Endoscopic corpus callosotomy and hemispherotomy

Sood, Sandeep; Marupudi, Neena I.; Asano, Eishi; Haridas, Abilash; Ham, Steven D.

doi:10.3171/2015.5.peds1531

Cited by 69 publications

(53 citation statements)

References 13 publications

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“…While many investigators have suggested that only anterior callosotomy is necessary to achieve clinical benefit, others advocate for a complete callosotomy [87]. One group has recently proposed performing a callosotomy using an endoscopic approach [114]. …”

Section: Disconnection Proceduresmentioning

confidence: 99%

Seizure outcomes in nonresective epilepsy surgery: an update

2016

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In approximately 30% of patients with epilepsy, seizures are refractory to medical therapy, leading to significant morbidity and increased mortality. Substantial evidence has demonstrated the benefit of surgical resection in patients with drug-resistant focal epilepsy, and in the present journal, we recently reviewed seizure outcomes in resective epilepsy surgery. However, not all patients are candidates for or amenable to open surgical resection for epilepsy. Fortunately, several non-resective surgical options are now available at various epilepsy centers, including novel therapies which have been pioneered in recent years. Ablative procedures such as stereotactic laser ablation and stereotactic radiosurgery offer minimally invasive alternatives to open surgery with relatively favorable seizure outcomes, particularly in patients with mesial temporal lobe epilepsy. For certain individuals who are not candidates for ablation or resection, palliative neuromodulation procedures such as vagus nerve stimulation, deep brain stimulation, or responsive neurostimulation may result in a significant decrease in seizure frequency and improved quality of life. Finally, disconnection procedures such as multiple subpial transections and corpus callosotomy continue to play a role in select patients with an eloquent epileptogenic zone or intractable atonic seizures, respectively. Overall, open surgical resection remains the gold standard treatment for drug-resistant epilepsy, although it is significantly under-utilized. While non-resective epilepsy procedures have not replaced the need for resection, there is hope that these additional surgical options will increase the number of patients who receive treatment for this devastating disorder - particularly individuals who are not candidates for or who have failed resection.

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Section: Disconnection Proceduresmentioning

confidence: 99%

Seizure outcomes in nonresective epilepsy surgery: an update

2016

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“…In a subsequent cadaveric report, a frontal precoronal craniotomy was used to achieve a total endoscopic callosotomy [4]. In a recent report, Sood, et al used the same precoronal route to successfully perform an endoscopic total callosotomy in four patients [7]. However, even if the above described technique represents a minimally invasive approach of performing a corpus callosotomy, it still necessitates a small craniotomy and a microscopic interhemispheric approach before switching to the endoscopic portion of the procedure.…”

Section: Discussionmentioning

confidence: 99%

Minimally Invasive Robotic Laser Corpus Callosotomy: A Proof of Concept

Singh

Essayed

Deb

et al. 2017

Cureus

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IntroductionWe describe the feasibility of using minimally invasive robotic laser interstitial thermotherapy (LITT) for achieving an anterior two-thirds as well as a complete corpus callosotomy.MethodsTen probe trajectories were plotted on normal magentic resonance imaging (MRI) scans using the Brainlab Stereotactic Planning Software (Brainlab, Munich, Germany). The NeuroBlate® System (Monteris Medical, MN, USA) was used to conform the thermal burn to the corpus callosum along the trajectory of the probe. The distance of the ideal entry site from either the coronal suture and the torcula or nasion and the midline was calculated. The distance of the probe tip from the dorsal and ventral limits of the callosotomy in the sagittal plane were also calculated.ResultsAnterior two-thirds callosotomy was possible in all patients using a posterior parieto-occipital paramedian trajectory through the non-dominant lobe. The average entry point was 3.64 cm from the midline, 10.6 cm behind the coronal suture, and 9.2 cm above the torcula. The probe tip was an average of 1.4 cm from the anterior commissure. For a total callosotomy, an additional contralaterally placed frontal probe was used to target the posterior one-third of the corpus callosum. The average entry site was 3.3 cm from the midline and 9.1 cm above the nasion. The average distance of the probe tip from the base of the splenium was 0.94 cm.ConclusionThe directional thermoablation capability of the NeuroBlate® system allows for targeted lesioning of the corpus callosum, to achieve a two-thirds or complete corpus callosotomy. A laser distance of < 2 cm is sufficient to reach the entire corpus callosum through one trajectory for an anterior two-thirds callosotomy and two trajectories for a complete callosotomy.

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“…4 We do not understand how the authors claim their originality on this technique when our paper was already published 1 before their own paper (date of acceptance of our paper: January 4, 2015, vs date of acceptance of Sood et al's paper: May 11, 2015). Even the PubMed publication shows our paper to have been published April 2015, while Sood and colleagues' paper was published September 2015.…”

Section: Margaret Kaminska MDmentioning

confidence: 91%

“…2 We wonder if any of those patients who went through tapering off of oral baclofen encountered any significant clinical problems. In our practice, we have encountered a case of severe spasticity due to multiple sclerosis, 4 that was minimally responsive to baclofen (60 mg 3 times daily) and tizanidine (4 mg 3 times daily), in which completely tapering off oral baclofen was deemed unfeasible. The patient had previously experienced severe spinal headache following lumbar puncture and therefore she firmly refused an ITB trial.…”

Section: Responsementioning

confidence: 99%

“…We performed an outpatient epidural infusion trial that lasted 12 days, in which her oral baclofen was slowly tapered off while the epidural baclofen rate was gradually titrated up to efficacy. 4 Another point we would like to comment on is the trial protocol (i.e., "Patients were encouraged to lie flat in bed for a minimum of 12 hours after LP [lumbar puncture] and following catheter removal, as well as with the catheter in situ."). We believe a strong focus during the trial should be placed on evaluating how patients are doing during their usual activities of daily living.…”

Section: Responsementioning

confidence: 99%

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