Jump to content

User:NoodleMed/Epilepsy surgery

From Wikipedia, the free encyclopedia

Article Draft

[edit]

Lead

[edit]

- mention sudden unexpected death in epilepsy (SUDEP)

Article body

[edit]

- overall many outdated studies cited

- expand pre-surgical evaluation and localization of epileptic focus

from Epilepsy surgery:

The pre-surgical evaluation for epilepsy is designed to locate the "epileptic focus" or the "epileptogenic zone" (the location where the epilepsy originates in the brain) and to determine if/how surgery could affect normal brain function.[1] Defining the epileptogenic zone has a fundamental role in determining the boundaries of the area that needs to be removed in order to relieve seizures but also to avoid harming the “eloquent cortex” or areas of the brain that control vital/everyday functions such as language, motor control, or vision.[1][2] Resective surgery involves cutting away or disconnecting areas of the brain that are generating or propagating seizures to other parts of the brain.[1] Epileptologists, neurologists with special training in epilepsy, will also confirm the diagnosis of epilepsy to make sure that seizure-like activity is truly due to epilepsy (as opposed to non-epileptic seizures).

The evaluation typically includes neurological physical examination, routine electroencephalography (EEG), Long-term video-EEG monitoring, neuropsychological evaluation, and neuroimaging such as MRI, functional magnetic resonance imaging (fMRI), single photon emission computed tomography (SPECT), positron emission tomography (PET), and magnetoencephalography (MEG).[1][3] Neuroimaging can help identify if there is a structural cause for the seizures, such as a tumor or abnormal blood vessels such as arteriovenous malformations (AVMs). Several imaging techniques including MRI, SPECT, and PET have been found to identify the epileptogenic zone in anywhere from 50% to 80% of cases.[1] Some epilepsy centers use intracarotid sodium amobarbital test (Wada test) and fMRI when evaluating temporal lobe epilepsy surgery, as surgeries in this area of the brain can affect memory.[4] Recent studies note fMRI outperforming the Wada test for memory and language localization.[4][5] Current research into pre-surgical evaluation includes computer models of seizure generation, high-frequency oscillations as biomarkers of epilepsy, and magnetoencephalography for repeat epilepsy surgeries.[6][7][8]

If noninvasive testing was inadequate in identifying the epileptic focus or in distinguishing the surgical target from normal brain tissue and function, then long-term video-EEG monitoring with the use of intracranial electrodes may be required for evaluation.[9] Brain mapping by the technique of cortical electrical stimulation or electrocorticography are other procedures used in the process of invasive testing for certain patients.[10]

Once the epilepsy focus is located, the specific surgery involved in treatment is decided on. The type of surgery depends on the location of the seizure focal point. Surgeries for epilepsy treatment include, but are not limited to: temporal lobe resection, hemispherectomy, ground temporal and extratemporal resection, parietal resection, occipital resection, frontal resection, extratemporal resection, and callosotomy.[11][12]

- add incidence and epidemiology discussion for each resection type

Hemispherectomy

Hemispherectomies can be divided into three main types: anatomic, functional, and hemidecortication.[13] Anatomic hemispherectomy involves the surgical removal of an entire cerebral hemisphere excluding deep structures such as the basal ganglia, thalamus, and brainstem to preserve vital functions. WE Dandy recorded the first anatomic hemispherectomy in 1928 for glioma resection and the first surgery for epilepsy was performed by McKenzie ten years later.[13] This approach is less commonly performed due to high risks of complications, such as hydrocephalus due to blockage of the foramen of Monro, one of the passages that drains cerebrospinal fluid in the brain and spine, and superficial cerebral hemosiderosis (SCH).[13] The procedure became less popular with the introduction of new antiepileptic drugs in the 1960s.[14] Functional hemispherectomies differ in that they disconnect the affected hemisphere from the rest of the brain to prevent spread from the epileptogenic focus to other parts of the brain.[15] Structures involved can include the corpus callosum and thalamocortical fibers, as they are implicated in relaying information between the brain's hemispheres. Many approaches are available and overall are described according to their surgical plane including vertical (between the two hemispheres) and lateral (along the Sylvian fissure).[16] Depending on each patient case, alternate procedures such as hemidecortication or peri-insular hemispherectomies are available to disrupt the epilepsy signal but remain less invasive to minimize risks.[13]

Temporal Lobe Resection

Added citations: Temporal lobe seizures are the most common type (approximately 30% of diagnoses) of seizures for teens and young adults. [17] The surgery has produced successful outcomes, controlling seizures in as much as 70 percent of temporal lobe epilepsy patients.[18]...the surgery can also produce negative outcomes such as memory impairment, visual disturbance, and cognitive dysfunction[19]

Hemispheric dominance can determine the likelihood of certain complications of surgery in the temporal lobe; for the majority of right-handed people, the left hemisphere is dominant and is associated with the brain's language centers (most notably Wernicke's area) and the right (non-dominant) hemisphere is associated with memory and learning of non verbal information such as vision.[20][21] Thus, temporal lobe resection of the dominant hemisphere often causes verbal memory impairment while resection of the non-dominant hemisphere often causes visual memory impairment.[20]

Important structures implicated in temporal lobectomies include the auditory cortex, hippocampus, Wernicke's area, and amygdala; the latter three broadly affecting memory, language, and emotion, respectively. The hippocampus, amygdala, and parahippocampal gyrus are collectively termed the mesial temporal structures and are frequently targeted for resection in epilepsy.[22]

Types of temporal lobectomy include anterior temporal lobectomy (ATL), selective amygdalohippocampectomy (SAH), and laser interstitial thermal therapy (LITT).[19] The ATL resection is the most common technique where the lateral and polar cortex are removed along with the aforementioned mesial temporal structures as well as the posterior part depending on which hemisphere the epileptogenic zone lies.[23] The most common complication after ATL is a defect in vision known as a homonymous superior quadrantanopsia, wherein the upper quarter field of vision on both eyes is altered, known as the "pie in the sky defect", with a frequency from 1.5% to 22%.[23][24][25] ATL surgery resection encompasses the amygdala, hippocampus as well as surrounding tissue or neocortex whereas SAH is more targeted to the former two structures to be as minimally disruptive as possible.[23] The SAH approach goes through a space on the lateral side of the brain known as the Sylvian fissure to reach the amygdala and hippocampus which are deeper in the middle of the brain. These structures may also be targeted through the middle temporal gyrus, below the Sylvian fissure, to avoid the visual pathways that course near the top of the temporal lobe.[26]

The decision between the ATL and SAH should include a multidisciplinary team involving an epileptologist and neurosurgeon and tailored to each patient's specific case. Both have varying rates of seizure freedom depending on how well the epileptogenic zone is localized.[23] One meta-analysis found that there is no significant difference in seizure freedom but visual complications after surgery were less frequent in SAH.[27]

LITT is a minimally invasive technique under imaging guidance (typically MRI) where a small hole is drilled through the skull (a Burr hole) and a precise laser targets structures that are causing seizures, known as laser ablation. Ablative procedures are appropriate options for patients who otherwise would not be good surgical candidates due to other medical problems or specific anatomical reasons that would make targeting their epilepsy difficult with a traditional surgery.[28] Outcomes for each type of surgery vary widely depending on seizure localization, epilepsy specifics, and surgeon approach. Given that this is a new technique, more research into comparing outcomes is necessary but preliminary studies suggest lower seizure freedom.[23][29][30]

From Epilepsy surgery:Extratemporal resection

Extratemporal lobe resection acts as a treatment option for patients with extratemporal epilepsy, or epilepsy patients whose seizure focus is outside of the temporal lobe, and stems from either the occipital lobes, parietal lobe, frontal lobe, or in multiple lobes. The evaluation for the procedure often requires more than clinical, MRI, and EEG convergence due to the variability of the seizure focus. Along with additional imaging techniques such as PET and SPECT, invasive studies may be needed to pinpoint the seizure focus. The efficacy of extratemporal lobe resection generally is less than resection of the temporal lobe. For example, in frontal lobe resections seizure freedom has been achieved in 38-44 percent of patients.

References

[edit]
  1. ^ a b c d e Singh, Jaysingh; Ebersole, John S.; Brinkmann, Benjamin H. (2022-10). "From theory to practical fundamentals of electroencephalographic source imaging in localizing the epileptogenic zone". Epilepsia. 63 (10): 2476–2490. doi:10.1111/epi.17361. ISSN 0013-9580. PMC 9796417. PMID 35811476. {{cite journal}}: Check date values in: |date= (help)CS1 maint: PMC format (link)
  2. ^ Ghatan, Saadi (2025), "Epilepsy in eloquent cortex: resection versus responsive neurostimulation", Pediatric Epilepsy Surgery Techniques, Elsevier, pp. 107–132, doi:10.1016/b978-0-323-95981-0.00002-3, ISBN 978-0-323-95981-0, retrieved 2024-11-26
  3. ^ Yang, Chuanzuo; Liu, Zilu; Wang, Qishao; Wang, Qingyun; Liu, Zhao; Luan, Guoming (2021-05). "Epilepsy as a dynamical disorder orchestrated by epileptogenic zone: a review". Nonlinear Dynamics. 104 (3): 1901–1916. doi:10.1007/s11071-021-06420-4. ISSN 0924-090X. {{cite journal}}: Check date values in: |date= (help)
  4. ^ a b Massot-Tarrús, Andreu; White, Kevin P.; Mousavi, Seyed Reza; Hayman-Abello, Susan; Hayman-Abello, Brent; Mirsattari, Seyed M. (2020-06). "Concordance between fMRI and Wada test for memory lateralization in temporal lobe epilepsy: A meta-analysis and systematic review". Epilepsy & Behavior. 107: 107065. doi:10.1016/j.yebeh.2020.107065. {{cite journal}}: Check date values in: |date= (help)
  5. ^ Dym, R. Joshua; Burns, Judah; Freeman, Katherine; Lipton, Michael L. (2011-11). "Is Functional MR Imaging Assessment of Hemispheric Language Dominance as Good as the Wada Test?: A Meta-Analysis". Radiology. 261 (2): 446–455. doi:10.1148/radiol.11101344. ISSN 0033-8419. {{cite journal}}: Check date values in: |date= (help)
  6. ^ Jirsa, Viktor; Wang, Huifang; Triebkorn, Paul; Hashemi, Meysam; Jha, Jayant; Gonzalez-Martinez, Jorge; Guye, Maxime; Makhalova, Julia; Bartolomei, Fabrice (2023-05). "Personalised virtual brain models in epilepsy". The Lancet Neurology. 22 (5): 443–454. doi:10.1016/S1474-4422(23)00008-X. {{cite journal}}: Check date values in: |date= (help)
  7. ^ Chen, Zhuying; Maturana, Matias I.; Burkitt, Anthony N.; Cook, Mark J.; Grayden, David B. (2021-03-02). "High-Frequency Oscillations in Epilepsy: What Have We Learned and What Needs to be Addressed". Neurology. 96 (9): 439–448. doi:10.1212/WNL.0000000000011465. ISSN 0028-3878.
  8. ^ Otsubo, Hiroshi; Ogawa, Hiroshi; Pang, Elizabeth; Wong, Simeon M; Ibrahim, George M; Widjaja, Elysa (2021-11-02). "A review of magnetoencephalography use in pediatric epilepsy: an update on best practice". Expert Review of Neurotherapeutics. 21 (11): 1225–1240. doi:10.1080/14737175.2021.1910024. ISSN 1473-7175.
  9. ^ Jamal Omidi, Shirin; Hampson, Johnson P.; Lhatoo, Samden D. (2021-03). "Long-term Home Video EEG for Recording Clinical Events". Journal of Clinical Neurophysiology. 38 (2): 92–100. doi:10.1097/WNP.0000000000000746. ISSN 0736-0258. {{cite journal}}: Check date values in: |date= (help)
  10. ^ Roland, Jarod L; Hacker, Carl D; Leuthardt, Eric C (2021-01). "A Review of Passive Brain Mapping Techniques in Neurological Surgery". Neurosurgery. 88 (1): 15–24. doi:10.1093/neuros/nyaa361. ISSN 0148-396X. {{cite journal}}: Check date values in: |date= (help)
  11. ^ Samanta, Debopam; Singh, Rani; Gedela, Satyanarayana; Scott Perry, M.; Arya, Ravindra (2021-04). "Underutilization of epilepsy surgery: Part II: Strategies to overcome barriers". Epilepsy & Behavior. 117: 107853. doi:10.1016/j.yebeh.2021.107853. PMC 8035223. PMID 33678576. {{cite journal}}: Check date values in: |date= (help)CS1 maint: PMC format (link)
  12. ^ Ahmad, Shahjehan; Khanna, Ryan; Sani, Sepehr (2020-12). "Surgical Treatments of Epilepsy". Seminars in Neurology. 40 (06): 696–707. doi:10.1055/s-0040-1719072. ISSN 0271-8235. {{cite journal}}: Check date values in: |date= (help)
  13. ^ a b c d Alotaibi, Faisal; Albaradie, Raidah; Almubarak, Salah; Baeesa, Saleh; Steven, David A.; Girvin, John P. (2021-07). "Hemispherotomy for Epilepsy: The Procedure Evolution and Outcome". Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques. 48 (4): 451–463. doi:10.1017/cjn.2020.216. ISSN 0317-1671. {{cite journal}}: Check date values in: |date= (help)
  14. ^ Rasmussen, Theodore (1983-05). "Hemispherectomy for Seizures Revisited". Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques. 10 (2): 71–78. doi:10.1017/S0317167100044668. ISSN 0317-1671. {{cite journal}}: Check date values in: |date= (help)
  15. ^ Chen, Jia-Shu; Harris, William B.; Wu, Katherine J.; Phillips, H. Westley; Tseng, Chi-Hong; Weil, Alexander G.; Fallah, Aria (2023-07-25). "Comparison of Hemispheric Surgery Techniques for Pediatric Drug-Resistant Epilepsy: An Individual Patient Data Meta-analysis". Neurology. 101 (4). doi:10.1212/WNL.0000000000207425. ISSN 0028-3878. PMC 10435062. PMID 37202158.{{cite journal}}: CS1 maint: PMC format (link)
  16. ^ Chen, Jia-Shu; Harris, William B.; Wu, Katherine J.; Phillips, H. Westley; Tseng, Chi-Hong; Weil, Alexander G.; Fallah, Aria (2023-07-25). "Comparison of Hemispheric Surgery Techniques for Pediatric Drug-Resistant Epilepsy: An Individual Patient Data Meta-analysis". Neurology. 101 (4). doi:10.1212/WNL.0000000000207425. ISSN 0028-3878. PMC 10435062. PMID 37202158.{{cite journal}}: CS1 maint: PMC format (link)
  17. ^ Martinez, Bridget; Peplow, PhilipV (2023). "MicroRNAs as potential biomarkers in temporal lobe epilepsy and mesial temporal lobe epilepsy". Neural Regeneration Research. 18 (4): 716. doi:10.4103/1673-5374.354510. ISSN 1673-5374. PMC 9700089. PMID 36204827.{{cite journal}}: CS1 maint: PMC format (link) CS1 maint: unflagged free DOI (link)
  18. ^ Mathon, Bertrand; Clemenceau, Stéphane (2022-01-01), Miceli, Gabriele; Bartolomeo, Paolo; Navarro, Vincent (eds.), "Chapter 29 - Surgery procedures in temporal lobe epilepsies", Handbook of Clinical Neurology, The Temporal Lobe, vol. 187, Elsevier, pp. 531–556, doi:10.1016/b978-0-12-823493-8.00007-9, retrieved 2024-11-27
  19. ^ a b Kohlhase, Konstantin; Zöllner, Johann Philipp; Tandon, Nitin; Strzelczyk, Adam; Rosenow, Felix (2021-04). "Comparison of minimally invasive and traditional surgical approaches for refractory mesial temporal lobe epilepsy: A systematic review and meta‐analysis of outcomes". Epilepsia. 62 (4): 831–845. doi:10.1111/epi.16846. ISSN 0013-9580. {{cite journal}}: Check date values in: |date= (help)
  20. ^ a b Lee, Tatia M. C.; Yip, James T. H.; Jones‐Gotman, Marilyn (2002-03). "Memory Deficits after Resection from Left or Right Anterior Temporal Lobe in Humans: A Meta‐Analytic Review". Epilepsia. 43 (3): 283–291. doi:10.1046/j.1528-1157.2002.09901.x. ISSN 0013-9580. {{cite journal}}: Check date values in: |date= (help)
  21. ^ Braunsdorf, Marius; Blazquez Freches, Guilherme; Roumazeilles, Lea; Eichert, Nicole; Schurz, Matthias; Uithol, Sebo; Bryant, Katherine L.; Mars, Rogier B. (2021-12). "Does the temporal cortex make us human? A review of structural and functional diversity of the primate temporal lobe". Neuroscience & Biobehavioral Reviews. 131: 400–410. doi:10.1016/j.neubiorev.2021.08.032. {{cite journal}}: Check date values in: |date= (help)
  22. ^ Zachlod, Daniel; Kedo, Olga; Amunts, Katrin (2022), "Anatomy of the temporal lobe: From macro to micro", Handbook of Clinical Neurology, vol. 187, Elsevier, pp. 17–51, doi:10.1016/b978-0-12-823493-8.00009-2, ISBN 978-0-12-823493-8, retrieved 2024-11-27
  23. ^ a b c d e Dorfer, Christian (2025), "Medial temporal lobe epilepsy: selective amygdalohippocampectomy versus anterior temporal lobectomy", Pediatric Epilepsy Surgery Techniques, Elsevier, pp. 91–106, doi:10.1016/b978-0-323-95981-0.00003-5, ISBN 978-0-323-95981-0, retrieved 2024-11-27
  24. ^ Lopez-Gonzalez, Miguel Angel; Gonzalez-Martinez, Jorge Alvaro; Jehi, Lara; Kotagal, Prakash; Warbel, Ann; Bingaman, William (2012-03-01). "Epilepsy Surgery of the Temporal Lobe in Pediatric Population: A Retrospective Analysis". Neurosurgery. 70 (3): 684–692. doi:10.1227/NEU.0b013e318235183d. ISSN 0148-396X.
  25. ^ Kim, Seung-Ki; Wang, Kyu-Chang; Hwang, Yong-Seung; Kim, Ki Joong; Chae, Jong Hee; Kim, In-One; Cho, Byung-Kyu (2008-04). "Epilepsy surgery in children: outcomes and complications". Journal of Neurosurgery: Pediatrics. 1 (4): 277–283. doi:10.3171/PED/2008/1/4/277. ISSN 1933-0707. {{cite journal}}: Check date values in: |date= (help)
  26. ^ Hori, Tomokatsu; Yamane, Fumitaka; Ochiai, Taku; Hayashi, Motohiro; Taira, Takaomi (2003). "Subtemporal Amygdalohippocampectomy Prevents Verbal Memory Impairment in the Language-Dominant Hemisphere". Stereotactic and Functional Neurosurgery. 80 (1–4): 18–21. doi:10.1159/000075154. ISSN 1011-6125.
  27. ^ Xu, Ke; Wang, Xiongfei; Guan, Yuguang; Zhao, Meng; Zhou, Jian; Zhai, Feng; Wang, Mengyang; Li, Tianfu; Luan, Guoming (2020-10). "Comparisons of the seizure-free outcome and visual field deficits between anterior temporal lobectomy and selective amygdalohippocampectomy: A systematic review and meta-analysis". Seizure. 81: 228–235. doi:10.1016/j.seizure.2020.07.024. {{cite journal}}: Check date values in: |date= (help)
  28. ^ Zemmar, Ajmal; Nelson, Bradley J.; Neimat, Joseph S. (2020-07-31). "Laser thermal therapy for epilepsy surgery: current standing and future perspectives". International Journal of Hyperthermia. 37 (2): 77–83. doi:10.1080/02656736.2020.1788175. ISSN 0265-6736.
  29. ^ Marathe, Kajol; Alim-Marvasti, Ali; Dahele, Karan; Xiao, Fenglai; Buck, Sarah; O'Keeffe, Aidan G.; Duncan, John S.; Vakharia, Vejay N. (2021-12-09). "Resective, Ablative and Radiosurgical Interventions for Drug Resistant Mesial Temporal Lobe Epilepsy: A Systematic Review and Meta-Analysis of Outcomes". Frontiers in Neurology. 12. doi:10.3389/fneur.2021.777845. ISSN 1664-2295. PMC 8695716. PMID 34956057.{{cite journal}}: CS1 maint: PMC format (link) CS1 maint: unflagged free DOI (link)
  30. ^ Wang, Ryan; Beg, Usman; Padmanaban, Varun; Abel, Taylor J; Lipsman, Nir; Ibrahim, George M; Mansouri, Alireza (2021-08). "A Systematic Review of Minimally Invasive Procedures for Mesial Temporal Lobe Epilepsy: Too Minimal, Too Fast?". Neurosurgery. 89 (2): 164–176. doi:10.1093/neuros/nyab125. ISSN 0148-396X. {{cite journal}}: Check date values in: |date= (help)
Retrieved from "http://en.wiki.x.io/w/index.php?title=User:NoodleMed/Epilepsy_surgery&oldid=1260241782"