Visual field defects following different resective procedures for mesiotemporal lobe epilepsy

Schmeiser, Barbara; Daniel, Moritz Claudius; Kogias, Evangelos; Böhringer, Daniel; Egger, Karl; Yang, Shan; Foit, Niels Alexander; Schulze‐Bonhage, Andreas; Steinhoff, Bernhard J.; Zentner, Josef; Lagrèze, Wolf A.; Gross, Nikolai

doi:10.1016/j.yebeh.2017.08.037

Cited by 33 publications

(34 citation statements)

References 55 publications

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“…32,33 The 1.3% rate of radiographic hemorrhage, 0.4% rate of symptomatic hemorrhage, and 0.4% rate of permanent deficit from hemorrhage is comparable to reported rates in stereotactic neurosurgical procedures. 10,29,36,37 Visual complications in 5.1% of this cohort are lower than what has been reported for both LITT and temporal lobe resections. Comorbid mood disturbances in patients with epilepsy with worsening of symptoms after temporal lobe surgery have been described.…”

Section: Complicationscontrasting

confidence: 51%

“…Visual disturbances such as diplopia and visual field loss have also been commonly described complications of temporal lobe surgery. 10,29,36,37 Visual complications in 5.1% of this cohort are lower than what has been reported for both LITT and temporal lobe resections. Of interest, the presence of a postoperative complication was associated with poorer seizure outcome.…”

Section: Complicationscontrasting

confidence: 51%

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Effects of surgical targeting in laser interstitial thermal therapy for mesial temporal lobe epilepsy: A multicenter study of 234 patients

et al. 2019

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Objective Laser interstitial thermal therapy (LITT) for mesial temporal lobe epilepsy (mTLE) has reported seizure freedom rates between 36% and 78% with at least 1 year of follow‐up. Unfortunately, the lack of robust methods capable of incorporating the inherent variability of patient anatomy, the variability of the ablated volumes, and clinical outcomes have limited three‐dimensional quantitative analysis of surgical targeting and its impact on seizure outcomes. We therefore aimed to leverage a novel image‐based methodology for normalizing surgical therapies across a large multicenter cohort to quantify the effects of surgical targeting on seizure outcomes in LITT for mTLE. Methods This multicenter, retrospective cohort study included 234 patients from 11 centers who underwent LITT for mTLE. To investigate therapy location, all ablation cavities were manually traced on postoperative magnetic resonance imaging (MRI), which were subsequently nonlinearly normalized to a common atlas space. The association of clinical variables and ablation location to seizure outcome was calculated using multivariate regression and Bayesian models, respectively. Results Ablations including more anterior, medial, and inferior temporal lobe structures, which involved greater amygdalar volume, were more likely to be associated with Engel class I outcomes. At both 1 and 2 years after LITT, 58.0% achieved Engel I outcomes. A history of bilateral tonic‐clonic seizures decreased chances of Engel I outcome. Radiographic hippocampal sclerosis was not associated with seizure outcome. Significance LITT is a viable treatment for mTLE in patients who have been properly evaluated at a comprehensive epilepsy center. Consideration of surgical factors is imperative to the complete assessment of LITT. Based on our model, ablations must prioritize the amygdala and also include the hippocampal head, parahippocampal gyrus, and rhinal cortices to maximize chances of seizure freedom. Extending the ablation posteriorly has diminishing returns. Further work is necessary to refine this analysis and define the minimal zone of ablation necessary for seizure control.

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Section: Complicationscontrasting

confidence: 51%

Section: Complicationscontrasting

confidence: 51%

Effects of surgical targeting in laser interstitial thermal therapy for mesial temporal lobe epilepsy: A multicenter study of 234 patients

et al. 2019

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“…One study in particular reported a higher rate of major visual field deficits in children when compared to adults (38% vs. 14%) and a lower rate of minor visual field deficits in children when compared to adults (6.35 vs. 16%). The higher variability in estimates of the rate of visual field deficits following epilepsy surgery in a pediatric cohort in comparison to previous adult reports, likely arises due to the more diverse surgeries performed as opposed to pure anterior temporal lobectomies that are performed in adults (Hader et al, 2013;Schmeiser et al, 2017) and due to the ability of the brain to reorganize and revert to some extent the severity of visual field deficit initially determined (Yam et al, 2010). In this study, the optic radiations were found to be involved in the resection in 20/43 (46%) patients.…”

Section: Clinical Correlations With Tractographymentioning

confidence: 91%

Microstructural Investigations of the Visual Pathways in Pediatric Epilepsy Neurosurgery: Insights From Multi-Shell Diffusion Magnetic Resonance Imaging

et al. 2020

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Background: Surgery is a key approach for achieving seizure freedom in children with focal onset epilepsy. However, the resection can affect or be in the vicinity of the optic radiations. Multi-shell diffusion MRI and tractography can better characterize tissue structure and provide guidance to help minimize surgical related deficits. Whilst in adults tractography has been used to demonstrate that damage to the optic radiations leads to postoperative visual field deficits, this approach has yet to be properly explored in children.Objective: To demonstrate the capabilities of multi-shell diffusion MRI and tractography in characterizing microstructural changes in children with epilepsy pre-and post-surgery affecting the occipital, parietal or temporal lobes.Methods: Diffusion Tensor Imaging and the Spherical Mean Technique were used to investigate the microstructure of the optic radiations. Furthermore, tractography was used to evaluate whether pre-surgical reconstructions of the optic radiations overlap with the resection margin as measured using anatomical post-surgical T1weighted MRI.Results: Increased diffusivity in patients compared to controls at baseline was observed with evidence of decreased diffusivity, anisotropy, and neurite orientation distribution in contralateral hemisphere after surgery. Pre-surgical optic radiation tractography overlapped with post-surgical resection margins in 20/43 (46%) children, and where visual data was available before and after surgery, the presence of overlap indicated a visual field deficit. Frontiers in Neuroscience | www.frontiersin.org 1 April 2020 | Volume 14 | Article 269 Lacerda et al. Visual Pathways in Pediatric SurgeryConclusion: This is the first report in a pediatric series which highlights the relevance of tractography for future pre-surgical evaluation in children undergoing epilepsy surgery and the usefulness of multi-shell diffusion MRI to characterize brain microstructure in these patients.

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“…Schmeiser and colleagues found new visual field defects in 48% of their cohort. 26,28 Indeed, as shown in anatomical studies based on white matter fiber dissection, 15 disruption of the optic radiation can also occur with a transsylvian procedure if the corticectomy is placed more posterior than it should be, thus violating the limits of the amygdala. These anatomical data clearly explain the high incidence of visual field defects reported in the literature also after transsylvian SA.…”

Section: Complication Rate and Safety Of The Pst Approachmentioning

confidence: 99%

“…4,33 Performing an SA seems to be an important factor (together-among others-with the patient's age and disease laterality) for preserving neuropsychological function. 9 Still, despite the minimally invasive nature of transsylvian SA, in some centers trauma to neocortical structures remains an issue, particularly to visual pathways 4,[26][27][28] and to the so-called temporal stem. The recent introduction of the paramedian supracerebellar-transtentorial (PST) approach in 2012 by Professor Türe offered thus a brilliant solution to obviate the abovementioned issues.…”

mentioning

confidence: 99%

Safety of the paramedian supracerebellar–transtentorial approach for selective amygdalohippocampectomy

Serra

Akeret

Staartjes

et al. 2020

Neurosurgical Focus

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OBJECTIVEThe goal of this study was to assess the reproducibility and safety of the recently introduced paramedian supracerebellar–transtentorial (PST) approach for selective amygdalohippocampectomy (SA).METHODSThe authors performed a retrospective analysis of prospectively collected data originating from their surgical register of patients undergoing SA via a PST approach for lesional medial temporal lobe epilepsy. All patients received thorough pre- and postoperative clinical (neurological, neuropsychological, psychiatric) and instrumental (ictal and long-term EEG, invasive EEG if needed, MRI) workup. Surgery-induced complications were assessed at discharge and at every follow-up thereafter and were classified according to Clavien-Dindo grade (CDG). Epilepsy outcome was defined according to Engel classification. Data were reported according to common descriptive statistical methods.RESULTSBetween May 2015 and May 2018, 17 patients underwent SA via a PST approach at the authors’ institution (hippocampal sclerosis in 13 cases, WHO grade II glioma in 2 cases, and reactive gliosis in 2 cases). The median postoperative follow-up was 7 months (mean 9 months, range 3–19 months). There was no surgery-related mortality and no complication (CDG ≥ 2) in the whole series. Transitory CDG 1 surgical complications occurred in 4 patients and had resolved in all of them by the first postoperative follow-up. One patient showed a deterioration of neuropsychological performance with new slight mnestic deficits. No patient experienced a clinically relevant postoperative visual field defect. No morbidity due to semisitting position was recorded. At last follow-up 13/17 (76.4%) patients were in Engel class I (9/17 [52.9%] were in class IA).CONCLUSIONSThe PST approach is a reproducible and safe surgical route for SA. The achievable complication rate is in line with the best results in the literature. Visual function outcome particularly benefits from this highly selective, neocortex-sparing approach. A larger patient sample and longer follow-up will show in the future if the seizure control rate and neuropsychological outcome also compare better than those achieved with current common surgical techniques.

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Visual field defects following different resective procedures for mesiotemporal lobe epilepsy

Cited by 33 publications

References 55 publications

Effects of surgical targeting in laser interstitial thermal therapy for mesial temporal lobe epilepsy: A multicenter study of 234 patients

Effects of surgical targeting in laser interstitial thermal therapy for mesial temporal lobe epilepsy: A multicenter study of 234 patients

Microstructural Investigations of the Visual Pathways in Pediatric Epilepsy Neurosurgery: Insights From Multi-Shell Diffusion Magnetic Resonance Imaging

Safety of the paramedian supracerebellar–transtentorial approach for selective amygdalohippocampectomy

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