Stereoelectroencephalography-Guided Laser Ablations in Patients With Neocortical Pharmacoresistant Focal Epilepsy: Concept and Operative Technique

Ross, Louis; Naduvil, Ahsan M.; Bulacio, Juan; Najm, Imad; González-Martínez, Jorge

doi:10.1093/ons/opy022

Cited by 15 publications

(14 citation statements)

References 36 publications

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“…Once clinicians have sufficiently formed an SOZ hypothesis based on the iEEG data they have collected, and deem that surgery will not affect eloquent regions, then they proceed with surgery. The types of procedures can be broadly classified as a resection, or laser ablation [147, 128, 148, 149].…”

Section: Supplementary Materials and Methodsmentioning

confidence: 99%

Neural Fragility as an EEG Marker of the Seizure Onset Zone

Huynh

Fitzgerald

et al. 2019

Preprint

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Epilepsy is a global epidemic and 30% of the 60 million patients do not respond to medication treatment. The only treatment options for patients with medically refractory epilepsy are surgical removal or electrical stimulation of the epileptogenic zone (EZ) i.e. the source of their seizures. Despite extensive evaluations with neuroimaging, visual EEG analysis and clinical testing, surgical success rates vary between 30-70%. Currently, no computational methods have been translated into the clinic to assist in localizing the EZ. Here, we applied a dynamical network model that quantifies the fragility of nodes within a patient's intracranial EEG (iEEG) brain network. Fragility is quantified as the minimal amount of perturbation that must to be applied to a node's influence on a "balanced" network to cause imbalance. Here, a balanced network is one in which the connectivity between excitatory and inhibitory nodes render a stable system, and an imbalanced network is unstable and hence can generate seizures. Using iEEG data from 91 patients treated across 5 epilepsy centers (44 successes, 47 failures), we demonstrated that nodal fragility is greater in electrodes within the EZ. In addition, we compared fragility of iEEG nodes to 7 frequency-based and 14 graph theoretic features of the EZ in both seizure (n=91) and non-seizure data (n=54). We calculated a confidence statistic, defined as the ratio of the value of a given feature averaged across electrodes in the clinically annotated seizure onset zone to its average across all other electrodes. Fragility has a significantly greater effect size difference between surgical outcomes when compared to other features. This novel feature, outperformed the most popular iEEG features when comparing across surgical outcomes, possibly defining a superior network-based EEG fingerprint for the EZ.1 Also reachable at adam2392 at gmail dot com. For more information, visit the NCSL website: https://sarmalab.icm.jhu.edu/.

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Section: Supplementary Materials and Methodsmentioning

confidence: 99%

Neural Fragility as an EEG Marker of the Seizure Onset Zone

Huynh

Fitzgerald

et al. 2019

Preprint

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“…MRI-guidance and MR thermography combined with dedicated software allow precise, real-time monitoring of the procedure and direct visual feedback regarding the threedimensional (3D) distribution of the induced thermal tissue damage, thus providing an opportunity to avoid injury to functionally important brain structures [8,9]. LITT also offers the ability to produce lesions of various volumes and shapes by modifying the laser probe position along the planned trajectory [10].…”

Section: Laser Interstitial Thermal Therapymentioning

confidence: 99%

“…Today, stereotactic ablative techniques are used for limited conditions: arteriovenous and cavernous malformations, HHs, mesial temporal lobe sclerosis and, to a lesser extent, complex and deep focal cortical dysplasias, nodular periventricular heterotopias, tuberous sclerosis [139] and subependymal giant cell astrocytomas [140]. Favorable reports exist also for stereoelectroencephalography-guided surgery of neocortical nonlesional epilepsy [10].…”

Section: Drug-resistant Epilepsymentioning

confidence: 99%

Ablative brain surgery: an overview

Franzini

Moosa

Servello

et al. 2019

International Journal of Hyperthermia

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Background: Ablative therapies have been used for the treatment of neurological disorders for many years. They have been used both for creating therapeutic lesions within dysfunctional brain circuits and to destroy intracranial tumors and space-occupying masses. Despite the introduction of new effective drugs and neuromodulative techniques, which became more popular and subsequently caused brain ablation techniques to fall out favor, recent technological advances have led to the resurgence of lesioning with an improved safety profile. Currently, the four main ablative techniques that are used for ablative brain surgery are radiofrequency thermoablation, stereotactic radiosurgery, laser interstitial thermal therapy and magnetic resonance-guided focused ultrasound thermal ablation. Object: To review the physical principles underlying brain ablative therapies and to describe their use for neurological disorders. Methods: The literature regarding the neurosurgical applications of brain ablative therapies has been reviewed. Results: Ablative treatments have been used for several neurological disorders, including movement disorders, psychiatric disorders, chronic pain, drug-resistant epilepsy and brain tumors. Conclusions: There are several ongoing efforts to use novel ablative therapies directed towards the brain. The recent development of techniques that allow for precise targeting, accurate delivery of thermal doses and real-time visualization of induced tissue damage during the procedure have resulted in novel techniques for cerebral ablation such as magnetic resonance-guided focused ultrasound or laser interstitial thermal therapy. However, older techniques such as radiofrequency thermal ablation or stereotactic radiosurgery still have a pivotal role in the management of a variety of neurological disorders.

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“…Laser ablation with MR-guided laser interstitial thermal therapy (MR-g-LITT) is another minimally-invasive technique in which a fiber-optic laser applicator is stereotactically inserted, and ablation is performed while acquiring real-time thermal MRI sequences [27,45,61,62]. At some centers, SEEG electrodes are used to identify ablation targets [82]. Favorable outcomes from SEEG followed by MR-g-LITT for children with MRE have been described [18], although one study reported a relatively high rate of transient functional deficits (7/24 procedures, 29.2%) [78].…”

Section: Therapeutic Applicationsmentioning

confidence: 99%

Stereoelectroencephalography in Pediatric Epilepsy Surgery

Tomlinson

Buch

Armstrong

et al. 2019

J Korean Neurosurg Soc

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Stereoelectroencephalography (SEEG) is an invasive technique used during the surgical management of medically refractory epilepsy. The utility of SEEG rests in its ability to survey the three-dimensional organization of the epileptogenic zone as well as nearby eloquent cortices. Once concentrated to specialized centers in Europe and Canada, the SEEG methodology has gained worldwide popularity due to its favorable morbidity profile, superior coverage of deep structures, and ability to perform multilobar explorations without the need for craniotomy. This rapid shift in practice represents both a challenge and an opportunity for pediatric neurosurgeons familiar with the subdural grid approach. The purpose of this review is to discuss the indications, technique, and safety of long-term SEEG monitoring in children. In addition to reviewing the conceptual and technical points of the diagnostic evaluation, attention will also be given to SEEG-based interventions (e.g., radiofrequency thermo-coagulation).

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Stereoelectroencephalography-Guided Laser Ablations in Patients With Neocortical Pharmacoresistant Focal Epilepsy: Concept and Operative Technique

Abstract: The preliminary experience with the described method shows the feasibility of a unique combination of the SEEG methodology with laser thermocoagulation in patients with neocortical MRI-negative pharmacoresistant focal epilepsy.

Cited by 15 publications

References 36 publications

Neural Fragility as an EEG Marker of the Seizure Onset Zone

Neural Fragility as an EEG Marker of the Seizure Onset Zone

Ablative brain surgery: an overview

Stereoelectroencephalography in Pediatric Epilepsy Surgery

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