Extratemporal resections in pediatric epilepsy surgery—an overview

Blount, Jeffrey P.

doi:10.1111/epi.13680

Cited by 14 publications

(8 citation statements)

References 41 publications

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“…Focal cortical dysplasia caused medically refractory epilepsy and was amenable to surgical treatment (Blümcke et al, 2011). Completeness of resection of the dysplastic tissue and additional epileptogenic tissue was considered to be one critical factor in determining outcome after surgery (Blount, 2017). Even with the most advanced imaging techniques, the subtle radiographic appearance of FCD still rendered visual identification challenging.…”

Section: Discussionmentioning

confidence: 99%

Clinical Value of Machine Learning in the Automated Detection of Focal Cortical Dysplasia Using Quantitative Multimodal Surface-Based Features

Zhang

et al. 2019

Front. Neurosci.

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Objective: To automatically detect focal cortical dysplasia (FCD) lesion by combining quantitative multimodal surface-based features with machine learning and to assess its clinical value.Methods: Neuroimaging data and clinical information for 74 participants (40 with histologically proven FCD type II) was retrospectively included. The morphology, intensity and function-based features characterizing FCD lesions were calculated vertex-wise on each cortical surface and fed to an artificial neural network. The classifier performance was quantitatively and qualitatively assessed by performing statistical analysis and conventional visual analysis.Results: The accuracy, sensitivity, specificity of the neural network classifier based on multimodal surface-based features were 70.5%, 70.0%, and 69.9%, respectively, which outperformed the unimodal classifier. There was no significant difference in the detection rate of FCD subtypes (Pearson’s Chi-Square = 0.001, p = 0.970). Cohen’s kappa score between automated detection outcomes and post-surgical resection region was 0.385 (considered as fair).Conclusion: Automated machine learning with multimodal surface features can provide objective and intelligent detection of FCD lesion in pre-surgical evaluation and can assist the surgical strategy. Furthermore, the optimal parameters, appropriate surface features and efficient algorithm are worth exploring.

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Section: Discussionmentioning

confidence: 99%

Clinical Value of Machine Learning in the Automated Detection of Focal Cortical Dysplasia Using Quantitative Multimodal Surface-Based Features

Zhang

et al. 2019

Front. Neurosci.

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“…60 There is a wide variety of etiologies of extratemporal lobe epilepsy ranging from cortical dysplasia 61 to tumors, 62 ischemic changes, 63 inflammatory lesions, and vascular malformations. 64…”

Section: Indicationsmentioning

confidence: 99%

Surgical Treatments of Epilepsy

2020

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Nearly 30% of epilepsy patients are refractory to medical therapy. Surgical management of epilepsy is an increasingly viable option for these patients. Although surgery has historically been used as a palliative option, improvements in technology and outcomes show its potential in certain subsets of patients. This article reviews the two main categories of surgical epilepsy treatment—resective surgery and neuromodulation. Resective surgery includes temporal lobe resections, extratemporal resections, laser interstitial thermal therapy, and disconnection procedures. We discuss the three main types of neuromodulation—vagal nerve stimulation, responsive neurostimulation, and deep brain stimulation for epilepsy. The history and indications are explored for each type of treatment. Given the myriad types of resection and neuromodulation techniques, patient selection is reviewed in detail, with a discussion on which patients are most likely to benefit from different treatment strategies. We also discuss outcomes with examples of the pertinent landmark trials and their results. Finally, complications and surgical technique are reviewed. As new indications emerge and patient selection is refined, surgical management will continue to evolve as an adjuvant therapy for epileptic patients.

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“…Epilepsien, die von FCDs innerhalb des frontalen, parietalen oder okzipitalen Neokortex hervorgerufen wer-den, neigen zudem zu einer Reorganisation des Netzwerkes. Diese kann dazu führen, dass Anfälle postoperativ nach einiger Zeit wieder auftreten können [34].…”

Section: Prächirurgische Abklärung Bei Pädiatrischen Patientenunclassified

Pädiatrische Epilepsiechirurgie bei posterioren Epilepsien

2020

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Zusammenfassung Hintergrund Die Epilepsiechirurgie hat sich als wirksame Behandlungsmethode für pharmakoresistente, strukturelle Epilepsien erwiesen. Läsionen im posterioren Kortex stellen dabei – gerade bei Kindern – eine besondere Herausforderung dar. Fragestellung Wirksamkeit der epilepsiechirurgischen Eingriffe bei Kindern und Jugendlichen mit posterioren strukturellen Läsionen. Material und Methoden Literaturüberblick und Zusammenfassung der hauptsächlichen Befunde publizierter Studien zu pädiatrischen Kohorten nach epilepsiechirurgischer Behandlung posteriorer Epilepsien. Ergebnisse Epilepsien aufgrund posteriorer Läsionen sind bei Kindern häufiger als bei Erwachsenen und sind oft weniger klar lokalisiert und weniger deutlich von eloquentem Kortex abgrenzbar. Dennoch haben sich die postoperativen Verläufe in den letzten Jahrzehnten auf Grund von Fortschritten in der Abklärung deutlich verbessert. Schlussfolgerung Auch bei posterioren epileptogenen Läsionen ist die Epilepsiechirurgie oft eine wirksame Behandlungsmethode. Dabei bestehen die besten Aussichten auf Anfallsfreiheit nach frühzeitigen, ausreichend ausgedehnten Eingriffen. Das heißt, diese Kinder und Jugendlichen müssen für ein optimales Outcome umfangreich und v. a. frühzeitig abgeklärt werden.

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Extratemporal resections in pediatric epilepsy surgery—an overview

Cited by 14 publications

References 41 publications

Clinical Value of Machine Learning in the Automated Detection of Focal Cortical Dysplasia Using Quantitative Multimodal Surface-Based Features

Clinical Value of Machine Learning in the Automated Detection of Focal Cortical Dysplasia Using Quantitative Multimodal Surface-Based Features

Surgical Treatments of Epilepsy

Pädiatrische Epilepsiechirurgie bei posterioren Epilepsien

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