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Peter C. Warnke - One of the best experts on this subject based on the ideXlab platform.
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stereotactic laser anterior Corpus Callosotomy for lennox gastaut syndrome
Epilepsia, 2020Co-Authors: David Satzer, Naoum P. Issa, Sandra Rose, John J. Collins, Shasha Wu, Julia Henry, Fabiane Santos De Lima, Douglas R Nordli, Peter C. WarnkeAbstract:Objective Corpus Callosotomy is an effective palliative treatment for drug-resistant Lennox-Gastaut syndrome (LGS). Laser interstitial thermal therapy has been increasingly used in the treatment of epilepsy. Here, we assess the safety and effectiveness of minimally invasive stereotactic laser anterior Corpus Callosotomy (SLACC) for drop attacks in LGS. Methods We reviewed sequential cases of patients with medically intractable LGS who underwent SLACC using a two-cannula technique between November 2014 and July 2019. Pre- and postoperative magnetic resonance imaging was used to measure the anteroposterior length of callosal ablation (contrast-enhancing lesion) and estimated disconnection (gap in tract projections on diffusion tensor imaging). Patients were followed longitudinally to assess clinical outcomes. Results Ten patients were included in this study. The median age was 33 (range = 11-52) years, median duration of epilepsy was 26 (range = 10-49) years, and median duration of postoperative follow-up was 19 (range = 6-40) months. In the anteroposterior direction, 53 ± 7% (mean ± SD) of the Corpus callosum was ablated and 62 ± 19% of the Corpus callosum was estimated to be disconnected. Six (60%) of 10 patients achieved >80% seizure reduction, two (20%) of whom became seizure-free. Eight (80%) patients had >80% reduction in drop attacks, five (50%) of whom became free of drop attacks. Three patients subsequently underwent laser posterior Callosotomy with further improvement in drop attacks and/or overall seizure frequency. One patient had an asymptomatic intracerebral hemorrhage along the cannula tract. One patient developed significant aggression after becoming seizure-free. Significance Seizure outcomes following SLACC were comparable to previously reported outcomes of open Callosotomy, with reasonable safety profile. SLACC appears to be an effective alternative to open anterior Corpus Callosotomy with minimal postoperative discomfort and a short recovery period.
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Interstitial Stereotactic Laser Anterior Corpus Callosotomy: A Report of 2 Cases with Operative Technique and Effectiveness.
Neurosurgery, 2018Co-Authors: James X. Tao, Naoum P. Issa, Sandra Rose, John J. Collins, Peter C. WarnkeAbstract:BACKGROUND AND IMPORTANCE Corpus Callosotomy is an effective palliative treatment for medically intractable Lennox-Gastaut syndrome (LGS) that disrupts the interhemispheric synchronization of epileptiform discharges. However, traditional open Corpus Callosotomy carries a significant risk of surgical complications associated with craniotomy and a parafalcine approach to the Corpus callosum. Here, we report 2 cases of anterior Corpus Callosotomy using MRI-guided stereotactic laser interstitial thermal therapy (LITT) as a minimally invasive technique for mitigating the risks of craniotomy while achieving favorable outcomes. CLINICAL PRESENTATION Two patients with medically intractable LGS underwent stereotactic laser anterior Corpus Callosotomy using a 2 laser-fiber approach. Ablation of 70%-80% of the Corpus callosum was confirmed by postoperative MRI diffusion tensor imaging and volumetric analysis. Marked reduction of epileptiform activity was observed in both patients during postoperative video-EEG studies as compared to preoperative video-EEG studies. Freedom from disabling seizures including drop attacks was achieved in 1 patient for 18 mo, and more than a 90% reduction of disabling seizures was achieved in the other patient for 7 mo with cognitive improvement and without surgical complications. CONCLUSION These early data demonstrate the technical feasibility, safety, and favorable outcomes of MRI-guided stereotactic laser anterior Corpus Callosotomy in patients with LGS, making it a potentially safe and effective alternative to traditional open Corpus Callosotomy and other stereotactic methods including radiofrequency ablation and radiosurgery due to the ability to monitor the ablation in real time with MRI.
Teiji Tominaga - One of the best experts on this subject based on the ideXlab platform.
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Clinical profiles for seizure remission and developmental gains after total Corpus Callosotomy
Brain & Development, 2015Co-Authors: Masaki Iwasaki, Shin-ichiro Osawa, Kazutaka Jin, Mitsugu Uematsu, Nobukazu Nakasato, Naomi Hino-fukuyo, Yoshiteru Shimoda, Teiji TominagaAbstract:Purpose: This study was aimed to determine what preoperative profiles were associated with seizure remission after Corpus Callosotomy and whether such seizure outcome was associated with the postoperative developmental outcome. Methods: This retrospective study included 26 consecutive patients with childhood onset epilepsy who underwent one-stage total Corpus Callosotomy at our institution and were followed up for a minimum of 1 year. The age at surgery ranged from 13 months to 32 years (median 6 years). The association between postoperative seizure freedom and preoperative profiles, post-operative developmental gains was examined. Results: Five patients achieved seizure freedom (Engel class I), and 10 patients achieved worthwhile reduction of seizures (class III), whereas the remaining patients had a class IV outcome. All five seizure-free patients had “lack of abnormal magnetic resonance imaging findings”, “lack of proven etiology of seizures”, and underwent “surgery at age 6 years or younger”. These three factors were associated with seizure freedom (p < 0.05, Fisher exact test). Post-operative gains in developmental quotient were significantly better in patients with seizure freedom than in those without (p < 0.05, Mann Whitney U test). Conclusion: Our study replicated the notion that seizure remission can be achieved after total Corpus Callosotomy in subsets of patients with medically-uncontrolled epilepsy, and suggested that a better developmental outcome can be expected in patients benefiting from seizure freedom.
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Time-varying inter-hemispheric coherence during Corpus Callosotomy
Clinical Neurophysiology, 2013Co-Authors: Eiichi Okumura, Masaki Iwasaki, Rie Sakuraba, Izumi Itabashi, Shin-ichiro Osawa, Kazutaka Jin, Hisashi Itabashi, Kazuhiro Kato, Akitake Kanno, Teiji TominagaAbstract:highlights abstract Objective: Corpus Callosotomy limits the bilateral synchrony of epileptic discharges. However, the instan- taneous changes in bilateral synchrony during Corpus Callosotomy are unclear. The present study inves- tigated how and when bilateral synchrony is suppressed in the anterior and then posterior steps of Corpus Callosotomy. Methods: Intra-operative scalp electroencephalography (EEG) was recorded simultaneously with surgical video for six patients who underwent total Corpus Callosotomy for medically intractable drop attacks. The time-varying EEG inter-hemispheric coherence was quantified by wavelet transform coherence and trend analysis. Results: The 4-13 Hz coherence decreased after Corpus Callosotomy in five patients. Significant decrease in coherence was observed only during the posterior step of callosal sectioning in three patients, but throughout both steps in two patients. Conclusions: Decrease in inter-hemispheric coherence is not always correlated with the stages of callosal sectioning. Inter-hemispheric coherence is decreased during the final stage of Corpus Callosotomy and the effect is maximized after sectioning is completed. Significance: Various patterns of coherence decrease suggest individual variations in the participation of the Corpus callosum in the genesis of bilateral synchrony. Time-varying inter-hemispheric EEG coherence is useful to monitor the physiological completeness of Corpus Callosotomy.
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A primary epileptogenic tuber revealed after Corpus Callosotomy in a patient with tuberous sclerosis complex and multiple tubers
No shinkei geka. Neurological surgery, 2013Co-Authors: Keisuke Sato, Masaki Iwasaki, Mitsugu Uematsu, Nobukazu Nakasato, Teiji TominagaAbstract:Identification of primary epileptogenic tuber is often challenging in patients with bilateral multiple tubers in tuberous sclerosis complex. We report a 3 year old girl with tuberous sclerosis complex presenting with intractable epilepsy and multiple tubers, who was successfully treated by Corpus Callosotomy and subsequent resective surgery. She initially presented with West syndrome which was intractable to ACTH therapy and multiple antiepileptic medications. Her EEG was characterized by generalized and multifocal spikes, and by non-focal changes at seizure onset. Ictal single photon emission computed tomography(SPECT)showed no focal hyperperfusion. Total Corpus Callosotomy was performed to alleviate her drop attacks. Post-operatively, interictal spikes were completely lateralized to the right hemisphere. Since her seizures were still kept uncontrolled with medications, second pre-surgical evaluation was planned and ictal SPECT disclosed focal hyperperfusion at a tuber in the right frontal lobe. After complete resection of the right frontal tuber, she was completely seizure free on antiepileptic medications for 1 year with no additional neurological deficits. Generalized or multifocal electroencephalographic(EEG)spikes are occasionally lateralized to one hemisphere after Corpus Callosotomy, which may help identifying the primary epileptogenic focus. Repeat pre-surgical evaluation is important after Corpus Callosotomy in patients with generalized or multifocal epileptiforms in EEG.
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Complete remission of seizures after Corpus Callosotomy.
Journal of Neurosurgery, 2012Co-Authors: Masaki Iwasaki, Shin-ichiro Osawa, Kazutaka Jin, Hisashi Itabashi, Mitsugu Uematsu, Yuko Sato, Tojo Nakayama, Kazuhiro Haginoya, Nobukazu Nakasato, Teiji TominagaAbstract:Object Corpus Callosotomy is usually intended to alleviate—not to achieve total control of—epileptic seizures. A few patients experience complete seizure control after Callosotomy, but the associated clinical factors are unknown. The object of this study was to investigate clinical factors associated with long-term seizure remission after total Corpus Callosotomy in patients with infantile or early childhood onset epilepsy. Methods Thirteen consecutive patients with infantile or early childhood onset epilepsy underwent 1-stage total Corpus Callosotomy for alleviation of seizures. Their age at surgery ranged from 1 year and 5 months to 24 years (median 7 years). Eleven patients had West syndrome at the onset of disease, and the other 2 had Lennox-Gastaut syndrome. All patients suffered from spasms, axial tonic seizures, or atonic seizures. Six patients had proven etiology of epilepsy, including tuberous sclerosis, polymicrogyria, trauma, and Smith-Magenis syndrome. The association between postoperative sei...
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Lateralization of interictal spikes after Corpus Callosotomy
Clinical Neurophysiology, 2011Co-Authors: Masaki Iwasaki, Akitake Kanno, Mitsugu Uematsu, Kazuhiro Haginoya, Nobukazu Nakasato, Yosuke Kakisaka, Teiji TominagaAbstract:Abstract Objective Corpus Callosotomy may limit secondary bilateral synchrony into the primary epileptogenic hemisphere. This study investigated whether pre-operative EEG can predict post-operative spike lateralization. Methods The subjects included 14 patients with medically intractable drop attacks who underwent total Corpus Callosotomy. Pre-operative patterns of inter-hemispheric propagation were quantified by peak-latency analysis with the template-based spike averaging technique. Results Postoperative lateralization of interictal spikes was observed in 5 of the 14 patients. Inter-hemispheric latency was significantly longer in these 5 patients (mean 14.0 ms, range from 0 to 78 ms, versus mean 5.2 ms, range from 0 to 29 ms, p p Conclusions Interictal spikes are lateralized to the epileptogenic hemisphere in some patients after Callosotomy. Lateralization can be expected in the presence of structural lesions and/or longer inter-hemispheric latency. Significance Analysis of pre-operative EEG spikes may predict the primary epileptogenic hemisphere before Corpus Callosotomy.
Robert J Bollo - One of the best experts on this subject based on the ideXlab platform.
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anterior two thirds Corpus Callosotomy via stereotactic laser ablation
Neurosurgical Focus, 2018Co-Authors: Michael Karsy, Daxa M Patel, Kyle Halvorson, Vance Mortimer, Robert J BolloAbstract:Anterior two-thirds Corpus Callosotomy is a common palliative surgical intervention most commonly employed in patients with atonic or drop seizures. Recently, stereotactic laser ablation of the Corpus callosum without a craniotomy has shown promise in achieving similar outcomes with fewer side effects and shorter hospitalizations. The authors demonstrate ablation of the anterior two-thirds Corpus callosum in a patient with Lennox-Gastaut syndrome and drug-resistant drop seizures. Technical nuances of laser ablation with 3 laser fibers are described. Postoperatively, the patient showed a significant reduction in seizure frequency and severity over a 9-month follow-up period. The video can be found here: https://youtu.be/3-mMq5-PLiM .
Matthew D. Smyth - One of the best experts on this subject based on the ideXlab platform.
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Corpus Callosotomy performed with laser interstitial thermal therapy
Journal of Neurosurgery, 2019Co-Authors: Jarod L. Roland, Syed Hassan A. Akbari, Afshin Salehi, Matthew D. SmythAbstract:Objective Corpus Callosotomy is a palliative procedure that is effective at reducing seizure burden in patients with medically refractory epilepsy. The procedure is traditionally performed via open craniotomy with interhemispheric microdissection to divide the Corpus callosum. Concerns for morbidity associated with craniotomy can be a deterrent to patients, families, and referring physicians for surgical treatment of epilepsy. Laser interstitial thermal therapy (LITT) is a less invasive procedure that has been widely adopted in neurosurgery for the treatment of tumors. In this study, the authors investigated LITT as a less invasive approach for Corpus Callosotomy. Methods The authors retrospectively reviewed all patients treated for medically refractory epilepsy by Corpus Callosotomy, either partial or completion, with LITT. Chart records were analyzed to summarize procedural metrics, length of stay, adverse events, seizure outcomes, and time to follow-up. In select cases, resting-state functional MRI was performed to qualitatively support effective functional disconnection of the cerebral hemispheres. Results Ten patients underwent 11 LITT procedures. Five patients received an anterior two-thirds LITT Callosotomy as their first procedure. One patient returned after LITT partial Callosotomy for completion of Callosotomy by LITT. The median hospital stay was 2 days (IQR 1.5-3 days), and the mean follow-up time was 1.0 year (range 1 month to 2.86 years). Functional outcomes are similar to those of open Callosotomy, with the greatest effect in patients with a significant component of drop attacks in their seizure semiology. One patient achieved an Engel class II outcome after anterior two-thirds Callosotomy resulting in only rare seizures at the 18-month follow-up. Four others were in Engel class III and 5 were Engel class IV. Hemorrhage occurred in 1 patient at the time of removal of the laser fiber, which was placed through the bone flap of a prior open partial Callosotomy. Conclusions LITT appears to be a safe and effective means for performing Corpus Callosotomy. Additional data are needed to confirm equipoise between open craniotomy and LITT for Corpus Callosotomy.
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Corpus Callosotomy-Open and endoscopic surgical techniques.
Epilepsia, 2017Co-Authors: Matthew D. Smyth, Eishi Asano, Ananth K. Vellimana, Sandeep SoodAbstract:Summary Corpus Callosotomy is a palliative surgical procedure for patients with refractory epilepsy. It can be performed through an open approach via a standard craniotomy and the aid of an operating microscope, or alternatively via a mini-craniotomy with endoscope assistance. The extent of callosal disconnection performed varies according to indications and surgeon preference. In this article, we describe both open and endoscopic surgical techniques for anterior and complete Corpus Callosotomy.
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Endoscopic Corpus Callosotomy: An animal study
Journal of pediatric neurology, 2015Co-Authors: R. Shane Tubbs, Matthew D. Smyth, George Salter, Jeffrey P. BlountAbstract:We have previously described a technique for the partial bisection of the Corpus callosum in the cadaver in order to increase the minimally invasiveness of this procedure. We now present our experience with this procedure in an animal model. Following a 1.0 cm midline skin incision, cranial trephinations (approximately 0.5 cm) were performed in five adult pigs under general endotracheal anesthesia. A rigid endoscope (AESCULAP, Tuttlingen, Germany) was next introduced and used to transect the approximate anterior two-thirds of the Corpus callosum. Following the procedure, brains were observed for gross injury to vascularities or non callosal nervous tissue. No vascular complications were encountered in any of our animal specimens (e.g. superior sagittal sinus, anterior cerebral, frontopolar, or pericallosal arteries). The Corpus callosum was easily transected in each specimen. All animals survived the procedure. We believe this technique could provide a less invasive mechanism for patients primarily children, who require Corpus Callosotomy and will minimize much of the morbidity associated with the traditional methods of sectioning the Corpus callosum. Human studies are now necessary to confirm our findings. (J Pediatr Neurol 2003; 1(1): 25-28).
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Radiosurgical posterior Corpus Callosotomy in a child with Lennox-Gastaut syndrome. Case report.
Journal of neurosurgery, 2007Co-Authors: Matthew D. Smyth, Eric E Klein, W Edwin Dodson, David B MansurAbstract:The authors report the successful use of radiosurgery in a child for posterior Corpus Callosotomy; the early results are good and the patient has not suffered any morbid conditions. The relevant literature pertaining to the use of radiosurgery for treating epilepsy is reviewed. Details of the radiosurgical techniques and prescription dose used are presented, along with 1-year serial neuroimaging results.
Naoum P. Issa - One of the best experts on this subject based on the ideXlab platform.
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stereotactic laser anterior Corpus Callosotomy for lennox gastaut syndrome
Epilepsia, 2020Co-Authors: David Satzer, Naoum P. Issa, Sandra Rose, John J. Collins, Shasha Wu, Julia Henry, Fabiane Santos De Lima, Douglas R Nordli, Peter C. WarnkeAbstract:Objective Corpus Callosotomy is an effective palliative treatment for drug-resistant Lennox-Gastaut syndrome (LGS). Laser interstitial thermal therapy has been increasingly used in the treatment of epilepsy. Here, we assess the safety and effectiveness of minimally invasive stereotactic laser anterior Corpus Callosotomy (SLACC) for drop attacks in LGS. Methods We reviewed sequential cases of patients with medically intractable LGS who underwent SLACC using a two-cannula technique between November 2014 and July 2019. Pre- and postoperative magnetic resonance imaging was used to measure the anteroposterior length of callosal ablation (contrast-enhancing lesion) and estimated disconnection (gap in tract projections on diffusion tensor imaging). Patients were followed longitudinally to assess clinical outcomes. Results Ten patients were included in this study. The median age was 33 (range = 11-52) years, median duration of epilepsy was 26 (range = 10-49) years, and median duration of postoperative follow-up was 19 (range = 6-40) months. In the anteroposterior direction, 53 ± 7% (mean ± SD) of the Corpus callosum was ablated and 62 ± 19% of the Corpus callosum was estimated to be disconnected. Six (60%) of 10 patients achieved >80% seizure reduction, two (20%) of whom became seizure-free. Eight (80%) patients had >80% reduction in drop attacks, five (50%) of whom became free of drop attacks. Three patients subsequently underwent laser posterior Callosotomy with further improvement in drop attacks and/or overall seizure frequency. One patient had an asymptomatic intracerebral hemorrhage along the cannula tract. One patient developed significant aggression after becoming seizure-free. Significance Seizure outcomes following SLACC were comparable to previously reported outcomes of open Callosotomy, with reasonable safety profile. SLACC appears to be an effective alternative to open anterior Corpus Callosotomy with minimal postoperative discomfort and a short recovery period.
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Interstitial Stereotactic Laser Anterior Corpus Callosotomy: A Report of 2 Cases with Operative Technique and Effectiveness.
Neurosurgery, 2018Co-Authors: James X. Tao, Naoum P. Issa, Sandra Rose, John J. Collins, Peter C. WarnkeAbstract:BACKGROUND AND IMPORTANCE Corpus Callosotomy is an effective palliative treatment for medically intractable Lennox-Gastaut syndrome (LGS) that disrupts the interhemispheric synchronization of epileptiform discharges. However, traditional open Corpus Callosotomy carries a significant risk of surgical complications associated with craniotomy and a parafalcine approach to the Corpus callosum. Here, we report 2 cases of anterior Corpus Callosotomy using MRI-guided stereotactic laser interstitial thermal therapy (LITT) as a minimally invasive technique for mitigating the risks of craniotomy while achieving favorable outcomes. CLINICAL PRESENTATION Two patients with medically intractable LGS underwent stereotactic laser anterior Corpus Callosotomy using a 2 laser-fiber approach. Ablation of 70%-80% of the Corpus callosum was confirmed by postoperative MRI diffusion tensor imaging and volumetric analysis. Marked reduction of epileptiform activity was observed in both patients during postoperative video-EEG studies as compared to preoperative video-EEG studies. Freedom from disabling seizures including drop attacks was achieved in 1 patient for 18 mo, and more than a 90% reduction of disabling seizures was achieved in the other patient for 7 mo with cognitive improvement and without surgical complications. CONCLUSION These early data demonstrate the technical feasibility, safety, and favorable outcomes of MRI-guided stereotactic laser anterior Corpus Callosotomy in patients with LGS, making it a potentially safe and effective alternative to traditional open Corpus Callosotomy and other stereotactic methods including radiofrequency ablation and radiosurgery due to the ability to monitor the ablation in real time with MRI.
