Treatment for patients with recurrent intractable epilepsy after primary hemispherectomy

Chen, Sichang; Guan, Yuguang; Liu, Changqing; Du, Xiuyu; Zhang, Yao; Chen, Shuai; Wang, Jie; Li, Tianfu; Luan, Guoming

doi:10.1016/j.eplepsyres.2017.11.021

Cited by 7 publications

(5 citation statements)

References 8 publications

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“…However, this would certainly not explain the majority of recurrent cases. Incomplete frontobasal disconnection is another cause of seizure recurrence 31 and may have differed between groups. Some surgeons use the sphenoid ridge as guidance in the lateral approach, leaving the posterior third of the frontobasal connections unresected.…”

Section: Discussionmentioning

confidence: 99%

Comparison of the real‐world effectiveness of vertical versus lateral functional hemispherotomy techniques for pediatric drug‐resistant epilepsy: A post hoc analysis of the HOPS study

Fallah

Lewis²,

Ibrahim

et al. 2021

Epilepsia

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Objective:This study was undertaken to determine whether the vertical parasagittal approach or the lateral peri-insular/peri-Sylvian approach to hemispheric surgery is the superior technique in achieving long-term seizure freedom.Methods:We conducted a post hoc subgroup analysis of the HOPS (Hemispheric Surgery Outcome Prediction Scale) study, an international, multicenter, retrospective cohort study that identified predictors of seizure freedom through logistic regression modeling. Only patients undergoing vertical parasagittal, lateral peri-insular/peri-Sylvian, or lateral trans-Sylvian hemispherotomy were included in this post hoc analysis. Differences in seizure freedom rates were assessed using a time-to-event method and calculated using the Kaplan-Meier survival method.

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Section: Discussionmentioning

confidence: 99%

Comparison of the real‐world effectiveness of vertical versus lateral functional hemispherotomy techniques for pediatric drug‐resistant epilepsy: A post hoc analysis of the HOPS study

Fallah

Lewis²,

Ibrahim

et al. 2021

Epilepsia

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“…The most frequent cause of surgical failure in disconnective surgeries is incomplete disconnection, and reoperation is the treatment of choice. [14][15][16] Usually, persisting connections are deep-seated and small and are particularly suited to being disrupted by MRIgLITT.…”

Section: Discussionmentioning

confidence: 99%

“…Reoperation is the most effective treatment for failed disconnective surgeries, although it is technically challenging and can result in severe complications. [14][15][16] The technique of MRI-guided laser interstitial thermal therapy (MRIgLITT) has previously been used successfully in the treatment of epilepsy. [17][18][19][20][21][22][23][24][25][26] This technology was initially incorporated into our hospital in 2019 to treat hypothalamic hamartomas (HHs) and had very promising outcomes.…”

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confidence: 99%

Completion of disconnective surgery for refractory epilepsy in pediatric patients using robot-assisted MRI-guided laser interstitial thermal therapy

Candela-Cantó

Muchart

Valera

et al. 2023

Journal of Neurosurgery: Pediatrics

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OBJECTIVE Since 2007, the authors have performed 34 hemispherotomies and 17 posterior quadrant disconnections (temporoparietooccipital [TPO] disconnections) for refractory epilepsy at Sant Joan de Déu Barcelona Children’s Hospital. Incomplete disconnection is the main cause of surgical failure in disconnective surgery, and reoperation is the treatment of choice. In this study, 6 patients previously treated with hemispherotomy required reoperation through open surgery. After the authors’ initial experience with real-time MRI-guided laser interstitial thermal therapy (MRIgLITT) for hypothalamic hamartomas, they decided to use this technique instead of open surgery to complete disconnective surgeries. The objective was to report the feasibility, safety, and efficacy of MRIgLITT to complete hemispherotomies and TPO disconnections for refractory epilepsy in pediatric patients. METHODS Eight procedures were performed on 6 patients with drug-resistant epilepsy. Patient ages ranged between 4 and 18 years (mean 10 ± 4.4 years). The patients had previously undergone hemispherotomy (4 patients) and TPO disconnection (2 patients) at the hospital. The Visualase system assisted by a Neuromate robotic arm was used. The ablation trajectory was planned along the residual connection. The demographic and epilepsy characteristics of the patients, precision of the robot, details of the laser ablation, complications, and results were prospectively collected. RESULTS Four patients underwent hemispherotomy and 2 underwent TPO disconnection. Two patients, including 1 who underwent hemispherotomy and 1 who underwent TPO disconnection, received a second laser ablation because of persistent seizures and connections after the first treatment. The average precision of the system (target point localization error) was 1.7 ± 1.4 mm. The average power used was 6.58 ± 1.53 J. No complications were noted. Currently, 5 of the 6 patients are seizure free (Engel class I) after a mean follow-up of 20.2 ± 5.6 months. CONCLUSIONS According to this preliminary experience, laser ablation is a safe method for complete disconnective surgeries and allowed epilepsy control in 5 of the 6 patients treated. A larger sample size and longer follow-up periods are necessary to better assess the efficacy of MRIgLITT to complete hemispherotomy and TPO disconnection, but the initial results are encouraging.

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“…One possible source of incomplete disconnection is the frontobasal disconnection. 38 In lateral approaches, the sphenoid ridge may be erroneously used as a landmark to guide the frontobasal disconnection with the junction of A1 and A2 being the posterior limit, which creates the possibility of leaving the posterior third of the fronto-orbital cortex and its residual frontobasal connections intact. 39 This differs from vertical approaches, which first resect the posterior gyrus rectus.…”

Section: Discussionmentioning

confidence: 99%

Comparison of Hemispheric Surgery Techniques for Pediatric Drug-Resistant Epilepsy

Chen

Harris

et al. 2023

Neurology

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Objective:Hemispheric surgery effectively treats unihemispheric pediatric drug-resistant epilepsy (DRE) by resecting or disconnecting the epileptic hemisphere. Modifications to the original anatomic hemispherectomy have generated multiple functionally equivalent, disconnective techniques for performing hemispheric surgery, termed functional hemispherotomy. While myriad hemispherotomy variants exist, all of them can be categorized according to the anatomic plane they are performed in, which includes vertical approaches at or near the interhemispheric fissure and lateral approaches at or near the Sylvian fissure. This meta-analysis of individual patient data (IPD) aimed to compare seizure outcomes and complications between the hemispherotomy approaches to better characterize their relative efficacy and safety in the modern neurosurgical treatment of pediatric DRE given emerging evidence that outcomes may differ between them.Methods:CINAHL, Embase, PubMed, and Web of Science were searched from inception to September 9th, 2020 for studies reporting IPD from pediatric patients with DRE who underwent hemispheric surgery. Outcomes of interest were seizure freedom at last follow-up, time-to-seizure recurrence, and complications including hydrocephalus, infection, and mortality. Chi-squared test compared the frequency of seizure freedom and complications. Multivariable mixed-effects Cox regression controlling for predictors of seizure outcome was performed on propensity-score matched patients to compare time-to-seizure recurrence between approaches. Kaplan-Meier curves were made to visualize differences in time-to-seizure recurrence.Results:Fifty-five studies reporting on 686 unique pediatric patients treated with hemispheric surgery were included for meta-analysis. Among the hemispherotomy subgroup, vertical approaches had greater seizure freedom rates (81.2% vs. 70.7%,p=0.014) than lateral approaches. While there were no differences in complications, lateral hemispherotomy had higher rates of revision hemispheric surgery due to incomplete disconnection and/or recurrent seizures than vertical hemispherotomy (16.3% vs. 1.2%,p<0.001). After propensity-score matching, vertical hemispherotomy approaches independently conferred longer time-to-seizure recurrence than lateral hemispherotomy approaches (HR=0.44, 95%-CI=0.19-0.98).Conclusions:Among functional hemispherotomy techniques, vertical hemispherotomy approaches confer more durable seizure freedom than lateral approaches without compromising safety. Future prospective studies are required to definitively determine whether vertical approaches are indeed superior and how it should influence clinical guidelines for performing hemispheric surgery.

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Treatment for patients with recurrent intractable epilepsy after primary hemispherectomy

Cited by 7 publications

References 8 publications

Comparison of the real‐world effectiveness of vertical versus lateral functional hemispherotomy techniques for pediatric drug‐resistant epilepsy: A post hoc analysis of the HOPS study

Comparison of the real‐world effectiveness of vertical versus lateral functional hemispherotomy techniques for pediatric drug‐resistant epilepsy: A post hoc analysis of the HOPS study

Completion of disconnective surgery for refractory epilepsy in pediatric patients using robot-assisted MRI-guided laser interstitial thermal therapy

Comparison of Hemispheric Surgery Techniques for Pediatric Drug-Resistant Epilepsy

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