Techniques in Epilepsy Surgery: The MNI Approach

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Techniques in Epilepsy Surgery: The MNI Approach
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Copyright
Contents
Acknowledgment
Preface
1: History of epilepsy surgery
	Introduction
	Paul Broca (1824–1880)
	William Macewen (1848–1924)
	Victor Horsley (1857–1916)
	Fedor Krause (1857–1937)
	Harvey Cushing (1869–1939)
	Otfrid Foerster (1873–1941)
	Montreal Neurological Institute
	Theodore Rasmussen (1910–2002)
	Percival Bailey and the Gibbs
	Murray Falconer (1910–1977)
	Paulo Niemeyer (1914–2004)
	Paul Crandall
	Jean Talairach (1911–2007)
	Gazi Yasargil
	References
2: The search for the epileptic focus: investigation of the surgical candidate
	Introduction
	Concept of the epileptic focus
		The limbic focus
		The neocortical focus
	Investigation of the surgical candidate
		Initial patient evaluation
		The seizure pattern(s)
		EEG and video monitoring
		Intracranial recording
		Imaging
		Spectroscopy
		Volumetry
		Nuclear imaging
		Magneto-encephalography
		EEG–Functional magnetic resonance imaging
		Neuropsychology
		Intracarotid memory and speech evaluation
		Psychiatry
	Epilepsy team
	References
3: Surgical anatomy
	Surgical anatomy
	The gyral continuum
	The gyral continuum over the lateral convexity
	The gyral continuum over the mesial surface: the temporo-occipito-parietal region
	The gyral continuum over the mesial surface: the frontal area
	The gyral continuum over the inferior surface
	Vascular considerations
	The callosal grid
	Construction of the callosal grid
		Callosal planes (Figure 3.12)
		Cerebral planes
		The temporal grid
		Display of the callosal grid on anatomical MRI and over the vasculature of the brain
	Applications of the callosal grid (surgical anatomy)
	Localization of lesions within various compartments or in reference to callosal planes
	Surgical planning and postoperative evaluations
	Application of the callosal grid as a brain-imaging (MRI) methodology
	Conclusion
	References
4: Neuronavigation and preoperative brain mapping
	Introduction
	Neuronavigation procedure
	Preoperative data acquisition: MR and CT imaging
	Functional activation data
	Functional activation of speech areas
	Operative procedure
	Applications
		Presurgical and topographic planning
		Craniotomy
	Topographic brain mapping
	Electrocorticography (ECOG)
	Removal of brain tumors
	Surgery of cortical dysplasias
	Temporal resections
	Frontal resections
	Central resections
	Parieto-occipital resections
	Callosotomy
	Reoperations
	Discussion
		Accuracy of measurements and system limitations
	Conclusion
	References
5: Stereoelectroencephalography (stereotactic intracranial recording)
	Introduction
	Direct brain recording
	Purpose of intracranial recording
	Main indications for SEEG
	Ambiguity of hemispheric lateralization
	Ambiguity of intrahemispheric localization
	SEEG in migration disorders
	Preoperative magnetic resonance imaging
	Integration of positron emission tomography with magnetic resonance imaging or functional magnetic resonance imaging
	Target selection
	Coverage of temporal lobe
		Lateral orthogonal approach
		Occipito-temporal approach
	Coverage of the insula
	Coverage of frontal lobe
	Coverage of central area
	Coverage of parieto-occipital area
	Recording electrodes
	Frameless electrode placement
	Frameless stereotactic apparatus (Free Guide)
		Robotic Assistance
	Registration
		Fixation of the optical reference device
		Insertion of the Free Guide to the head clamp
	Depth electrode placement
		Step 1: Selection of trajectory to target
		Step 2: Scalp punch
		Step 3: Skull perforation
		Step 4: Bone peg insertion
		Step 5: Dural perforation
		Step 6: Calculation of distance to target
		Step 7: Insertion of ruler guide
		Step 8: Placement of electrode
		Step 9: Immobilization of electrode
		Step 10: Electrode identification
	Placement of cortical electrodes
		Step 1: Identification of cortical sites
		Step 2: Identification of scalp sites
		Step 3: Skull perforation and peg insertion
		Step 4: Placement of cortical epidural electrodes
	Reference and ground electrodes
	Dressing
	Brain maps
	Connecting the electrodes
	Electrode montage and recording
	Patient monitoring
	Stimulation of depth electrodes
	Head dressing and dressing care
	Removal of electrodes
	Results
	Conclusion
	References
6: Anesthesia and awake procedure
	Historical perspective
	Local anesthesia for awake craniotomy
		General anesthesia for epilepsy surgery
	References
7: Peroperative brain mapping
	Introduction
	History of human brain mapping
	Electrocorticography
	Mapping under local anesthesia: visual identification of the central sulcus
	Stimulation of somatic motor and sensory areas
		Cortical stimulation and parameters of stimulation
		Identification of the tongue area under local anesthesia
		Motor mapping under general anesthesia
		Speech mapping
	Functional imaging
	Conclusion
	References
8: Endopial resection (intervascular endopial gyral emptying)
	Introduction
	The rationale
	Technique of intervascular multicompartment endopial gyral emptying
	Subpial endopial resection examples
		Anterior temporal resection
		Selective amygdalohippocampectomy
		Opercular resection
		Frontal-parietal resection
		Central resection
		Illustrative case of central area resection
	Conclusion
	Reference
9: Surgery of temporal lobe epilepsy: cortico-amygdalohippo-campectomy
	Introduction
	Surgical anatomy of the temporal lobe
	Temporal grid
	White matter connections of the temporal lobe
		Long association fibers
		Circuit of Papez
		Projection pathways
		Commissural pathways
	Amygdala
	Visual radiations
	Auditory area
	Different modalities of temporal cortical resections
		Temporal lobectomy
	Cortico-amygdalohippocampectomy (CAH)
	Technique of CAH
		Head position
		Scalp incision
		Craniotomy
		Topographic landmarks
		Opercular arteries
		Extent of resection
		En bloc resection of neocortex
		Resection of the mesial temporal structures
	Cortico-amygdalectomy
	References
10: Surgery of temporal lobe epilepsy: transcortical selective amygdalohippocampectomy
	Introduction
	Concept of mesial temporal lobe epilepsy
	Concept of selective amygdalohippocampectomy
		Transsylvian selective amygdalohippocampectomy
		Subtemporal selective amygdalohippocampectomy
		Stereotactic lesioning
		The MNI selective amygdalohippocampectomy
	Surgical technique
		Preoperative imaging and planning
		Positioning and registration
		Pterional craniotomy approach
		Keyhole approach
		Cortical incision
	Pitfalls of selective amygdalohippocampectomy
		Corticoamygdalectomy
		Tailored resections associated with a lesion of the temporal lobe
	Advantages and disadvantages: selective versus non-selective resections
	Seizure outcome: selective versus non-selective resections
	Neuropsychological outcome: selective versus non-selective temporal resections
		How selective is SelAH?
	Conclusion
	References
11: Surgery of central area epilepsy
	Historical perspective
	Central area anatomy and function
		Topography
		Somatotopic organization
		Cortical structure
		Connections of the central area
		Functional anatomy of the central area
		Central area vascular anatomy
	Surgery of the central area
	Stimulation under local anesthesia
	Resections of the lower pre- and postcentral gyri
	Resection in lower right central area: illustrative case
	Illustrative case – left dominant
	Resection of cavernous hemangioma: illustrative case
	En bloc cortical central resections in the sensorimotor area
	Multiple subpial cortical transections
		Illustrative case
	Pitfalls and complications of surgery in the central area
	References
12: Surgery of frontal lobe epilepsy
	Introduction
	Historical perspective
	Seizure patterns in frontal lobe epilepsy
		Substratum of frontal lobe seizures
		Strategies of investigation
	Surgical anatomy
		Overview of the frontal lobe
		Sulcal anatomy
		Gyral anatomy
	Functional anatomy of the frontal lobe: main connection systems
	Surgical strategy in frontal lobe epilepsy
		Main surgical options in frontal lobe epilepsy in relation to etiology and localization
	Surgical method and techniques of cortical resection
		Scalp incisions and types of craniotomies
		Dural opening
		Cortical resection proper
		Various types of frontal resections
		Frontal lobectomy
		Illustrative case
		Anterior subtotal lobectomy
		Illustrative case
		Fronto-polar resections
		Illustrative case: fronto-polar orbital
		Paramedian frontal resections (medio-dorsal)
		Illustrative case of F1 (mesio-dorsal resection)
		Illustrative case of F1 (mesio-dorsal resection)
		Lateral convexity resections
		Illustrative case
		Example of posterior F2 resection (lesionectomy)
	Outcome of surgery: results on seizure tendency
	Complications in frontal lobe surgery
	Conclusion
	References
13: Surgery of parietal lobe epilepsy
	Introduction
	Historical perspective
	Surgical anatomy of the parietal lobe
	Functional anatomy of the parietal region
	Seizure patterns and clinical manifestations
	Scalp incision and craniotomy
	Technical pitfalls in parietal resections
	Illustrative cases
		Case A.H.
		Case K.G.
		Case L.M.
	Surgical results
	Conclusion
	References
14: Surgery of insular lobe epilepsy
	Introduction
	Anatomy
		Sulci
		Gyri
		Vascular
	Functional anatomy
	Insular epilepsy
	Surgical approaches to the insula
		Pitfalls
		Illustrative case L.N.
	References
15: Surgery of occipital lobe epilepsy
	Introduction
	Surgical anatomy of the occipital lobe
	Functional anatomy of the occipital region
	Seizure patterns and clinical manifestations
	Occipital lobe surgery
		Scalp incisions and craniotomies
		Technical pitfalls in the occipital resections
		Visual loss following occipital surgery
		Neuronavigation
		Case B.B.
		Case T.
		Case J.G.
		Case H.
	Results of surgery
	Conclusion
	References
16: Hemispherectomy
	Introduction and historical perspective
	Indications and preoperative evaluation
	Surgical techniques
		Step 1: Central resection
		Step 2: Temporal lobectomy
		Step 3: Callosotomy
		Step 4: Anterior and posterior disconnections
	Pitfalls
	References
17: Callosotomy
	Introduction and historical perspective
	Physiological observations
	Surgical anatomy
	Patient selection
	Preoperative evaluation
	Callosotomy versus hemispherectomy
	Surgical procedure
		Preoperative – preparation
		Positioning
		Scalp incision
		Craniotomy
		Dural opening
	Interhemispheric dissection and separation of the hemisphere
		Callosotomy proper
	Reoperation and extension of callosotomy
		Anterior approach
		Posterior approach
		Positioning
		Dealing with ascending veins
		Interhemispheric approach
		Transection of the splenium proper
	Results of callosotomy on seizure tendency
	Conclusion
	References
18: Epilepsy and brain tumors
	Incidence of epilepsy as a symptom of brain tumor
	Pathophysiology
	Clinical presentation
	Investigation of the epileptic tumor suspect
		Tumor diagnosis
		Seizure focus identification
	Surgical treatment
	Surgical techniques
		Local or general anesthesia
		Scalp incisions and craniotomy
		Intraoperative cortical mapping
		Cortical resection: general principles
	Resection methods and illustrative cases
		Frontal tumors
			Illustrative case L.C.
		Central tumors
			Illustrative case P.Y.
			Illustrative case C.A.
		Temporal neocortical tumors
			Example of neocortical tumor within left dominant temporal lobe: Case N.A.
		Parietal area lesions
			Illustrative case A.O.
		Distribution of benign gliomas with seizures
		Temporal lobe gliomas
		Frontal lobe gliomas
		Gliomas of the frontal, central, parietal, and occipital areas
		Tumor recurrence
	Discussion
	Conclusion
	References
19: Surgical treatment of cortical dysplasias
	Introduction
	Development of cerebral cortex and pathogenesis of dysplasias
	Classification of dysplasias
	Their association with tumor
	Location, size and extent
	Epileptogenicity
	Surgical approach
	Distribution according to regions and pathology
	Dysplasia of right temporal area
	Dysplasia of right frontopolar area
	Dysplasia of left frontal cingulate area
	Outcome in temporal lobe resections
	Outcome in frontal lobe resections
	Outcome in extra-temporal and extra-frontal resections
	Outcome of callosotomy
	Surgical complications
	Discussion
		Size of lesion
		Location of lesions
		Relationship to the electrically defined epileptogenic area
		Relationship of dysplastic lesions to tumor
	Conclusion
	References
20: Reoperations in failed epilepsy surgery
	Introduction
		Preoperative evaluation
		Indications for reoperations
	Technical aspects of reoperation in temporal lobe epilepsy
	Outcome of reoperations in temporal lobe epilepsy
		Causes of seizure recurrence after temporal lobe surgery
		Results of surgery and morbidity following reoperation for temporal lobe epilepsy
		Reoperation for extra-temporal lobe epilepsy
		Reoperations after callosotomy
	Conclusion
	References
21: Alternative procedures in surgery for epilepsy
	Introduction
	Multiple subpial transections
		Indications
		Surgical technique
		Pitfalls
	Vagus nerve stimulation
		Indications
		Surgical technique
		Mechanism of action
		Conclusion
	Brain stimulation
		Mechanism of action
		Anterior nucleus of thalamus stimulation
		Intracerebral and cortical stimulation
	Gamma Knife radiosurgery
		Hypothalamic hamartoma
		Medial temporal lobe epilepsy
	Intracerebral drug delivery
	Gene- and cell-based therapies for epilepsy
		Gene therapy for epilepsy
		Cell-based therapy for epilepsy
	Conclusion
	References
22: Complications of epilepsy surgery
	Introduction
	Definition of a complication
	Complications of invasive recordings
	Complications of craniotomy
		Surgical complications
		Neurological complications
		Callosotomy
		Miscellaneous complications
		Neuronavigation
	Conclusion
	References
23: Quality of life after epilepsy surgery
	Introduction
		Quality of life after temporal lobe epilepsy surgery
	Quality of life after extra-temporal lobe epilepsy surgery
	Conclusion
	References
Index