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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