Operative Techniques in Epilepsy Surgery

 

Description:

An indispensable, single-volume resource on state-of-the-art epilepsy procedures from renowned international experts!

Epilepsy is a common neurological disorder affecting an estimated 1% of the population, about 20 to 30% of which experience seizures inadequately controlled by medical therapy alone. Advances in anatomic and functional imaging modalities, stereotaxy, and the integration of neuronavigation during surgery have led to cutting-edge treatment options for patients with medically refractory epilepsy. Operative Techniques in Epilepsy Surgery, Second Edition by Gordon Baltuch, Arthur Cukiert, and an impressive international group of contributors has been updated and expanded, reflecting the newest treatments for pediatric and adult epilepsy.

Seven sections with 30 chapters encompass surgical planning, invasive EEG studies, cortical resection, intraoperative mapping, disconnection, neuromodulation, and further topics. Twelve cortical resection chapters cover surgical approaches such as amygdalohippocampectomy; hippocampal transection; frontal lobe, central region, and posterior quadrant resections; and microsurgery versus endoscopy for hypothalamic hamartomas. Disconnection procedures discussed in section five include corpus callosotomy, hemispherectomy, and endoscopic-assisted approaches. Well-established procedures such as vagus nerve and deep brain stimulation are covered in the neuromodulation section, while the last section discusses radiosurgery for medically intractable cases.

Key Highlights:

Chapters new to this edition include endoscopic callosotomy, laser-induced thermal therapy (LITT), and focused ultrasound

High-quality illustrations, superb operative and cadaver photographs, radiologic images, and tables enhance understanding of impacted anatomy and specific techniques

The addition of videos provides insightful step-by-step procedural guidance

This is an essential reference for fellows and residents interested in epilepsy and functional neurosurgery, and an ideal overview for neurosurgeons, neurologists, and neuroradiologists in early career stages who wish to pursue this subspecialty.

 

 

Table of Contents:

 

 

 

Part I: Surgical Planning

 

1 Collaborative Planning in Epilepsy Surgery

1.1 Introduction

1.2 Epileptology Phase: Establishing the Plan

1.2.1 Computer Processing of Neuroimaging Data

1.2.2 Planning Using Regions of Interest

1.3 Neurosurgical Phase: Building the Plan

1.3.1 The Vascular Network during Trajectory Planning

1.3.2 Virtual Reality during the Planning Process

1.4 Revision Phase: Locking the Plan

1.5 Implantation Phase: Executing the Plan

1.5.1 Frame-Based Implantation Approaches

1.5.2 Frameless Implantation Approaches

1.5.3 Robot-Assisted Implantation Approaches

1.5.4 Augmented-Reality Approaches

1.6 Validation Phase: Evaluating the Plan

1.7 Collaborative Workflow Systems: Planning Together

1.7.1 SYLVIUS: A VR-CWS for Epilepsy Surgery

1.8 Conclusion

2 Intraoperative Neuronavigation

2.1 Introduction

2.2 Frame Based

2.3 Frameless

2.4 Robotics

Part II: Invasive EEG Studies

3 Invasive EEG Studies: Peg, Strip, and Grid Implantation

3.1 Introduction

3.2 History

3.3 Patient Selection

3.4 Electrode Types

3.5 Planning Electrode Placement

3.6 Surgical Technique

3.7 Postimplant Management

3.8 Outcomes/Complications

3.9 Conclusion

4 Depth Electrodes

4.1 Introduction

4.2 Preoperative Planning

4.3 Operative Process

4.4 Bone Fiducial Placement

4.5 Frame Placement and Positioning

4.6 Bolt Placement and Preparation for Electrode Insertion

4.7 Frameless Stereotactic Insertion Method

4.8 Frame-Based Methods

4.9 Electrode Insertion

4.10 Postoperative Care

4.11 Complications

4.12 Epilepsy Monitoring Unit Stay

4.13 Explant

4.14 Postdischarge Care

Part III: Cortical Resection

5 Radiofrequency Lesions through Depth Electrodes

5.1 Introduction

5.2 Technical Details of RF-TC

5.2.1 Side-Effects and Morbidity of RF-TC

5.3 Illustrative Case

5.3.1 RF-TC Tips and Tricks

5.4 Conclusions

6 Temporal Lobectomy and Amygdalohippocampectomy

6.1 Introduction

6.2 Layout of the Operating Room and Positioning the Patient

6.3 Surface Anatomy and Designing the Incision for Right Temporal Lobectomy

6.4 Incision and Extracranial Dissection

6.5 Durotomy and Surface Exposure

6.6 Lateral Lobectomy

6.7 Microsurgical Resection of the Mesial Temporal Lobe

6.8 Closure

6.9 Conclusion

7 Selective Amygdalohippocampectomy

7.1 Introduction

7.2 Surgical Anatomy of the Temporal Lobe with Emphasis on the Mesial Structures

7.3 Surgery for Temporal Lobe Epilepsy

7.3.1 Temporal Lobectomy

7.3.2 Cortico amygdalohippocampectomy

7.3.3 Cortico amygdalectomy

7.3.4 Selective Amygdalohippocampectomy

7.4 Surgical Technique of Selective Amygdalohippocampectomy

7.4.1 Keyhole Approach in Selective Amygdalohippocampectomy

7.5 Results of Selective Amygdalohippocampectomy on Seizure Tendency

7.6 Conclusion

8 Parahippocampectomy: A New Surgical Technique for Temporal Lobe Epilepsy

8.1 Introduction

8.2 Historical Evolution of Some Surgical Techniques for SAH

8.3 Proposed Approach: Parahippocampectomy

8.3.1 Rationale

8.3.2 Surgical Technique

8.3.3 Indications for Parahippocampectomy

8.3.4 Contraindications for Parahippocampectomy

8.4 Concluding Remarks

9 Hippocampal Transection

9.1 Introduction

9.2 Surgical Procedure

9.2.1 Position, Incision, and Extent of Craniotomy

9.2.2 Opening the Sylvian Fissure and Approach to the Inferior Horn of the Lateral Ventricle

9.2.3 Resection of the Amygdala and Hippocampal Recording

9.2.4 Incision of the Alveus and Transection of the Pyramidal Cell Layer

9.2.5 Transection of the Parahip-pocampal Gyrus and Entorhinal Area

9.3 Memory Outcome

9.4 Conclusion

10 Frontal Lobe Resection in Refractory Epilepsy

10.1 Introduction

10.2 Patient Workup and Outcome

10.3 Technical Issues

10.4 Complications

10.5 Conclusion

11 Cortical Resection: Central Region

11.1 Introduction

11.2 Anatomical Considerations

11.3 Seizures of the Central Region

11.4 Etiology of Central Seizures

11.5 Presurgical Evaluation

11.6 Clinical Features

11.6.1 Neuroimaging

11.7 Electroencephalographic Investigation

11.7.1 Neuropsychological Testing

11.8 Psychosocial Assessment

11.9 Diagnostic Surgical Options

11.10 Therapeutic Surgical Options

11.11 Surgical Results of Central Resections

11.12 Conclusions

12 Posterior Quadrant Resections

12.1 Introduction

12.2 Indications for Surgery

12.3 Surgical Technique

12.3.1 Temporo-Parieto-Occipital (Posterior Quadrant) Resection

12.3.2 Outcome

12.3.3 Complications

13 Surgery of the Insula

13.1 Introduction

13.2 Insular Seizure Semiology

13.3 Insular Anatomy and Function

13.4 Vascular Anatomy and the Insular Lobe

13.5 Risks of Surgical Approaches to the Insula

13.6 Insular Tumors Presenting with Epilepsy

13.6.1 Tumors: Surgical Technique

13.6.2 Nonlesional Epilepsy Surgery and the Insula

13.7 Investigations and Workup

13.7.1 Noninvasive Studies

13.7.2 Invasive Studies

13.8 Resective Surgery

13.8.1 Technical Considerations

13.8.2 Alternatives to Open Resection

13.9 Where to Go from Here: Clinical Perspectives

13.10 Conclusions and Future Perspectives

14 Treatment Strategies for Hypothalamic Hamartomas: Microsurgery versus Endoscopy

14.1 Introduction

14.2 Pathophysiology

14.3 Clinical Features

14.4 Diagnosis and Neuroimaging

14.5 Indications for Intervention

14.6 Surgical Technique

14.6.1 Open Surgery—Craniotomy (Interhemispheric or Orbitozygomatic)

14.6.2 Endoscopic Resection

14.7 Alternative Approaches

14.7.1 Stereotactic Laser Ablation

14.8 Specific Considerations

14.9 Surgical Pearls

14.10 Surgical Risks

14.11 Outcome and Prognosis

14.12 Stereotactic Laser Thermoablation

14.13 Conclusion

15 Multiple Subpial Transections

15.1 Introduction

15.2 From Bench to Operating Theater

15.3 Surgical Technique

15.4 Preoperative Evaluation

15.5 Specific Indications

15.6 Outcome Data

15.7 Future Considerations

16 Laser-Induced Thermal Therapy for Medically Refractory Epilepsy

16.1 Introduction

16.2 History

16.3 Relevant Pathophysiology

16.4 Physics and Hardware Considerations

16.5 Surgical Steps

16.6 Outcomes

16.6.1 Mesial Temporal Lobe Epilepsy

16.6.2 Developmental Anomalies/Lesional Epilepsy

16.6.3 Pediatric Epilepsy Syndromes

16.7 Complications

16.8 Future Directions

16.9 Conclusion

Part IV: Intraoperative Mapping

17 Motor, Sensory, and Language Mapping in Epilepsy Surgery

17.1 Introduction

17.2 History

17.3 Patient Selection and Preoperative Functional Localization

17.4 Intraoperative Stimulation Technique

17.5 Language Task Selection and Patterns of Language Function

17.6 Clinical Outcomes following Resection

17.7 Limitations

17.8 Conclusions

Part V: Disconnection

18 Cortical Disconnections

18.1 Introduction

18.2 Preoperative Evaluation Workup

18.3 Indications for Surgery

18.4 Surgical Anatomy

18.4.1 Cerebral Cortex

18.4.2 White Matter Pathways

18.5 Disconnective Procedures

18.5.1 Surgical Adjuncts

18.5.2 Frontal Disconnection

18.5.3 Temporo-Parieto-Occipital (Posterior Quadrantic) Disconnection

18.5.4 Parieto-Occipital Disconnection

18.5.5 Combined Disconnection/Subtotal Hemispherectomy

18.5.6 Extension to Hemispheric Disconnection

18.6 Complications

18.7 Outcome

19 Corpus Callosotomy

19.1 Introduction

19.2 Open Classic Corpus Callosotomy

19.3 Other Techniques as Described in the Literature

19.3.1 Endoscopy-Assisted Procedures

19.3.2 The Use of Laser Techniques in Performing Corpus Callosotomy

19.3.3 Corpus Callosotomy Using Radiosurgery

19.4 Comments and Discussion

20 Endoscopic Callosotomy and Hemispherotomy: Bimanual Endoscopic Technique

20.1 Evolution of Endoscopic Surgical Techniques

20.1.1 Endoscopic Approaches to Disconnective Surgery

20.2 Equipment/Medications

20.2.1 Operating Room Setup

20.3 Anterior Interhemispheric Endoscopic Complete Callosotomy: Precoronal

20.4 Posterior Interhemispheric Endoscopic Complete Corpus Callosotomy

20.4.1 Procedure

20.5 Precoronal Endoscopic (Hemispherotomy) Technique

20.5.1 Procedure

20.6 Benefits and Results

20.7 Conclusion and Future Directions

21 Anatomical Hemispherectomy

21.1 Introduction

21.2 Background

21.3 Surgical Technique

21.4 Postoperative Care

21.5 Complications

21.6 Conclusions

22 Functional Hemispherectomy and Peri-insular Hemispherotomy

22.1 Introduction

22.2 Indications

22.3 Operative Techniques

22.3.1 Functional Hemispherectomy

22.3.2 Resection of the Central Region

22.3.3 Peri-insular Hemispherotomy

22.4 Conclusion

23 Endoscopic-Assisted Hemispherotomy

23.1 Introduction

23.2 Principles

23.3 Surgical Technique

23.4 Outcomes following Surgery

23.5 Summary with Important Points to Note

24 Vertical Parasagittal Hemispherotomy

24.1 Introduction

24.2 Historical Background

24.3 Description of the Surgical Technique of VPH

24.3.1 Approach to the Ventricle: Posterior Frontal Resection

24.3.2 Posterior Callosotomy

24.3.3 Interrupting the Hippocampal Tail

24.3.4 Laterothalamic Disconnection

24.3.5 Anterior Callosotomy

24.3.6 Frontal Disconnection

24.4 Results

24.5 Complications

24.6 Incomplete Disconnection

24.7 Conclusion

Part VI: Neuromodulation

25 Vagus Nerve Stimulation

25.1 Preclinical Studies

25.2 Surgical Indications

25.3 Device

25.4 Surgical Anatomy

25.5 Surgical Implantation

25.6 Stimulation Programming

25.7 Battery Change and System Removal

25.8 Adverse Events and Complications

25.9 Conclusion

26 Hippocampal Deep Brain Stimulation in Refractory Temporal Lobe Epilepsy

26.1 Introduction

26.2 Rationale

26.3 Development Timeline

26.4 Patient Selection

26.5 Targeting

26.6 Hip-DBS Efficacy and Paradigms

26.7 Effects on Memory

27 Deep Brain Stimulation: Stimulation of the Anterior Nucleus of the Thalamus

27.1 General Anatomy

27.2 ANT as a Stereotactic Target

27.3 Surgical Trajectory to the ANT

28 Responsive (Closed-Loop) Stimulation

28.1 Introduction

28.2 Localization of Cortical Function

28.3 Deep Brain Stimulation for Epilepsy

28.4 Cortical Stimulation for Epilepsy

28.5 External Responsive Neurostimulation

28.6 The Implantable RNS System

28.6.1 System Components

28.6.2 Surgical Implantation

28.7 Clinical Trials

28.7.1 Feasibility Clinical Trial

28.7.2 RNS System Pivotal Clinical Investigation in Epilepsy

28.7.3 RNS System: After the Pivotal Trial

28.8 Case Examples

28.8.1 Case 1

28.8.2 Case 2

28.9 Conclusions

Part VII: Further Topics

29 Radiosurgery for Medically Refractory Epilepsy

29.1 Introduction

29.2 Developments Permitting Noninvasive Techniques

29.3 Basic Principles of Radiobiology

29.4 Vascular Effects and Seizure Control

29.5 Effects of Radiation in the Epileptic Focus

29.6 Radiosurgery in Mesial Temporal Epilepsy

29.7 Radiosurgery for Hypothalamic Hamartoma

29.8 Other Focal Epilepsy Syndromes Treated by Radiosurgery

29.9 Conclusion

30 Focused Ultrasound as a Surgical Treatment for Epilepsy

30.1 Introduction

30.2 Barriers in Transcranial MR-Guided FUS for Epilepsy Treatments

30.2.1 Therapeutic Envelope of Current Systems

30.2.2 Volume Mismatch in Acoustic Focus and Epileptic Target

30.3 Potential Applications

30.3.1 Hypothalamic Hamartoma

30.3.2 Malformations of Cortical Development

30.3.3 Mesial Temporal Sclerosis

30.3.4 Disconnection Procedures

30.3.5 Other Focal Lesions Causing Epilepsy

30.4 Conclusions

Index

Additional MedOne Information

 

An aparitie	18 Oct. 2019
Autor	Gordon H. Baltuch, Arthur Cukiert
Dimensiuni	‎ 27.94 x 21.59 cm
Editura	Thieme
Format	Hardcover
ISBN	9781626238183
Limba	Engleza
Nr pag	520