Pediatric Epilepsy Surgery: Preoperative Assessment and Surgical Treatment

Pediatric Epilepsy Surgery: Preoperative Assessment and Surgical Treatment 2nd Edition
Title Page
Copyright
Dedication
Contents
Videos
Foreword
Preface
Acknowledgments
Contributors
Chapter 1 Basic Considerations of Pediatric Epilepsy Surgery
	Introduction
		Historical Evolution
	Epilepsy Surgery in Children
	Unique Characteristics of and Special Considerations for Children
		Age Group
		Epileptic Syndromes and Pathologies Specific to Children
		Semiology and Electrophysiological Characteristics
		The Effect of Seizures on the Developing Brain
		Functional Plasticity
		Medical Intractability
		Timing of Surgery
		Goals of Surgery
		Surgical Procedures
	Present Status and Future Considerations
	Conclusion
Chapter 2 A Historical Review of Epilepsy Surgery and Its Application in Children
	Introduction
	The Beginning: England
	Germany: Cortical Stimulation, Mapping and Electroencephalography
	The Montreal Neurological Institute: The Beginning of a New Era
	The Quest for a Surgical Treatment for Temporal Lobe Epilepsy
	Exploring the Epileptogenic Network: Stereoencephalography
	Recording Seizures: Long-term Electroencephalography/Video Monitoring
	New Frontier: Pediatric Epilepsy Surgery
	Pediatric Guidelines, Task Forces, and Meetings
	Conclusion
Chapter 3 Epidemiology of Intractable Epilepsy in Children
	Introduction
	Definitions of Intractable Epilepsy
	Intractability that Comes and Goes
	Predicting Intractable Epilepsy
	Epilepsy Syndromes
	Mortality
	Conclusion
Chapter 4 Genetics in Epilepsy Surgery
	Introduction
	Neurobiological Pathways in Genetic Epilepsy
	Genetic Principles in Nonstructural and Structural Epilepsies
		Nonstructural Epilepsies
		Structural Epilepsies
		Challenges of Genetics in Epilepsy Surgery
Chapter 5 Surgical Neuropathology of Pediatric Epilepsy
	Introduction
	Malformations of Cortical Development
		Malformations of Cortical Development Due to Abnormal Neuronal and Glial Proliferation or Differentiation
		Malformations of Cortical Development Due to Abnormal Neuronal Migration
		Malformations of Cortical Development Due to Abnormal Cortical Organization
	Neoplastic Lesions
		Glioneuronal Tumors
		Glial Tumors
	Hamartomas
		Glioneuronal and Glial Hamartomas
		Hypothalamic Hamartomas
		Meningioangiomatosis
	Hippocampal (Mesial Temporal) Sclerosis
	Vascular Malformations
		Arteriovenous and Cavernous Vascular Malformations
		Sturge–Weber Syndrome
	Acquired Lesions
		Vascular and Traumatic Lesions
		Inflammatory Lesions
Chapter 6 Epilepsy and Brain Plasticity
	Introduction: Seizure Susceptibility and Transient Plasticity in the Developing Brain
	Etiology of Seizure Onset and Long-term Plasticity
	Seizures Beget Seizures?
	Neurogenesis in Epilepsy
	Cell Death and Axonal Sprouting
	Inflammation and Epilepsy
	Lesional Epilepsy and Mirror Focus Development
	Possible Clinical Implications
	Conclusion
Chapter 7 Effects of Seizures and Their Comorbidities on the Developing Brain
	Comorbidities in Epilepsy
		Cognitive Deficits
		Psychiatric Comorbidities
	Effects of Early-Life Seizures
	The Impact of Treatment
	Conclusion
Chapter 8 Ethical Considerations in Pediatric Epilepsy Surgery
	Introduction
	Ethical Issues Surrounding Access to Epilepsy Surgery
	Ethical Issues in the Presurgical Evaluation of Children with Intractable Epilepsy
		Informed Consent for Epilepsy Surgery
		Informed Consent in Children
		Informed Consent for Research and the Therapeutic Misconception
	Ethical Issues in Operative Decision-making
		Surgery in Eloquent Cortex
		Clinical Translation of Surgical Innovations
	Conclusion
Chapter 9 Infantile and Childhood-Onset Catastrophic Epilepsy Syndromes
	Introduction
	Catastrophic Epilepsies with an Onset During Infancy and Childhood
		Neonatal Period (~1 Month of Age)
		Infant Period (Aged 1–24 Months)
		Childhood Period (Aged 24+ Months)
Chapter 10 Epilepsy Surgery for Congenital or Early Brain Lesions
	Introduction
	Types of Congenital or EarlyAcquired Lesions Causing Epilepsy
		Hemispheric Lesions
		Focal Lesions
		Nonlesional MRI
	Impact of Early Lesions
		Early Lesions: Role of Adaptive Plasticity
		Early Lesions: Electroencephalography Manifestations
		Timing of Surgery
	Selection of Surgical Candidates
		Types of Surgeries for Early Lesions
	Outcome
	Conclusion
Chapter 11 Intractable Epilepsy in Children and Selection of Surgical Candidates
	Introduction
	When to Refer Children for Epilepsy Surgery?
	Process of Evaluation for Selection of Surgical Candidates
	The Presurgical Clinical Evaluation
		Seizure Semiology and Neurological Examination
		Physical Examination
	Presurgical Evaluation Techniques and Modalities
		Noninvasive Electrophysiology Monitoring
		Structural Neuroimaging
		Functional Neuroimaging
		Neuropsychological Evaluation
	Epilepsy Surgery Conference and Invasive Monitoring
	Surgical Treatment and Outcome
	Postsurgical Follow-up
Chapter 12 Clinical Semiology in Preoperative Assessment
	Introduction
	Localization-Dependent Seizure Semiology
		Frontal Lobe Seizures
		Temporal Lobe Seizures
		Posterior Cortex Seizures
		Seizures with Insular Origin
		Seizure Semiology of Multilobar and Hemispheric Epilepsies
	Epileptic Spasms: When Age Overcomes Localization
	Does Etiology Play a Role in Childhood Seizure Semiology?
	Peri-ictal Lateralizing Signs in Children
	Semiology Pitfalls in Childhood
		Nonepileptic Events Mimicking Childhood Epilepsy Semiology
		Focal Semiology in Nonsurgical Childhood Epilepsy Syndromes
		Extratemporal Epilepsies with Temporal Semiology
		Temporal Lobe Epilepsies with Extratemporal Semiology
		Inconcordant/Incongruent Data During Presurgical Assessment
Chapter 13 Preoperative Neuropsychological and Cognitive Assessment
	Introduction
	Neuropsychological Assessment of Children
	Standardized Psychological Tests
	Domains of Neuropsychological Assessment
		General Cognitive Ability
		Language
		Memory
		Visual–Spatial
		Executive Functions
		Motor and Function
		Psychosocial Adjustment
		Academic Skills
		Adaptive Function
	Epilepsy in Children and Its Effect on Neuropsychological Function
	Goals of Neuropsychological Assessment in Pediatric Epilepsy Surgery
	Special Considerations Regarding Neuropsychological Assessment of Children with Epilepsy
	Neuropsychological Data for Localizing and Lateralizing the Epileptogenic Area
		Language
		Memory
		Visual–Spatial
		Executive Functions
		Special Tests for Localization and Lateralization of Cognitive Function
	Advice to Parents and Teachers Regarding Potential Postoperative Issues
	Follow-up Assessment and Neuropsychological Outcome
	Conclusion
	Acknowledgment
Chapter 14 Electroencephalography and Noninvasive Electrophysiological Assessment
	Introduction
	Electroencephalography Interpretation
		Temporal Lobe Epilepsy
		Extratemporal Lobe Epilepsy
	Activation Procedures
	Functional Imaging and EEG
		EEG Monitoring and SPECT Scan
		EEG Monitoring and PET Imaging
		EEG and Magnetoencephalography
	EEG and Functional MRI
	Pitfalls of Localization of Epileptiform Activity
		Seizure Semiology
		EEG and Epileptogenic Lesions
		False Lateralization/Localization
		Normal EEG
	Emerging Noninvasive Neurophysiology Methods
		EEG Source Imaging
		Infraslow Activity
		High-Frequency Oscillations
		Functional Near-Infrared Spectroscopy-EEG
Chapter 15 Invasive Electrophysiological Monitoring
	Introduction
	Pragmatic Considerations
	Indications
	Inconclusive Preoperative Data
		Normal or Nonspecific Structural Neuroimaging Findings
		Multiple or Large Structural Lesions
		Divergent Preoperative Data
		Epileptogenic Region in Proximity to Eloquent Cortex
	Technical Aspects
		Spatial Coverage
		Type of Electrodes
		Surgical Insertion
	Risks
	Recording
	Interpretation
		Ictal Onset Zone
		Irritative Zone
		Functional Deficit Zone
	Conclusion
Chapter 16 Extraand Intraoperative Electrocortical Stimulation
	Introduction
	Electrocortical Stimulation Basics
		Pediatric Aspects of the Presurgical Evaluation
		A Historical Note
		Physiology of Electrocortical Stimulation
	Extraoperative Electrocortical Stimulation
		General Principles and Techniques
		Safety Issues and Complications in Pediatric Patients
		Special Considerations in Children
		The Effect of Pathology on Electrocortical Stimulation Mapping
		Electrocortical Stimulation with Depth Electrodes in Children
		Electrocortical Stimulation-Induced Responses
		Studying More Specific Brain Anatomy with Stimulation
		Extraoperative Electrocortical Stimulation Compared with Other Noninvasive Functional Mapping Techniques
	Intraoperative Electrocortical Stimulation
	Conclusion
	Acknowledgment
Chapter 17 Stereoelectroencephalography
	Introduction
	Historical Evolution of Stereoelectroencephalography
	Basic Principles of Stereoelectroencephalography
		Anatomo-Electro-Clinical Correlations and Epileptogenic Network Concepts
		Propagation Theory
	Stereoelectroencephalography Indications
	Stereoelectroencephalography Implantation Strategy
	Stereoelectroencephalography Recording
		Stereoelectroencephalography Data Analysis and Interpretation
		Interictal Activities
		Ictal Activities
		Postictal Activities
		Stimulation
		Defining the Epileptogenic Zone
	Special Considerations for Pediatric Patients
	Conclusion
Chapter 18 Magnetoencephalography
	Introduction
	Basic Principles of Magnetoencephalography and Magnetic Source Imaging
	Magnetoencephalography Spike Sources
	Lesional Epilepsy
	Focal Cortical Dysplasia
	Tuberous Sclerosis Complex
	Extratemporal Lobe Epilepsy
	Insular Epilepsy
	Temporal Lobe Epilepsy
	Nonlesional Epilepsy
	Recurrent or Residual Seizures after Surgery
	Functional Mapping
Chapter 19 Structural Brain Imaging in Pediatric Epilepsy
	Introduction
	Magnetic Resonance Techniques
	Epileptogenic Substrates
		Low-Grade Epilepsy-Associated Tumors
		Common Malformations of Cortical Development
		Other Malformations of Cortical Development
		Hypothalamic Hamartoma
		Hippocampal Sclerosis
		Rasmussen’s Encephalitis
		Other Causes for Partial or Catastrophic Epilepsies in Children
	Conclusion
Chapter 20 Functional Magnetic Resonance Imaging in Pediatric Epilepsy Surgery
	Introduction
	Instrumentation and Methods
		Basic Principles of Functional Magnetic Resonance Imaging
		Experimental Designs
		Response Monitoring
		Assessment of Laterality of fMRI Activation
	Applications for Presurgical Evaluation
		Preoperative Assessment of Language Lateralization
		Assessment of Language Lateralization: fMRI and IAT
		Localization of Language Cortex: fMRI and ECS
		Preoperative Assessment of Memory Lateralization
		Localization of Epileptic Discharge Activity Using fMRI
	Conclusion
Chapter 21 Application of Positron Emission Tomography and Single-Photon Emission Computed Tomography in Pediatric Epilepsy Surg
	Introduction
	Rationale for PET and SPECT
	Principles and Techniques of PET
	Principles and Techniques of SPECT
	The Role of PET and SPECT in Pediatric Epilepsy Surgery
		Epileptogenic Region
		Functional Status of the Rest of the Brain
		Postsurgical Evaluation
	Experience with Other PET Tracers in Epilepsy
	Multimodality Imaging with PET-MR
	Conclusion
Chapter 22 Multimodality Imaging and Coregistration
	Introduction
	Coregistration
	Newer Imaging Technologies
		Magnetic Resonance Imaging
		Functional Magnetic Resonance Imaging
		Diffusion Tensor Imaging
		Magnetoencephalography
		Intraoperative Imaging
		Future Perspectives
	Conclusion
	Acknowledgment
Chapter 23 Cerebral Cortex: Embryological Development and Topographical Anatomy
	Introduction
	The Human Cerebral Cortex
	Embryology and Cortical Development of the Cerebral Cortex
	The Cerebral Sulci and Gyri
		Frontal Lobe
		Central Lobe
		Insula and the Peri-insular Region
		Temporal Lobe
		Parietal Lobe
		Occipital Lobe
	Addendum: Topographical Anatomy of the Cerebral Cortex on MRI
		Frontal Lobe
		Parietal Lobe
		Temporal Lobe
		Insular Region
		Occipital Lobe
	Acknowledgment
Chapter 24 Tractographic Anatomy of White Matter
	Introduction
	Limbic System
		Fornix
		Mammillothalamic Tract
		Cingulum
		Thalamic Radiations
	Projection System
		Thalamocortical Sensory Projections
		Extrathalamic Projections
		Optic Radiations
		Auditory Projections
		Corticocerebellar Projections
		Descending Motor Projections
	Commissural Fibers
		Anterior and Posterior Commissures
		Corpus Callosum
	Association System
		Arcuate Fasciculus
		Superior Longitudinal Fasciculus
		Inferior Fronto-Occipital Fasciculus
		Uncinate Fasciculus
		Inferior Longitudinal Fasciculus
		Middle Longitudinal Fasciculus
	Cranial Nerves
	Conclusion
Chapter 25 Localization of Motor Cortex and Subcortical Pathways Using Functional Magnetic Resonance Imaging and Diffusion Tenso
	Introduction
	Functional MRI for Localization of the Motor Cortex
		Indications
		Blood Oxygen Level Dependent fMRI
		Stimulus Presentation
		Functional Anatomy of Sensorimotor System
		Common Sensorimotor Paradigms
		Bilateral Complex Finger Tapping
		Passive Movement or Sensory Paradigms
		Resting State fMRI
		Validation in Literature
	Diffusion Tensor Imaging
		Rationale for Presurgical White Matter Mapping
		Imaging Technique
		Basic Anatomy of Corticospinal Tract
	Essential Considerations and Limitations with BOLD fMRI and DTI Techniques
		Special Considerations and Challenges in Young Children
	Conclusion
Chapter 26 The Wada Test: Lateralization of Language and Memory
	Introduction
	Special Considerations for Pediatric Wada Testing
	Wada Language Testing in Pediatrics
	Wada Memory Testing in Pediatrics
	Conclusion
Chapter 27 Language Lateralization and Localization: Functional Magnetic Resonance Imaging
	Introduction
	fMRI in Children: Challenges and Limitations
	fMRI Language Task Selection
	Language Laterality by fMRI
	New Applications of fMRI in Language Mapping in Children
	Conclusion
Chapter 28 Localization of Eloquent Cortex and White Matter Tracts Under General Anesthesia
	Introduction
	Anatomy and Applied Physiology
	Somatosensory-Evoked Potentials
		Short-Latency Somatosensory-Evoked Potentials
		Localization of the Primary Somatosensory and Motor Cortices with the SSEP Phase Reversal Technique
	Motor Evoked Potentials
		Direct Cortical and Subcortical Electrical Motor Stimulation
		The Multi-Pulse Train High-Frequency Technique: Taniguchi’s Method
		Direct Subcortical Stimulation
	Transcranial Electrical Stimulation
		Physiology, Stimulation, and Recording
		Anesthetic Considerations
		Applications and Interpretation during Lesion Resection in Proximity to Eloquent Cortex
	Navigated Transcranial Magnetic Motor Stimulation
	Future Directions
Chapter 29 Cortical Stimulation and Mapping
	Introduction
	Language Mapping
		Indications for Language Mapping
		Anesthesia for Language Mapping
		Language Mapping Technique
	Motor Mapping
		Indications and Contraindications for Motor Mapping
		Awake versus Asleep Motor Mapping
		Anesthesia for Awake Motor Mapping
		Anesthesia for Asleep Motor Mapping
		Importance of Temperature and Other Physiological Parameters
		Motor Mapping Technique
	Complications Avoidance
		Seizures
		Registration
		Patient Intolerance
		Anesthesia
	Conclusion
Chapter 30 Subcortical Mapping During Intracranial Surgery in Children
	Introduction
	Tractography
	Direct Cortical Stimulation: Traditional Penfield’s Technique
	Short Train Technique and Monitoring of Motor Evoked Potentials
	Subcortical Stimulation
	Cortico-Cortical Evoked Potentials
	Conclusion
Chapter 31 Anesthetic Considerations and Postoperative Intensive Care Unit Care in Pediatric Epilepsy Surgery
	Introduction
	Physiological Differences in Pediatrics
	Preoperative Evaluation and Preparation
	Anesthetic Management
		Premedication
		Induction of Anesthesia
		Airway Management
		Positioning
		Vascular Access
		Maintenance of Anesthesia
		Intraoperative Fluid and Electrolyte Management
	Anesthetic Considerations for Specific Procedures
		Anesthesia for Placement of Grids and Strips
		Stereotactic-Guided Ablations
		Resection of Seizure Focus
		Awake Craniotomy
		Corpus Callosotomy
		Hemispherectomy
		Vagal Nerve Stimulator
	Postoperative Management
	Conclusion
Chapter 32 Pediatric Awake Craniotomy
	Introduction
	Patient Selection and Evaluation
	Anesthetic Evaluation
	Neuropsychological Evaluation
	Psychological Preparation
	Intraoperative Technique
		Operating Room Setup
		Anesthetic Technique
		Induction and Initial Asleep Phase
		Regional Anesthesia for Awake Craniotomy
		Maintenance of Anesthesia
		Electroencephalography for Depth of Anesthesia and Detection of Afterdischarges
		Awake Phase
	Intraoperative Complications
	Conclusion
Chapter 33 Implantation of Strip, Grid, and Depth Electrodes for Invasive Electrophysiological Monitoring
	Introduction
	Indications
	Invasive Monitoring Techniques
		Subdural Strip and Grid Electrodes
		Depth Electrodes
		Advantages and Limitations of Invasive Monitoring Techniques
	Surgical Technique
		Subdural Strip Electrode Placement
		Subdural Grid Electrode Placement
		Intraparenchymal Depth Electrode Placement
	Postoperative Management
	Complications
	Conclusion
Chapter 34 Stereoelectroencephalography in Children: Methodology and Surgical Technique
	Introduction
	History and Basic Principles of the Stereoelectroencephalography Methodology
	Choosing SEEG as the Appropriate Method for Extraoperative Invasive Monitoring
	How to Select SEEG Trajectories: Planning the Implantation?
		Limbic Network Explorations
		Frontal–Parietal Network Explorations
		Posterior Quadrant Network Explorations
	The “Nuts and Bolts” of the SEEG Implantation Technique in Children
	Morbidity and Seizure Outcome in the Pediatric Population
	Conclusion
Chapter 35 Mesial Temporal Sclerosis in Pediatric Epilepsy
	Introduction
	Epidemiology
	Histopathology
	Pathophysiology
		MTS and Febrile Seizures
		Human Herpes Virus 6
		Dual Pathology
	Differential Diagnosis
	Presentation
	Evaluation
		Electroencephalography and Electrocorticography
		Magnetic Resonance Imaging
		Positron Emission Tomography and Single Proton Emission Tomography
		Magnetoencephalography
	Treatment
		Antiepileptic Medications
		Laser Interstitial Thermal Therapy
		Resective Surgery
	Conclusion
Chapter 36 Anteromesial Temporal Lobectomy
	Introduction
	Historical Evolution of the Surgical Technique
	Surgical Technique
		Positioning the Patient
		Scalp Incision
		Craniotomy
		Neocortical Resection
		Mesial Temporal Resection
	Complications
	Outcome
Chapter 37 Selective Amygdalohippocampectomy
	Introduction
	Patient Selection and Preoperative Evaluation
	Surgical Techniques
		Pterional Transsylvian–Transamygdalar Selective Amygdalohippocampectomy
		Paramedian Supracerebellar–Transtentorial Selective Amygdalohippocampectomy
		Surgical Considerations
	Conclusion
Chapter 38 Surgical Management of Lesional Temporal Lobe Epilepsy
	Introduction
		Vascular Malformations
	Pathological Substrate
		Tumors
	Mechanism of Seizures
	Surgical Strategy
		Extent of Resection
		Lesion
		Epileptogenic Zone
		Mesial Temporal Structures
		Dual Pathology
		Location
	Special Considerations in Vascular Malformations
		Cavernous Hemangioma
		Arteriovenous Malformations
	Outcome
		Tumors
		Cavernous Hemangioma
		Arteriovenous Malformation
	Conclusion
Chapter 39 Surgical Management of MRI-Negative Temporal Lobe Epilepsy
	Introduction
	Patients and Methods
		General Workflow at the “Claudio Munari” Center
		MRI-Negative Temporal Lobe Epilepsy Case Series at “Claudio Munari” Epilepsy Surgery Center
	Results
		Illustrative Case
		Continued)
	Discussion
	Conclusion
Chapter 40 Surgical Management of Insular–Opercular Epilepsy in Children
	Introduction
	Insular–Opercular Surgical and Functional Anatomy
		The Insula
		The Opercula
		Insular Function and Connectivity
	Surgical Pathology
	Patient Selection and Surgical Indications
		Surgical Candidate Identification and Selection
		Preoperative Evaluation
		Indication for Invasive Monitoring
		Options for Invasive Investigation
	Surgical Considerations for Invasive Investigation
		Open Method
		SEEG Method
	Insular–Opercular Resective Surgery
		Patient Positioning, Incision, and Craniotomy
		Transsylvian Selective Insulectomy
		Subpial Operculoinsulectomy
		Alternative Procedures
	Outcome
		Seizure Outcome
		Surgical Morbidity
		Neuropsychological Outcome
	Conclusion
Chapter 41 Focal Cortical Dysplasia: Histopathology, Neuroimaging, and Electroclinical Presentation
	Introduction
	Histopathology and Classification of Focal Cortical Dysplasia
	Neuroimaging of Focal Cortical Dysplasia
	Electrographic Signature and Functional Status of Focal Cortical Dysplasia
	Electroclinical Epilepsy Syndromes Associated with Focal Cortical Dysplasia
	Surgical Treatment and Outcomes of Epilepsy due to Focal Cortical Dysplasia
	An Illustrative Case
		Phase 1
		Phase 2
		Phase 3
Chapter 42 Surgical Approaches in Cortical Dysplasia
	Introduction
	Case 1: Well-Defined Focal Cortical Dysplasia Distant from Eloquent Cortex
	Case 2: Poorly Defined Lesion near Eloquent Cortex
	Case 3: Discrete Deep Lesion Close to Eloquent Cortex
	Case 4: Deep Lesion with Unclear Margins, Away from Eloquent Cortex
	Case 5: Deep Lesion, Clear
	Margins
	Outcomes
	Conclusion
	Introduction
	Epilepsy and Neurodevelopment
Chapter 43 Tuberous Sclerosis Complex
	Unknown
	Identification of Epilepsy Surgical Candidates and Challenges in Tuberous Sclerosis Complex
	Presurgical Evaluation of Tuberous Sclerosis Complex
		Imaging Techniques
		Neurophysiology
		Combined Modalities
		Other Experimental Modalities
	Controversies in Pediatric Epilepsy Surgery in Tuberous Sclerosis Complex
		Tuber-to-Tuber Propagation
		Intraversus Extratuber Onset of Seizures
		Minimally Invasive or Large Resection Volume?
		Can Extensive Preoperative Workup Preclude the Need for Invasive Monitoring?
Chapter 44 Resective Epilepsy Surgery for Tuberous Sclerosis Complex
	Introduction
	Epilepsy Syndromes in Tuberous Sclerosis Complex: Why Is It Difficult to Treat?
	The History of Resective Surgery
	Future Surgical Management Strategies
	An Illustrative Case
	Acknowldgement
Chapter 45 Extratemporal Resection and Staged Epilepsy Surgery in Children
	Introduction
	Unique Considerations in Pediatric Extratemporal Epilepsy Surgery
	Presurgical Evaluation
		Noninvasive Modalities
		Functional Mapping
	Surgical Techniques
		Implantation of Subdural Electrodes
		Stereoelectroencephalography
		Seizure Focus Resection
		Stereotactic Laser Ablation
	Results
	Conclusion
Chapter 46 Supplementary Sensorimotor Area Surgery
	Introduction
	Anatomy
	Supplementary Sensorimotor Area Function
	SMA Syndrome
	Functional Mapping
	Seizures Arising from the SSMA
	Seizure Outcomes following Surgical Resection
Chapter 47 Rolandic Cortex Surgery
	Introduction
	Historical Background of Rolandic Surgery
	Clinical and Pathological Features of Rolandic Epilepsy: Idiopathic and Lesional
	Evaluation of Patients for Surgery
		Presurgical Evaluation
		Locating the Epileptogenic Zone: The Case for Extraoperative Seizure Mapping
	Subdural Grid Placement
	Localization of Primary Motor and Somatosensory Cortex
	Resective Surgery
	Surgical Complications
	Neurological Outcomes
	Seizure Outcomes
	Conclusion
Chapter 48 Anterior Peri-insular Quadrantotomy
	Introduction
	Indications
		An Illustrative Case
	Preoperative Assessment
	Anesthetic Considerations
	Intraoperative Functional Mapping
	Operative Technique of Periinsular Anterior Quadrantotomy
		Step 1: Suprainsular Window
		Step 2: Anterior Callosotomy
		Step 3: Intrafrontal Disconnection
		Step 4: Frontobasal Disconnection
		Closure
	General Considerations and Complications
	Outcomes
	Acknowlgement
Chapter 49 Posterior Peri-insular Quadrantotomy
	Introduction
	Indications
	Case Series
		Illustrative Case
	Preoperative Assessment
	Anesthetic Considerations
	Intraoperative Functional Mapping
		Anatomical Localization of Perirolandic Cortices
		Electrophysiological Localization of Perirolandic Cortices
		Electrocorticographical Localization and Monitoring of Perirolandic Cortices
	Operative Technique of Peri-insular Posterior Quadrantotomy
		Step 1: Infrainsular Window
		Step 2: Parieto-occipital Disconnection
	Closure and Early Postoperative Management
	Complications
	Outcomes
	Acknowledgment
Chapter 50 Tailored Extratemporal Resection in Children with Epilepsy
	Introduction
	Patient Selection and Presurgical Evaluation
		Noninvasive Evaluation
		Invasive Evaluation
	Surgery
		Presurgical Planning
		Types of Resection
		Technical Aspects
		Sites of Resections
		Histological Findings
	Outcomes
		Seizure Outcome
		Functional Outcome
	Complications
	Two Illustrative Cases
		Case One
		Case Two
Chapter 51 Surgical Management of MRINegative Extratemporal Lobe Epilepsy
	Introduction
	Seizure Semiology
		Hemispheric Lateralization
		Frontal Lobe Seizures
		Parietal-Occipital Onset
		Insular Seizures
		Confirming Localization
	Advanced Imaging and Electrophysiology
		Positron Emission Tomography
		Single Photon Emission Computed Tomography
		Magnetoencephalography
		Electrocorticography
		Stereotactic EEG
	Seizure Outcomes
Chapter 52 Surgical Management of Hypothalamic Hamartomas
	Anatomic Features
	Molecular and Genetic Characteristics
	Clinical Manifestations
		Epilepsy
		Precocious Puberty
		Behavioral, Cognitive, and Psychiatric Disorders
	Neuroimaging Findings
		Computed Tomography
		Magnetic Resonance Imaging and Magnetic Resonance Spectroscopy
	Electrographic Findings
	Surgical Decision Making
	Surgical Techniques
		Microsurgical Approaches
		Staged Approaches and Repeat Surgery
		Stereotactic Gamma Knife Radiosurgery
		Stereotactic Laser Ablation
	Conclusion
Chapter 53 Hemispherectomy and Hemispherotomy Techniques in Pediatric Epilepsy Surgery
	Introduction
	Hemispheric Epilepsy Surgery: From Resection to Disconnection
	Epilepsy Syndromes Associated with Hemispheric Lesions
		Infantile Spasms
		Hemiconvulsion-Hemiplegia-Epilepsy Syndrome
		Sturge-Weber Syndrome
		Hemimegalencephaly
		Cortical Dysplasia
		Rasmussen’s Encephalitis
		Porencephalic Cyst
	Preoperative Assessment
		Medical Intractability
		Clinical Status
		Physical Examination
		Electroencephalographic Assessment
		Structural Imaging
		Functional Imaging
		Wada Test
		Neuropsychological Evaluation
	Surgical Planning
	Surgical Approaches
		Anatomical Hemispherectomy
		Hemidecortication
		Functional Hemispherectomy
		Hemispherotomy
		Vertical Approach: Transventricular Vertical Hemispherotomy
	Special Considerations Regarding the Hemispheric Surgical Approaches
	Complications
	Outcomes
	Conclusion
Chapter 54 Multifocal Epilepsy and Multilobar Resections
	Introduction
	Indications
	Epidemiology
	Workup
	Surgical Strategies
	Pathology
	Outcomes
	Conclusion
Chapter 55 Anatomical Hemispherectomy
	Introduction
	Historical Background
	Indications
	Preoperative Evaluation
	Surgical Technique
		Anesthesia and Perioperative Monitoring
		Operative Positioning and Opening
		Hemispherectomy
		Closure
	Complications
	Critical Analysis of Outcome
Chapter 56 Hemidecortication for Intractable Epilepsy
	Introduction
	History and Development
	Patient Selection and Indications
		Rasmussen’s Encephalitis
		Malformation of Cortical Development
		Vascular Injury
		Sturge-Weber
	The Differences between Hemidecortication and Other Techniques
	Presurgical Preparation
	Surgical Techniques—Pitfalls
	Postoperative Management
		Loss of Brain Volume
		Postoperative Medications
		Drains
	Morbidity and Mortality
		Meningitis
		Hydrocephalus
	Outcome and Prognosis
	Conclusion
Chapter 57 Functional Hemispherectomy at the University of California, Los Angeles
	Introduction
	History and Rationale of the UCLA Functional Hemispherectomy
	Presurgery Evaluation
	Operative Technique and Perioperative Care
		Preincision
		Opening
		Lateral Resection
		Mesial Dissections under the Operating Microscope
		Closure
		Immediate Postoperative and ICU Care
		Long-term Follow-up
	UCLA Cerebral Hemispherectomy Cohort
		Characteristics Based on Etiology
		Operation Time and Expected Blood Loss
		Postoperative Cerebrospinal Fluid Shunts
		Operative-Related Complications and Reoperations
		Outcome: Seizure Freedom, Use of Antiepilepsy Drugs, and Cognitive Development
		Long-term Studies: Motor Skills, Language, and Rehabilitation
	Assessment and Conclusion
	Acknowledgment
Chapter 58 Transsylvian Hemispheric Deafferentation
	Introduction
	Indication and Presurgical Evaluation
	Advantages and Limits of the Transsylvian Keyhole Deafferentation
	Presurgical Management
	Surgical Technique
		Craniotomy and Transsylvian Exposure
		Temporomesial Disconnection and Unco-amygdalohippocampectomy
		Exposure of Whole Ventricular System
		Basal and Mesial Disconnection
	Postoperative Management
	Our Series and Seizure Outcome
	Complications
	Conclusion
	Acknowledgment
Chapter 59 Vertical Parasagittal Hemispherotomy
	Introduction
	Historical Background
	Description of the Surgical Technique of Vertical Parasagittal Hemispherotomy
		Approach and Paracentral Resection
		Posterior Callosotomy
		Interrupting the Hippocampal Tail
		Laterothalamic Disconnection
		Anterior Callosotomy
		Frontal Disconnection
	Complications
	Results
	Incomplete Disconnection
	Conclusion
	Acknowledgment
Chapter 60 Peri-insular Hemispherotomy
	Introduction
	Preoperative Evaluation
	Surgical Procedure
		The Suprainsular Window
		Corpus Callosotomy
		The Infrainsular Window
	Modifications
	Surgical Outcome
	Complications
Chapter 61 Endoscope-Assisted Hemispherotomy
	Introduction
	Principles of Endoscope-Assisted Hemispherotomy
	Surgical Technique
		Preoperative Workup
		Procedure
		Postoperative Care
	Outcomes Following Surgery
	Complications
	Conclusion
	Acknowledgment
Chapter 62 Corpus Callosotomy
	Introduction
	Corpus Callosotomy
		Histological Refinement of Corpus Callosotomy
		Anatomical/Imaging Basis and Rationale for Corpus Callosotomy
		Case Demonstration of Anterior 1/2 Callosotomy in a Prepubertal Children with LGS and Multiple Seizure Types
	Patient Selection Criteria, Surgical Indications, and Preoperative Assessment
	Surgical Technique
	Complications and Disconnection Syndromes
	The Taipei VGH Experience
	Conclusion
Chapter 63 Endoscope-Assisted Corpus Callosotomy with Anterior, Hippocampal, and Posterior Commissurotomy
	Introduction
	Indications
	Principles of Endoscope-Assisted Corpus Callosotomy and Anterior, Middle, and Posterior Commissurotomy
	Surgical Technique
		Presurgical Workup
		Procedure
		Results
		Seizure Outcomes
		Neuropsychological Outcomes
		Control Cohort
		Complications
	Discussion
	Conclusion
	Acknowledgment
Chapter 64 Endoscopic Disconnection of Hypothalamic Hamartomas
	Introduction
	Indication of Endoscopic Transventricular Disconnection
	Description of the Endoscopic Transventricular Disconnection Technique
	Surgical Results
	Conclusion
Chapter 65 Multiple Subpial Transections in Children with Refractory Epilepsy
	Introduction
	Fundamentals of the Multiple Subpial Transection Technique
	Indications for the Multiple Subpial Transection Technique
		Focal Seizures Located in the Eloquent Cortex
		Landau-Kleffner Syndrome
		Syndrome of Malignant Rolandic-Sylvian Epilepsy
		Other Indications
	Presurgical Evaluation
	Surgical Technique
	Complications
	Discussion
	Conclusion
Chapter 66 Hippocampal Subpial Transection
	Introduction
	Rationale of Hippocampal Subpial Transection
	Surgical Exposure of the Hippocampus
	Electrocorticography over the Hippocampus and Amygdala
	Hippocampal Transection
	Seizure Outcome
	Postoperative Verbal Memory
	Pediatric Data and Case Report
		An Illustrative Case
	Other Series
Chapter 67 Vagal Nerve Stimulation
	Introduction
	Anatomy and Physiology of Vagal Nerve Stimulation
	Preclinical History of Vagal Nerve Stimulation
	Clinical Trials for Vagal Nerve Stimulation in Epilepsy
	Vagal Nerve Stimulation in Pediatric Epilepsy
	Operative Technique for Vagal Nerve Stimulation Placement
	Special Considerations and Complications
	Vagal Nerve Stimulation Hardware and Stimulation Parameters
	Conclusion
Chapter 68 Cortical and Deep Brain Stimulation
	Introduction
	Brain Stimulation Regions
		Subcortical Structures
		Cerebral Cortex
	Responsive Neurostimulation
	Transcranial Magnetic Stimulation
	Surgical Technique
	Use in Pediatric Subjects
	Conclusion
Chapter 69 Radiosurgical Treatment for Epilepsy
	Introduction
	Mesial Temporal Lobe Epilepsy
		Dose
		Target
		Patient Selection
		Complications
		Current Indications
	Hypothalamic Hamartomas
		HH Classification and Treatment Strategy
		Effect of GKS on Behavior and Cognitive Functions
		Limits and Strengths of Radiosurgery in HH
	Cavernous Malformations
		Prognostic Factors
		Management Strategy
		Target Definition
		Dose Selection
	Radiosurgical Callosotomy
		Callosotomy Techniques
		Gamma Knife Callosotomy
		Indications
		Extent of Callosotomy
		Dose Prescription
	Conclusion
Chapter 70 Stereotactic Laser Ablation for Hypothalamic Hamartomas
	Introduction
	Indications
	Preoperative Workup
	Choice of Laser System and Application
	Imaging and Ablation
	Postoperative Imaging
	Postoperative Care
	Outcomes
	Complications
	Conclusion
Chapter 71 MRI-Guided Laser Thermal Therapy in Pediatric Epilepsy Surgery
	Introduction
	MRIgLITT Technology
	Commercially Available MRIgLITT Systems
	Surgical Technique
	MRIgLITT Advantages
	MRIgLITT in Pediatric Epilepsy
	Conclusion
Chapter 72 Surgical Failure and Reoperation
	Introduction
	Surgical Failure
		Defining Surgical Failure
		Acute Postoperative Seizures
		Prediction of Surgical Failure
		Causes of Surgical Failure
		Evaluation for Reoperation
	Reoperation
		Repeat Localization in Reoperation
		Reoperation in Focal Cortical Resections
		Reoperation after Epileptogenic Lesional Resection
		Reoperation in Temporal Lobectomy
	Evolving Concepts in Goals of Pediatric Epilepsy Surgery
		A Changing Landscape in Pediatric Epilepsy Surgery
		New Techniques in Reoperation and Palliation
	Conclusion
Chapter 73 Postoperative Seizure Control
	Introduction
	Outcome with Respect to Seizure Control after Surgery
		Seizure Control after Surgery for a Structural Lesion
		Seizure Control after Temporal Lobe Surgery
		Seizure Control after Extratemporal Resection
		Seizure Control after Hemispherectomy
		Seizure Outcome in Relation to Pathology of the Epileptogenic Substrate
		Seizure Outcome after Reoperation
	Seizure Control after Surgical Treatment of Epilepsy in Children without an Obvious Structural Lesion
	Factors Affecting Postoperative Seizure Control
		Presurgical Factors
		Surgical Factors
		Postsurgical Factors
	Medical Management after Epilepsy Surgery
	Conclusion
Chapter 74 Postoperative Neuropsychological and Psychosocial Outcome
	Introduction
	Neuropsychological Outcome
		Resection from the Temporal Lobe
		Extratemporal Resections
		Hemispheric Resections
		Long-term Outcomes
	Psychosocial Outcome
		Psychiatric and Behavioral Outcomes
		Health-related Quality of Life
	Predictors of Neuropsychological and Psychosocial Outcomes
	Future Directions and Conclusion
Index
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