Abstract
Medically refractory pediatric epilepsy is a common problem in pediatric neurosurgery, resulting in serious morbidity and cognitive delay in pediatric patients. Traditionally, the preoperative management of refractory epilepsy has involved comprehensive imaging studies, observation, and both noninvasive and invasive methods of electrographic monitoring. With recent developments in stereotactic neurosurgery, invasive intracranial monitoring may be accomplished by stereotactic placement of depth electrodes, which can significantly decrease operative morbidity and improve operative workflow. These benefits are especially pronounced in cases where extensive multifocal or bilateral epilepsy monitoring is indicated. Furthermore, recent developments in laser interstitial thermal therapy for the treatment of pediatric epilepsy have allowed for significant reduction of seizure burden without performing extensive craniotomies. This is of special interest to patients with conditions such as tuberous sclerosis or hypothalamic hamartomas, which traditionally may have required multiple craniotomies for extensive epilepsy monitoring, iterative craniotomies for seizure control, or deep surgical approaches associated with increased morbidity. Instead, the advent of stereotactic neurosurgical methods allows for less invasive monitoring and treatment of epilepsy in patients with these conditions and other etiologies of epilepsy, and may form the basis of a new paradigm for neurosurgical management of pediatric epilepsy.
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Abbreviations
- EEG:
-
Electroencephalography
- HH:
-
Hypothalamic hamartoma
- LITT:
-
Laser interstitial thermal therapy
- MEG:
-
Magnetoencephalography
- MRI:
-
Magnetic resonance imaging
- PET:
-
Positron emission tomography
- RNS:
-
Responsive neurostimulation
- sEEG:
-
Stereoelectroencephalography
- SPECT:
-
Single-photon emission computed tomography
- TS:
-
Tuberous sclerosis
References
Dwivedi R, Ramanujam B, Chandra PS, Sapra S, Gulati S, Kalaivani M, et al. Surgery for drug-resistant epilepsy in children. N Engl J Med. 2017;377(17):1639–47.
Lee J, Adelson PD. Neurosurgical management of pediatric epilepsy. Pediatr Clin N Am. 2004;51:441–56.
Jayakar P, Gaillard WD, Tripathi M, Libenson MH, Mathern GW, Cross JH, et al. Diagnostic test utilization in evaluation for resective epilepsy surgery in children. Epilepsia. 2014;55(4):507–18.
Alomar S, Jones J, Maldonado A, Gonzalez-Martinez J. The stereo-electroencephalography methodology. Neurosurg Clin N Am. 2016;27(1):83–95.
Curry DJ, Gowda A, McNichols RJ, Wilfong AA. MR-guided stereotactic laser ablation of epileptogenic foci in children. Epilepsy Behav. 2012;24(4):408–14.
North RY, Raskin JS, Curry DJ. MRI-guided laser interstitial thermal therapy for epilepsy. Neurosurg Clin N Am. 2017;28(4):545–57.
Morrell MJ, Halpern C. Responsive direct brain stimulation for epilepsy. Neurosurg Clin N Am. 2016;27(1):111–21.
Bandt SK, Leuthardt EC. Minimally invasive neurosurgery for epilepsy using stereotactic MRI guidance. Neurosurg Clin N Am. 2016;27(1):51–8.
Buckley RT, Wang AC, Miller JW, Novotny EJ, Ojemann JG. Stereotactic laser ablation for hypothalamic and deep intraventricular lesions. Neurosurg Focus. 2016;41(4):E10.
Tovar-Spinoza Z, Carter D, Ferrone D, Eksioglu Y, Huckins S. The use of MRI-guided laser-induced thermal ablation for epilepsy. Child’s Nerv Syst. 2013;29(11):2089–94.
Dadey DY, Kamath AA, Smyth MD, Chicoine MR, Leuthardt EC, Kim AH. Utilizing personalized stereotactic frames for laser interstitial thermal ablation of posterior fossa and mesiotemporal brain lesions: a single-institution series. Neurosurg Focus. 2016;41(4):E4.
Drane DL, Loring DW, Voets NL, Price M, Ojemann JG, Willie JT, et al. Better object recognition and naming outcome with MRI-guided stereotactic laser amygdalohippocampotomy for temporal lobe epilepsy. Epilepsia. 2015;56(1):101–13.
Jermakowicz WJ, Kanner AM, Sur S, Bermudez C, D’Haese PF, Kolcun JPG, et al. Laser thermal ablation for mesiotemporal epilepsy: analysis of ablation volumes and trajectories. Epilepsia. 2017;58(5):801–10.
Kang JY, Wu C, Tracy J, Lorenzo M, Evans J, Nei M, et al. Laser interstitial thermal therapy for medically intractable mesial temporal lobe epilepsy. Epilepsia. 2016;57(2):325–34.
Lewis EC, Weil AG, Duchowny M, Bhatia S, Ragheb J, Miller I. MR-guided laser interstitial thermal therapy for pediatric drug-resistant lesional epilepsy. Epilepsia. 2015;56(10):1590–8.
Patel P, Patel NV, Danish SF. Intracranial MR-guided laser-induced thermal therapy: single-center experience with the Visualase thermal therapy system. J Neurosurg. 2016;125(4):853–60.
Willie JT, Laxpati NG, Drane DL, Gowda A, Appin C, Hao C, et al. Real-time magnetic resonance-guided stereotactic laser amygdalohippocampotomy for mesial temporal lobe epilepsy. Neurosurgery. 2014;74(6):569–84; discussion 84–5
Willie JT, Gross RE. 202 role of repeat ablation to treat seizure recurrence following stereotactic laser amygdalohippocampotomy. Neurosurgery. 2015;62(CN_suppl_1):233–4.
Kuo CH, Feroze AH, Poliachik SL, Hauptman JS, Novotny EJ Jr, Ojemann JG. Laser ablation therapy for pediatric patients with intracranial lesions in eloquent areas. World Neurosurg. 2019;121:e191.
Overwater IE, Bindels-de Heus K, Rietman AB, Ten Hoopen LW, Vergouwe Y, Moll HA, et al. Epilepsy in children with tuberous sclerosis complex: chance of remission and response to antiepileptic drugs. Epilepsia. 2015;56(8):1239–45.
Evans LT, Morse R, Roberts D. Epilepsy surgery in tuberous sclerosis: a review. Neurosurg Focus. 2011;32(3):E5.
Romanelli P, Verdecchia M, Rodas R, Seri S, Curatolo P. Epilepsy surgery for tuberous sclerosis. Pediatr Neurol. 2004;31(4):239–47.
Liang S, Zhang J, Yang Z, Zhang S, Cui Z, Cui J, et al. Long-term outcomes of epilepsy surgery in tuberous sclerosis complex. J Neurol. 2017;264(6):1146–54.
Fallah A, Rodgers SD, Weil AG, Vadera S, Mansouri A, Connolly MB, et al. Resective epilepsy surgery for tuberous sclerosis in children: determining predictors of seizure outcomes in a multicenter retrospective Cohort Study. Neurosurgery. 2015;77(4):517–24; discussion 24
Arya R, Tenney JR, Horn PS, Greiner HM, Holland KD, Leach JL, et al. Long-term outcomes of resective epilepsy surgery after invasive presurgical evaluation in children with tuberous sclerosis complex and bilateral multiple lesions. J Neurosurg Pediatr. 2015;15(1):26–33.
Weiner HL, Ferraris N, LaJoie J, Miles D, Devinsky O. Epilepsy surgery for children with tuberous sclerosis complex. J Child Neurol. 2004;19:687–9.
Curatolo P, Bombardieri R, Jozwiak S. Tuberous sclerosis. Lancet. 2008;372:657–68.
Wilfong AA, Curry DJ. Hypothalamic hamartomas: optimal approach to clinical evaluation and diagnosis. Epilepsia. 2013;54(Suppl 9):109–14.
Mittal S, Mittal M, Montes JL, Farmer J, Andermann F. Hypothalamic hamartomas. Part 1. Clinical, neuroimaging, and neurophysiological characteristics. Neurosurg Focus. 2013;34(6):1–12.
Munari C, Kahane P, Francione S, Hoffmann D, Tassi L, Cusmai R, et al. Role of the hypothalamic hamartoma in the genesis of gelastic fits (a video-stereo-EEG study). Electroencephalogr Clin Neurophysiol. 1995;95(3):154–60.
Palmini A, Chandler C, Andermann F, Costa Da Costa J. Resection of the lesion in patients with hypothalamic hamartomas and catastrophic epilepsy. Neurology. 2002;58(9):1338.
Mittal S, Mittal M, Montes JL, Farmer J, Andermann F. Hypothalamic hamartomas. Part 2. Surgical considerations and outcome. Neurosurg Focus. 2013;34(6):1–10.
Mittal S, Mittal M, Montes JL, Farmer JP, Andermann F. Hypothalamic hamartomas. Part 2. Surgical considerations and outcome. Neurosurg Focus. 2013;34(6):E7.
Harvey AS, Freeman JL, Berkovic SF, Rosenfeld JV. Transcallosal resection of hypothalamic hamartomas in patients with intractable epilepsy. Epileptic Disord. 2003;5(4):257–65.
Mottolese C, Stan H, Bret P, Berlier P, Lapras C. Hypothalamic hamartoma: the role of surgery in a series of eight patients. Child’s Nerv Syst. 2001;17(4–5):229–36. discussion 37-8
Ng YT, Rekate HL, Prenger EC, Chung SS, Feiz-Erfan I, Wang NC, et al. Transcallosal resection of hypothalamic hamartoma for intractable epilepsy. Epilepsia. 2006;47(7):1192–202.
Polkey CE. Resective surgery for hypothalamic hamartoma. Epileptic Disord. 2003;5(4):281–6.
Curry DJ, Raskin J, Ali I, Wilfong AA. MR-guided laser ablation for the treatment of hypothalamic hamartomas. Epilepsy Res. 2018;142:131–4.
Kameyama S, Murakami H, Masuda H, Sugiyama I. Minimally invasive magnetic resonance imaging-guided stereotactic radiofrequency thermocoagulation for epileptogenic hypothalamic hamartomas. Neurosurgery. 2009;65(3):438–49. discussion 49
Kameyama S, Shirozu H, Masuda H, Ito Y, Sonoda M, Akazawa K. MRI-guided stereotactic radiofrequency thermocoagulation for 100 hypothalamic hamartomas. J Neurosurg. 2016;124(5):1503–12.
Xu DS, Chen T, Hlubek RJ, Bristol RE, Smith KA, Ponce FA, et al. Magnetic resonance imaging-guided laser interstitial thermal therapy for the treatment of hypothalamic hamartomas: a retrospective review. Neurosurgery. 2018;83(6):1183–92.
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Prablek, M.A., Giridharan, N., Weiner, H.L. (2020). Pediatric Epilepsy. In: Pouratian, N., Sheth, S. (eds) Stereotactic and Functional Neurosurgery. Springer, Cham. https://doi.org/10.1007/978-3-030-34906-6_26
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DOI: https://doi.org/10.1007/978-3-030-34906-6_26
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