Seizure control after subtotal lesional resection

Gump, William; Skjei, Karen L.; Karkare, Shefali

doi:10.3171/2013.3.focus1348

Cited by 11 publications

(8 citation statements)

References 37 publications

(41 reference statements)

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“…To conclude, this study presented much better outcomes (91%) than other studies (60-85% of good surgical outcome : combination of Engel's classifications I and II)20,22,25,32,35). Comparing with only Engel class I, this study's patients revealed superior results (72.7%) to those (45.1%) of previous studies12,16).…”

Section: Resultscontrasting

confidence: 51%

Emerging Surgical Strategies of Intractable Frontal Lobe Epilepsy with Cortical Dysplasia in Terms of Extent of Resection

Shin

Jung

Kim

et al. 2014

J Korean Neurosurg Soc

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ObjectiveCortical dysplasia (CD) is one of the common causes of epilepsy surgery. However, surgical outcome still remains poor, especially with frontal lobe epilepsy (FLE), despite the advancement of neuroimaging techniques and expansion of surgical indications. The aim of this study was to focus on surgical strategies in terms of extent of resection to improve surgical outcome in the cases of FLE with CD.MethodsA total of 11 patients of FLE were selected among 67 patients who were proven pathologically as CD, out of a total of 726 epilepsy surgery series since 1992. This study categorized surgical groups into three according to the extent of resection : 1) focal corticectomy, 2) regional corticectomy, and 3) partial functional lobectomy, based on the preoperative evaluation, in particular, ictal scalp EEG onset and/or intracranial recordings, and the lesions in high-resolution MRI. Surgical outcome was assessed following Engel's classification system.ResultsFocal corticectomy was performed in 5 patients and regional corticectomy in another set of 5 patients. Only 1 patient underwent partial functional lobectomy. Types I and II CD were detected with the same frequency (45.45% each) and postoperative outcome was fully satisfactory (91%).ConclusionThe strategy of epilepsy surgery is to focus on the different characteristics of each individual, considering the extent of real resection, which is based on the focal ictal onset consistent with neuroimaging, especially in the practical point of view of neurosurgery.

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Section: Resultscontrasting

confidence: 51%

Emerging Surgical Strategies of Intractable Frontal Lobe Epilepsy with Cortical Dysplasia in Terms of Extent of Resection

Shin

Jung

Kim

et al. 2014

J Korean Neurosurg Soc

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“…A gross total resection is correlated with a higher likelihood of seizure freedom, ascribed to the increased chance of removal of the epileptogenic zone (You et al., ). Conversely, a subtotal resection is a major independent risk factor for both early and delayed postoperative seizures (Gump et al., ).…”

Section: Factors Contributing To Epileptogenicitymentioning

confidence: 99%

Depths and grids in brain tumors: Implantation strategies, techniques, and complications

et al. 2013

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SUMMARYPatients with intracranial mass lesions are at increased risk of intractable epilepsy even after tumor resection due to the potential epileptogenicity of lesional and perilesional tissue. Risk factors for tumoral epilepsy include tumor location, histology, and extent of tumor resection. In epilepsy that occurs after tumor resection, the epileptogenic zone often does not correspond precisely with the area of abnormality on imaging, and seizures often arise from a relatively restricted area despite widespread changes on imaging. Invasive monitoring via subdural grids and/or depth electrodes can therefore be helpful to delineate areas of eloquence and localize the epileptogenic zone for subsequent resection. Subdural grids offer excellent contiguous coverage of superficial cortex and allow resection using the same craniotomy, facilitating understanding of anatomic relationships. Depth electrodes offer superior coverage of deep structures, are easier to use in cases where a previous craniotomy is present, are not associated with anatomic distortion due to brain shift, and may be associated with a lower complication rate. We review the biology of focal postoperative epilepsy and invasive diagnostic strategies for the surgical evaluation of medically refractory epilepsy in patients who have undergone resection of intracranial mass lesions.

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“…The extent of resection has been found to correlate with seizure outcome; 30 thus, total lesionectomy is typically sought in attempts to achieve seizure freedom. 26,29,31,[34][35][36] Nevertheless, tumors associated with neuronal migration in adjacent tissue (e.g., dysembryoplastic neuroepithelial tumor, gangliogliomas) may have worse than expected outcome, even in the setting of total lesion resection. 27,37,38 Based on this notion, some would favor resecting additional near-by neuronal tissue, 27 which may be guided by ECoG.…”

Section: Is Electrocorticography Helpful? a Literature Reviewmentioning

confidence: 99%

Pediatric Intraoperative Neurophysiologic Mapping and Monitoring in Brain Surgery

Alsallom,

Simon

2024

Journal of Clinical Neurophysiology

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Summary: Similar to adults, children undergoing brain surgery can significantly benefit from intraoperative neurophysiologic mapping and monitoring. Although young brains present the advantage of increased plasticity, during procedures in close proximity to eloquent regions, the risk of irreversible neurological compromise remains and can be lowered further by these techniques. More so, pathologies specific to the pediatric population, such as neurodevelopmental lesions, often result in medically refractory epilepsy. Thus, their successful surgical treatment also relies on accurate demarcation and resection of the epileptogenic zone, processes in which intraoperative electrocorticography is often employed. However, stemming from the development and maturation of the central and peripheral nervous systems as the child grows, intraoperative neurophysiologic testing in this population poses methodologic and interpretative challenges even to experienced clinical neurophysiologists. For example, it is difficult to perform awake craniotomies and language testing in the majority of pediatric patients. In addition, children may be more prone to intraoperative seizures and exhibit afterdischarges more frequently during functional mapping using electrical cortical stimulation because of high stimulation thresholds needed to depolarize immature cortex. Moreover, choice of anesthetic regimen and doses may be different in pediatric patients, as is the effect of these drugs on immature brain; these factors add additional complexity in terms of interpretation and analysis of neurophysiologic recordings. Below, we are describing the modalities commonly used during intraoperative neurophysiologic testing in pediatric brain surgery, with emphasis on age-specific clinical indications, methodology, and challenges.

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Seizure control after subtotal lesional resection

Cited by 11 publications

References 37 publications

Emerging Surgical Strategies of Intractable Frontal Lobe Epilepsy with Cortical Dysplasia in Terms of Extent of Resection

Emerging Surgical Strategies of Intractable Frontal Lobe Epilepsy with Cortical Dysplasia in Terms of Extent of Resection

Depths and grids in brain tumors: Implantation strategies, techniques, and complications

Pediatric Intraoperative Neurophysiologic Mapping and Monitoring in Brain Surgery

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