Corpus callosotomy in children with intractable epilepsy using frameless stereotactic neuronavigation: 12-year experience at The Hospital for Sick Children in Toronto

Jea, Andrew; Vachhrajani, Shobhan; Johnson, Keyne K.; Rutka, James T.

doi:10.3171/foc/2008/25/9/e7

Cited by 36 publications

(36 citation statements)

References 31 publications

(26 reference statements)

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“…5,21,22,26,46 Neuronavigation became popular recently for lesionectomy of temporal and extratemporal regions, 6 lesions of the insular region, 49 and callosotomy. 20 With more than 15 years of experience with neuronavigation and intraoperative imaging, our department successfully developed and integrated multimodal imaging techniques in daily neurosurgery.…”

Section: Functional Mri Tractography (Dti) Neuronavigation and Imrimentioning

confidence: 99%

Integration of functional neuronavigation and intraoperative MRI in surgery for drug-resistant extratemporal epilepsy close to eloquent brain areas

Sommer¹,

Grummich²,

Coras

et al. 2013

FOC

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Object The authors performed a retrospective study to assess the impact of functional neuronavigation and intraoperative MRI (iMRI) on surgery of extratemporal epileptogenic lesions on postsurgical morbidity and seizure control. Methods Twenty-five patients (14 females and 11 males) underwent extratemporal resections for drug-resistant epilepsy close to speech/motor brain areas or adjacent to white matter tracts. The mean age at surgery was 34 years (range 12–67 years). The preoperative mean disease duration was 13.2 years. To avoid awake craniotomy, cortical motor-sensory representation was mapped during preoperative evaluation in 14 patients and speech representation was mapped in 15 patients using functional MRI. In addition, visualization of the pyramidal tract was performed in 11 patients, of the arcuate fascicle in 7 patients, and of the visual tract in 6 patients using diffusion tensor imaging. The mean minimum distance of tailored resection between the eloquent brain areas was 5.6 mm. During surgery, blood oxygen level–dependent imaging and diffusion tensor imaging data were integrated into neuronavigation and displayed through the operating microscope. The postoperative mean follow-up was 44.2 months. Results In 20% of these patients, further intraoperative resection was performed because of intraoperatively documented residual lesions according to iMRI findings. At the end of resection, the final iMRI scans confirmed achievement of total resection of the putative epileptogenic lesion in all patients. Postoperatively, transient complications and permanent complications were observed in 20% and 12% of patients, respectively. Favorable postoperative seizure control (Engel Classes I and II) was achieved in 84% and seizure freedom in 72% of these consecutive surgical patients. Conclusions By using functional neuronavigation and iMRI for treatment of epileptogenic brain lesions, the authors achieved a maximum extent of resection despite the lesions' proximity to eloquent brain cortex and fiber tracts in all cases. The authors' results underline possible benefits of this technique leading to a favorable seizure outcome with acceptable neurological deficit rates in difficult-to-treat extratemporal epilepsy.

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Section: Functional Mri Tractography (Dti) Neuronavigation and Imrimentioning

confidence: 99%

Integration of functional neuronavigation and intraoperative MRI in surgery for drug-resistant extratemporal epilepsy close to eloquent brain areas

Sommer¹,

Grummich²,

Coras

et al. 2013

FOC

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“…1,6,7,11,23,25 In the present series, neuronavigation was extremely helpful and reliable in delineating the residual white matter tracts of connectivity across the corpus callosum and anterior commissure. The neuroanatomy of the lateral ventricle, the anterior cerebral and pericallosal arteries, and the interhemispheric fissure may be somewhat distorted at the time of repeat hemispherotomy-hence the value of a tracking system such as neuronavigation.…”

Section: Discussionmentioning

confidence: 96%

Utility of diffusion tensor imaging studies linked to neuronavigation and other modalities in repeat hemispherotomy for intractable epilepsy

Kiehna

Widjaja

Holowka

et al. 2016

PED

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OBJECT Hemispherectomy for unilateral, medically refractory epilepsy is associated with excellent long-term seizure control. However, for patients with recurrent seizures following disconnection, workup and investigation can be challenging, and surgical options may be limited. Few studies have examined the role of repeat hemispherotomy in these patients. The authors hypothesized that residual fiber connections between the hemispheres could be the underlying cause of recurrent epilepsy in these patients. Diffusion tensor imaging (DTI) was used to test this hypothesis, and to target residual connections at reoperation using neuronavigation. METHODS The authors identified 8 patients with recurrent seizures following hemispherectomy who underwent surgery between 1995 and 2012. Prolonged video electroencephalography recordings documented persistent seizures arising from the affected hemisphere. In all patients, DTI demonstrated residual white matter association fibers connecting the hemispheres. A repeat craniotomy and neuronavigation-guided targeted disconnection of these residual fibers was performed. Engel class was used to determine outcome after surgery at a minimum of 2 years of follow-up. RESULTS Two patients underwent initial hemidecortication and 6 had periinsular hemispherotomy as their first procedures at a median age of 9.7 months. Initial pathologies included hemimegalencephaly (n = 4), multilobar cortical dysplasia (n = 3), and Rasmussen's encephalitis (n = 1). The mean duration of seizure freedom for the group after the initial procedure was 32.5 months (range 6–77 months). In all patients, DTI showed limited but definite residual connections between the 2 hemispheres, primarily across the rostrum/genu of the corpus callosum. The median age at reoperation was 6.8 years (range 1.3–14 years). The average time taken for reoperation was 3 hours (range 1.8–4.3 hours), with a mean blood loss of 150 ml (range 50–250 ml). One patient required a blood transfusion. Five patients are seizure free, and the remaining 3 patients are Engel Class II, with a minimum follow-up of 24 months for the group. CONCLUSIONS Repeat hemispherotomy is an option for consideration in patients with recurrent intractable epilepsy following failed surgery for catastrophic epilepsy. In conjunction with other modalities to establish seizure onset zones, advanced MRI and DTI sequences may be of value in identifying patients with residual connectivity between the affected and unaffected hemispheres. Targeted disconnection of these residual areas of connectivity using neuronavigation may result in improved seizure outcomes, with minimal and acceptable morbidity.

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“…Navigation system is not an essential part of the surgery but it may assist the midline section and confirm the length or selectiveness of callosotomy in special cases where length of commisurotomy is tailored. (Jea, Vachhrajani et al 2008) Intraoperative ECOG is not used routinely unless specific area of interest existed. After saline irrigation confirming complete hemostasis, dura is closed with nonabsorbable monofilament sutures in water-tight fashion.…”

Section: Fig 1 Callosotomy Following Midline Cleftmentioning

confidence: 99%

Corpus Callosotomy in Pediatric Intractable Epilepsy: Microsurgical Technique Implication and Variation

Park¹,

Kim²

2011

Epilepsy in Children - Clinical and Social Aspects

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Corpus callosotomy in children with intractable epilepsy using frameless stereotactic neuronavigation: 12-year experience at The Hospital for Sick Children in Toronto

Cited by 36 publications

References 31 publications

Integration of functional neuronavigation and intraoperative MRI in surgery for drug-resistant extratemporal epilepsy close to eloquent brain areas

Integration of functional neuronavigation and intraoperative MRI in surgery for drug-resistant extratemporal epilepsy close to eloquent brain areas

Utility of diffusion tensor imaging studies linked to neuronavigation and other modalities in repeat hemispherotomy for intractable epilepsy

Corpus Callosotomy in Pediatric Intractable Epilepsy: Microsurgical Technique Implication and Variation

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