Neurosurg Focus
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Case Reports Randomized Controlled Trial Multicenter Study Comparative Study
Implantation of a responsive neurostimulator device in patients with refractory epilepsy.
The authors summarize one center's experience with a novel device, the Responsive Neurostimulation (RNS) system, which is used to treat seizures, and they provide technical details regarding the implantation procedure. ⋯ The results obtained in this small preliminary series demonstrate a safe implantation method for the responsive neurostimulation device.
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Surgery is an established treatment for temporal lobe epilepsy refractory to medication. Several surgical approaches have been used to treat this condition including temporal lobectomy, transcortical selective amygdalohippocampectomy, subtemporal amygdalohippocampectomy, and transsylvian amygdalohippocampectomy. In this article the author reviews the transsylvian amygdalohyppocampectomy and pertinent anatomy. He also discusses the procedure's results with regard to seizure control, neuropsychological outcome, and visual field preservation.
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Comparative Study
Phase I trial: safety and feasibility of intracranial electroencephalography using hybrid subdural electrodes containing macro- and microelectrode arrays.
Cerebral cortex electrophysiology is poorly sampled using standard, low spatial resolution clinical intracranial electrodes. Adding microelectrode arrays to the standard clinical macroelectrode arrays increases the spatial resolution and may ultimately improve the clinical utility of intracranial electroencephalography (iEEG). However, the safety of hybrid electrode systems containing standard clinical macroelectrode and microelectrode arrays is not yet known. The authors report on their preliminary experience in 24 patients who underwent implantation of hybrid electrodes. ⋯ The authors demonstrate the use of hybrid subdural strip and grid electrodes containing high-density microwire arrays and standard clinical macroelectrodes. Hybrid electrodes provide high spatial resolution electrophysiology of the neocortex that is impossible with standard clinical iEEG. In this initial study in 24 patients, the complication rate is acceptable, and there does not appear to be increased risk associated with the use of hybrid electrodes compared with standard subdural and depth iEEG electrodes. More research is required to show whether hybrid electrode recordings will improve localization of epileptic foci and tracking the generation of neocortical seizures.
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Comparative Study
The role of optical spectroscopy in epilepsy surgery in children.
Surgery is an important therapeutic modality for pediatric patients with intractable epilepsy. However, existing imaging and diagnostic technologies such as MR imaging and electrocochleography (ECoG) do not always effectively delineate the true resection margin of an epileptic cortical lesion because of limitations in their sensitivity. Optical spectroscopic techniques such as fluorescence and diffuse reflectance spectroscopy provide a nondestructive means of gauging the physiological features of the brain in vivo, including hemodynamics and metabolism. In this study, the authors investigate the feasibility of using combined fluorescence and diffuse reflectance spectroscopy to assist epilepsy surgery in children. ⋯ The results of this study demonstrate the feasibility of using static fluorescence and diffuse reflectance spectroscopy to differentiate normal from abnormal cortex on the basis of intraoperative assessment of ECoG and histological features. It is therefore possible to use fluorescence and diffuse reflectance spectroscopy as an aid in epilepsy surgery.
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Case Reports
Robotic image-guided depth electrode implantation in the evaluation of medically intractable epilepsy.
The authors describe their experience with a technique for robotic implantation of depth electrodes in patients concurrently undergoing craniotomy and placement of subdural monitoring electrodes for the evaluation of intractable epilepsy. ⋯ Robotic image-guided placement of depth electrodes with concurrent craniotomy is feasible, and the technique is safe, accurate, and efficient.