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Neurosurgical Focus

Kevin Akeret, David Bellut, Hans-Jürgen Huppertz, Georgia Ramantani, Kristina König, Carlo Serra, Luca Regli, Niklaus Krayenbühl
OBJECTIVE Surgery has proven to be the best therapeutic option for drug-refractory cases of focal cortical dysplasia (FCD)-associated epilepsy. Seizure outcome primarily depends on the completeness of resection, rendering the intraoperative FCD identification and delineation particularly important. This study aims to assess the diagnostic yield of intraoperative ultrasound (IOUS) in surgery for FCD-associated drug-refractory epilepsy. METHODS The authors prospectively enrolled 15 consecutive patients with drug-refractory epilepsy who underwent an IOUS-assisted microsurgical resection of a radiologically suspected FCD between January 2013 and July 2016...
September 2018: Neurosurgical Focus
Joao Paulo Almeida, Fred Gentili
No abstract text is available yet for this article.
September 2018: Neurosurgical Focus
Erin N Kiehna, Robert J Bollo
No abstract text is available yet for this article.
September 2018: Neurosurgical Focus
Benjamin Davidson, Lior M Elkaim, Nir Lipsman, George M Ibrahim
No abstract text is available yet for this article.
September 2018: Neurosurgical Focus
Mark C Kendall, Lucas J Castro Alves
No abstract text is available yet for this article.
September 2018: Neurosurgical Focus
Jonathan Pindrik, Nguyen Hoang, Luke Smith, Mark Halverson, Mary Wojnaroski, Kelly McNally, Satyanarayana Gedela, Adam P Ostendorf
OBJECTIVE Despite perioperative risks, epilepsy surgery represents a legitimate curative or palliative treatment approach for children with drug-resistant epilepsy (DRE). Several factors characterizing infants and toddlers with DRE create unique challenges regarding optimal evaluation and management. Epilepsy surgery within children < 3 years of age has received moderate attention in the literature, including mainly case series and retrospective studies. This article presents a systematic literature review and explores multidisciplinary considerations for the preoperative evaluation and surgical management of infants and toddlers with DRE...
September 2018: Neurosurgical Focus
Erin N Kiehna, Catherine F McClung-Smith, Robert J Bollo
No abstract text is available yet for this article.
September 2018: Neurosurgical Focus
Catherine McClung-Smith
No abstract text is available yet for this article.
September 2018: Neurosurgical Focus
Kelsey Cobourn, Islam Fayed, Robert F Keating, Chima O Oluigbo
OBJECTIVE Stereoelectroencephalography (sEEG) and MR-guided laser interstitial thermal therapy (MRgLITT) have both emerged as minimally invasive alternatives to open surgery for the localization and treatment of medically refractory lesional epilepsy. Although some data are available about the use of these procedures individually, reports are almost nonexistent on their use in conjunction. The authors' aim was to report early outcomes regarding efficacy and safety of sEEG followed by MRgLITT for localization and ablation of seizure foci in the pediatric population with medically refractory lesional epilepsy...
September 2018: Neurosurgical Focus
Taylor J Abel, Emma Losito, George M Ibrahim, Eishi Asano, James T Rutka
Epileptic spasms (ES) are a common manifestation of intractable epilepsy in early life and can lead to devastating neurodevelopmental consequences. Epilepsy surgery for ES is challenging because of inherent difficulties in localizing the epileptogenic zone in affected infants and children. However, recent clinical series of resective neurosurgery for ES suggest that not only is surgery a viable option for appropriately selected patients, but postoperative seizure outcomes can be similar to those achieved in other types of focal epilepsy...
September 2018: Neurosurgical Focus
Zulma Tovar-Spinoza, Robert Ziechmann, Stephanie Zyck
OBJECTIVE Magnetic resonance-guided laser interstitial thermal therapy (MRgLITT) is a novel, minimally invasive treatment for the surgical treatment of epilepsy. In this paper, the authors report on clinical outcomes for a series of pediatric patients with tuberous sclerosis complex (TSC) and medication-refractory epileptogenic cortical tubers. METHODS A retrospective chart review was performed at SUNY Upstate Golisano Children's Hospital in Syracuse, New York. The authors included all cases involving pediatric patients (< 18 years) who underwent MRgLITT for ablation of epileptogenic cortical tubers between February 2013 and November 2015...
September 2018: Neurosurgical Focus
Allen L Ho, Austin Y Feng, Lily H Kim, Arjun V Pendharkar, Eric S Sussman, Casey H Halpern, Gerald A Grant
Stereoelectroencephalography (SEEG) is an intracranial diagnostic measure that has grown in popularity in the United States as outcomes data have demonstrated its benefits and safety. The main uses of SEEG include 1) exploration of deep cortical/sulcal structures; 2) bilateral recordings; and 3) 3D mapping of epileptogenic zones. While SEEG has gradually been accepted for treatment in adults, there is less consensus on its utility in children. In this literature review, the authors seek to describe the current state of SEEG with a focus on the more recent technology-enabled surgical techniques and demonstrate its efficacy in the pediatric epilepsy population...
September 2018: Neurosurgical Focus
Laureen D Hachem, Simeon M Wong, George M Ibrahim
Vagus nerve stimulation (VNS) is increasingly considered for the treatment of intractable epilepsy and holds potential for the management of a variety of neuropsychiatric conditions. The emergence of the field of connectomics and the introduction of large-scale modeling of neural networks has helped elucidate the underlying neurobiology of VNS, which may be variably expressed in patient populations and related to responsiveness to stimulation. In this report, the authors outline current data on the underlying neural circuitry believed to be implicated in VNS responsiveness in what the authors term the "vagus afferent network...
September 2018: Neurosurgical Focus
D L Marinus Oterdoom, Gertjan van Dijk, Martijn H P Verhagen, V Carel R Jiawan, Gea Drost, Marloes Emous, André P van Beek, J Marc C van Dijk
OBJECTIVE Morbid obesity is a growing problem worldwide. The current treatment options have limitations regarding effectiveness and complication rates. New treatment modalities are therefore warranted. One of the options is deep brain stimulation (DBS) of the nucleus accumbens (NAC). This review aims to summarize the current knowledge on NAC-DBS for the treatment of morbid obesity. METHODS Studies were obtained from multiple electronic bibliographic databases, supplemented with searches of reference lists. All animal and human studies reporting on the effects of NAC-DBS on body weight in morbidly obese patients were included...
August 2018: Neurosurgical Focus
Sanjeet S Grewal, Erik H Middlebrooks, Timothy J Kaufmann, Matthew Stead, Brian N Lundstrom, Gregory A Worrell, Chen Lin, Serhat Baydin, Jamie J Van Gompel
When medically intractable epilepsy is multifocal or focal but poorly localized, neuromodulation can be useful therapy. One such technique is deep brain stimulation (DBS) targeting the anterior nucleus of the thalamus (ANT). Unfortunately, the ANT is difficult to visualize in standard MRI sequences and its indirect targeting is difficult because of thalamic variability and atrophy in patients with epilepsy. The following study describes the novel use of the fast gray matter acquisition T1 inversion recovery (FGATIR) MRI sequence to delineate the mammillothalamic tract for direct targeting of the ANT through visualizing the termination of the mammillothalamic tract in the ANT...
August 2018: Neurosurgical Focus
Laura Y Cabrera, Hayden M K Boyce, Rachel McKenzie, Robyn Bluhm
OBJECTIVE The research required to establish that psychiatric treatments are effective often depends on collaboration between academic clinical researchers and industry. Some of the goals of clinical practice and those of commercial developers of psychiatric therapies overlap, such as developing safe and effective treatments. However, there might also be incompatible goals; physicians aim to provide the best care they can to their patients, whereas the medical industry ultimately aims to develop therapies that are commercially successful...
August 2018: Neurosurgical Focus
Neil Klinger, Sandeep Mittal
Antiepileptic drugs prevent morbidity and death in a large number of patients suffering from epilepsy. However, it is estimated that approximately 30% of epileptic patients will not have adequate seizure control with medication alone. Resection of epileptogenic cortex may be indicated in medically refractory cases with a discrete seizure focus in noneloquent cortex. For patients in whom resection is not an option, deep brain stimulation (DBS) may be an effective means of seizure control. Deep brain stimulation targets for treating seizures primarily include the thalamic nuclei, hippocampus, subthalamic nucleus, and cerebellum...
August 2018: Neurosurgical Focus
Sharona Ben-Haim, Zaman Mirzadeh, William S Rosenberg
OBJECTIVE Deep brain stimulation (DBS) is a well-established, evidence-based therapy with FDA approval for Parkinson's disease and essential tremor. Despite the early successful use of DBS to target the sensory thalamus for intractable facial pain, subsequent studies pursuing various chronic pain syndromes reported variable efficacy, keeping DBS for pain as an investigational and "off-label" use. The authors report promising results for a contemporary series of patients with intractable facial pain who were treated with DBS...
August 2018: Neurosurgical Focus
James J Zhou, Tsinsue Chen, S Harrison Farber, Andrew G Shetter, Francisco A Ponce
OBJECTIVE The field of deep brain stimulation (DBS) for epilepsy has grown tremendously since its inception in the 1970s and 1980s. The goal of this review is to identify and evaluate all studies published on the topic of open-loop DBS for epilepsy over the past decade (2008 to present). METHODS A PubMed search was conducted to identify all articles reporting clinical outcomes of open-loop DBS for the treatment of epilepsy published since January 1, 2008. The following composite search terms were used: ("epilepsy" [MeSH] OR "seizures" [MeSH] OR "kindling, neurologic" [MeSH] OR epilep* OR seizure* OR convuls*) AND ("deep brain stimulation" [MeSH] OR "deep brain stimulation" OR "DBS") OR ("electric stimulation therapy" [MeSH] OR "electric stimulation therapy" OR "implantable neurostimulators" [MeSH])...
August 2018: Neurosurgical Focus
David S Xu, Francisco A Ponce
OBJECTIVE The aim of this article is to review the authors' and published experience with deep brain stimulation (DBS) therapy for the treatment of patients with Alzheimer's disease (AD) and Parkinson's disease dementia (PDD). METHODS Two targets are current topics of investigation in the treatment of AD and PDD, the fornix and the nucleus basalis of Meynert. The authors reviewed the current published clinical experience with attention to patient selection, biological rationale of therapy, anatomical targeting, and clinical results and adverse events...
August 2018: Neurosurgical Focus
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