usually categorized as surgical or neurological but sometimes as major or minor.…”

Section: Discussionmentioning

confidence: 99%

“…Our rate of permanent neurological complications was 0.2%, which is analogous to other documented rates (0.1%-2.0%). 3,13,16,18 The most common permanent neurological complication described in the literature is hemiparesis. Major hemiparesis was not reported in our series of MTLE cases, probably because our surgical route does not require manipulation of the middle cerebral artery branches in the sylvian fissure.…”

Section: Discussionmentioning

confidence: 99%

Complications after mesial temporal lobe surgery via inferiortemporal gyrus approach

Vale

Reintjes

Garcia

2013

FOC

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Object The purpose of this study was to identify the complications associated with the inferior temporal gyrus approach to anterior mesial temporal lobe resection for temporal lobe epilepsy. Methods This retrospective study examined complications experienced by 483 patients during the 3 months after surgery. All surgeries were performed during 1998–2012 by the senior author (F.L.V.). Results A total of 13 complications (2.7%) were reported. Complications were 8 delayed subdural hematomas (1.6%), 2 superficial wound infections (0.4%), 1 delayed intracranial hemorrhage (0.2%), 1 small lacunar stroke (0.2%), and 1 transient frontalis nerve palsy (0.2%). Three patients with subdural hematoma (0.6%) required readmission and surgical intervention. One patient (0.2%) with delayed intracranial hemorrhage required readmission to the neuroscience intensive care unit for observation. No deaths or severe neurological impairments were reported. Among the 8 patients with subdural hematoma, 7 were older than 40 years (87.5%); however, this finding was not statistically significant (p = 0.198). Conclusions The inferior temporal gyrus approach to mesial temporal lobe resection is a safe and effective method for treating temporal lobe epilepsy. Morbidity and mortality rates associated with this procedure are lower than those associated with other neurosurgical procedures. The finding that surgical complications seem to be more common among older patients emphasizes the need for early surgical referral of patients with medically refractory epilepsy.

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“…27,33) Resective surgery for MTLE has shown favorable outcome and safety, but is not free from failure of seizure control, morbidity, and relapse of seizure. 1,23,26,28,32) Given such faults of conventional surgery, other treatment options should be developed with better outcome and lower morbidity than open surgery.…”

Section: Introductionmentioning

confidence: 99%

Serious Adverse Effects of Gamma Knife Radiosurgery for Mesial Temporal Lobe Epilepsy

Kawamura

Onishi

Kohda

et al. 2012

Neurol. Med. Chir.(Tokyo)

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Gamma knife radiosurgery (GKRS) for mesial temporal lobe epilepsy (MTLE) has been proposed as an alternative to surgical resection. We report serious adverse effects of the treatment after follow-up periods over 9 years in 11 patients treated with GKRS between 1997 and 2000. The target volume of the entorhinoamygdalohippocampectomy area was 4.8-17.1 ml. Marginal dose of 20-25 Gy to the 50% isodose was delivered. One patient was drowned after suffering seizure 7 months after GKRS. Two patients did not show any reduction in seizure frequency over 9 and 18 months. Both patients requested open surgery and became seizure-free postoperatively. Four of the other eight patients were classified as Engel's class I within 4 years after GKRS. One of the four patients experienced symptomatic radiation-induced cerebral edema transiently, one developed radiation necrosis and required surgery 5 years after GKRS, and one developed cognitive impairment with hemiparesis 10 years after GKRS. Magnetic resonance (MR) imaging showed a large cyst in the irradiated temporal lobe. This patient recovered fully after the cyst excision. Only one patient became seizure-free and antiepileptic drug-free without symptomatic radiation-induced complications. However, MR imaging revealed abnormal enhancement, cyst formation, and diffuse white matter change in the irradiated temporal lobe 9 years after GKRS. GKRS for MTLE causes adverse effects of delayed seizure remission and symptomatic radiationinduced complications. Therefore, GKRS cannot be considered as an ideal alternative to surgery for MTLE. Long-term follow-up studies including MR imaging with contrast medium are required for the patients even after successful control of seizures.

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Morbidity in epilepsy surgery: an experience based on 2449 epilepsy surgery procedures from a single institution

Cited by 131 publications

References 43 publications

The stereotactic approach for mapping epileptic networks: a prospective study of 200 patients

The stereotactic approach for mapping epileptic networks: a prospective study of 200 patients

Complications after mesial temporal lobe surgery via inferiortemporal gyrus approach

Serious Adverse Effects of Gamma Knife Radiosurgery for Mesial Temporal Lobe Epilepsy

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