Stereotactic Volumetric Radiofrequency Lesioning of Intracranial Structures for Control of Intractable Seizures

Patil, Arun Angelo; Andrews, Richard; Torkelson, Richard

doi:10.1159/000098741

Cited by 43 publications

(20 citation statements)

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“…This procedure has been used to treat patients with a variety of conditions such as intractable pain, movement disorders, refractory epilepsy, and metastatic brain tumors. 5,32,54,56 In 1999, Parrent 53 reported on a patient who continued to have disabling seizures despite partial excision of the HH, anterior temporal lobe resection, and orbitofrontal corticectomy. Later, stereotactic radiofrequency abla-tion of the HH was performed, resulting in progressive amelioration of the epileptic disorder during a 28-month follow-up.…”

Section: Stereotactic Radiofrequency Ablationmentioning

confidence: 99%

Hypothalamic hamartomas. Part 2. Surgical considerations and outcome

Mittal

Montes

et al. 2013

FOC

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Hypothalamic hamartomas are uncommon developmental heterotopic masses composed of an intermixed array of neurons, glia, and myelinated fibers closely associated with the mammillary bodies. Gelastic seizures, the hallmark feature of hypothalamic hamartomas, commonly present in early childhood. However, patients usually also display a disabling clinical syndrome, which may include various other types of refractory seizures with secondary generalization together with progressive cognitive, behavioral, and psychiatric dysfunction. The hamartoma itself has been unequivocally shown to be intrinsically epileptogenic. Over the past 2 decades there has been considerable effort to develop neurosurgical techniques to treat the epileptic syndrome effectively as well as to improve the neurocognitive and behavioral outcome.

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Section: Stereotactic Radiofrequency Ablationmentioning

confidence: 99%

Hypothalamic hamartomas. Part 2. Surgical considerations and outcome

Mittal

Montes

et al. 2013

FOC

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“…It was usually performed several days after MST surgery. The technique for this procedure has been described in previous publications [8,9] . In this procedure, an insulated cannula was stereotactically placed in the AHC, through either the middle temporal gyrus or the occipital lobe.…”

Section: Operative Proceduresmentioning

confidence: 99%

Is Epilepsy Surgery on both Hemispheres Effective?

Patil

Andrews²,

Johnson³

et al. 2004

Stereotact Funct Neurosurg

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Background: Patients with bilateral independent seizure foci are poor candidates for conventional resective epilepsy surgery. The authors have therefore used minimally invasive procedures to treat such patients. In this paper, the result of a large series of patients treated by this approach is examined to determine the effectiveness of this approach. Materials and Methods: The series had 61 patients. The range of follow-up was 15–90 months. The mean follow-up was 41.5 months with a median of 37 months. Patients’ ages at the time of surgery ranged from 3 to 54 years, with a mean of 11.3 and median of 6. Male to female ratio was 39/22. Fifty patients had complex partial seizures, 3 had Lennox-Gastaut syndrome, 4 had myotonic seizures, 2 had infantile spasm, and 2 had myoclonic seizures. Preoperative evaluation included: video electroencephalogram (EEG) monitoring using scalp electrodes, neuropsychological evaluation, magnetic resonance scans, positron emission topography and/or single photon emission computed tomography scans, magnetoencephalogram, Wada test and video EEG recording using subdural electrodes. Multiple subpial transection (MST) was the principle procedure. This procedure was supplemented (17 patients) with minimal cortical resection when intraoperative electroencephalogram indicated that an area failed to respond to MST. When an additional epileptogenic focus was present in the amygdala-hippocampus complex (5 patients), it was treated with stereotactic amygdala-hippocampotomy. The eloquent cortex was treated in 51 patients. The number of lobes treated was 2 in 5 patients, 3 in 5 patients, 4 in 10 patients, 5 in 2 patients, 6 in 38 patients and 8 in 1. Results: Seizure outcome based on Engel’s modified classification was as follows: 32 patients (52.45%) were class I, 5 (8.2%) were class II, 15 (24.59%) were class III, 3 (4.9%) were class IV and 6 (9.83%) were class V. There was no statistical difference between those who were operated on of the first half of the series and those who were operated on of the second half of the series (p = 0.1636). Similarly, there was no statistical difference between this series and two large series in which MST had been performed on one hemisphere (p values of 0.6863 and 0.7337). There was no statistical difference between those who had MST alone and those who had MST plus minimal cortical resection (p = 0.1698). There was no permanent neurological complication in this series. Conclusion: Patients with intractable epilepsy with independent seizure foci in both hemispheres can be safely treated with the approach described in this paper, and seizure control achieved by this approach is fairly satisfactory and similar to that reported in patients with surgery on one hemisphere.

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“…All the three later approaches spare the neocortical areas and achieve wide temporal disconnections. Non-opened techniques have also been developed: -destruction with implantation of Yttrium 90 by Talairach and Szikla [33]; stereotactic radiosurgery lesioning by Barcia [I] and more recently Gamma-knife A-H by Regis and Peragut [23] -stereotactic radio frequency lesions by Chitanondh [2] and Patil [19].…”

Section: Anatomical Characteristics Of the Various Modalities Of Tempmentioning

confidence: 99%