Stereotactic Surgery for Temporal Lobe Epilepsy

Abstract

There has been a resurgence of interest in stereotactic procedures for epilepsy and functional neurosurgical disorders. There are several factors responsible for this. The most important is the significant improvement in brain imaging which has come as a consequence of the development of computerized tomography and, in particular, magnetic resonance imaging (MRI). T h e s e procedures have improved the spatial definition and resolution of imaging and have made image-guided surgery easier, more accurate and more accessible to mainstream neurosurg e r y. T h e improvements in imaging have worked in concert with an increased understanding of the pathophysiology of epilepsy disorders such that the identification and selection of targets has a stronger scientific rationale than was previously available. In addition to these important developments, there is a large historical basis for the use of stereotactic procedures in the treatment of epilepsy with some interesting if not promising initial results.Finally the general trend towards minimally invasive surgery is responsible for the need to re-examine stereotactic procedures. With the trend towards minimizing surgical exposure and patient discomfort and shortening hospital stay, there will be a further need to re-examine the use of stereotactic functional procedures. ABSTRACT:In light of the recent resurgence of interest in stereotactic functional procedures, the authors have reviewed the role of stereotactic ablative surgery in the treatment of temporal lobe epilepsy. Literature pertaining to stereotactic amygdalotomy, hippocampotomy and fornicotomy is reviewed and summarized. However, the results presented in those early studies are difficult to interpret given the surgical techniques and outcome assessment used. Modern stereotactic ablative surgery using current image-guided technology offers the opportunity to revisit some of these techniques. In recent studies of stereotactic amygdalohippocampotomy, outcomes are not as favorable as those obtained with standard temporal resections. However, these relatively discrete ablative techniques may shed light on the anatomical substrate underlying temporal lobe epilepsy.RÉSUMÉ: La chirurgie stéréotaxique dans l'épilepsie temporale. Dans l'optique d'un regain récent d'intérêt pour les procédures fonctionnelles stéréotaxiques, les auteurs ont revu le rôle de la chirurgie ablative stéréotaxique dans le traitement de l'épilepsie temporale. La littérature concernant l'amygdalotomie stéréotaxique, l'hippocampotomie et la fornicotomie est revue et résumée. Cependant, les résultats présentés dans les études antérieures sont difficiles à interpréter compte tenu des techniques chirurgicales et des moyens d'évaluation des résultats utilisés. La chirurgie ablative stéréotaxique moderne utilisant la technologie sous guidage par imagerie offre l'occasion de revoir certaines de ces techniques. Dans les études récentes de l'amygdalohippocampotomie stéréotaxique, les résultats ne sont pas aussi favorables que ceux obtenus par les résecti...

Radiofrequency thermocoagulation of the seizure‐onset zone during stereoelectroencephalography

“…RFTC was developed >20 years ago, mainly to produce lesions in the amygdala and hippocampus in cases of mesial temporal lobe epilepsy (MTLE), with outcomes that proved to be less favorable than, or similar to, those of standard surgical resective procedures . Following a successful case report of RFTC of the mesial premotor cortex in a patients with nonlesional epilepsy studied by SEEG, the method has been reassessed and applied in etiologies other than hippocampal sclerosis and in extratemporal epilepsies, including MRI‐positive and MRI‐negative cases .…”

“…3 RFTC was developed >20 years ago, mainly to produce lesions in the amygdala and hippocampus in cases of mesial temporal lobe epilepsy (MTLE), with outcomes that proved to be less favorable than, or similar to, those of standard surgical resective procedures. [4][5][6][7][8][9][10][11] Following a successful case report of RFTC of the mesial premotor cortex in a patients with nonlesional epilepsy studied by SEEG, 12 the method has been reassessed and applied in etiologies other than hippocampal sclerosis and in extratemporal epilepsies, including MRI-positive and MRI-negative cases. 3,[13][14][15][16][17][18][19][20][21][22][23][24] The feasibility and safety of RFTC has been demonstrated, 3,[12][13][14][15][16][17][18][19][20][21][22][23][24][25] and outcomes appeared more favorable in patients with malformations of the cortical development (MCDs), especially focal cortical dysplasia (FCD) 14,15,18,20,[22][23]…”

Bilateral stereotactic radiofrequency amygdalohippocampectomy for a patient with bilateral temporal lobe epilepsy

“…Thermocoagulation of epileptic foci in the bilateral medial temporal lobe is not a new technique. As reported in the 1950-1970s, bilateral coagulation confined to the amygdala was safe according to simple neuropsychological studies (Parrent & Lozano, 2000). However, because of lack of advanced techniques and equipment, some severe complications occurred, especially in the coagulation of bilateral hippocampus (Cheung & Chan, 2003).…”

Thermoablation für fokale Epilepsien

“…Die Ergebnisse waren nicht überzeugend, sodass Mitte der 1970-Jahre beklagt wurde, dass es für die Epileptologie im Gegensatz zu den Bewegungsstörungen keine allgemein akzeptierten Indikationen und Zielregionen mehr gab (52) (53,54). Da die Behandlungsergebnisse der klassischen resektiven Verfahren wie der Amygdalohippocampektomie oder der anterioren Temporallappenteilresektion überzeugender waren und zwischenzeitlich viel Erfahrung mit diesen Verfahren gesammelt wurde, wurde die Thermoablation wieder in den Hintergrund gedrängt (55).…”