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Neurosurgical Focus: Video Jul 2024Hypothalamic hamartomas are congenital lesions of the hypothalamus, with a range of symptoms defined by lesion location. Common presenting symptoms include gelastic...
Hypothalamic hamartomas are congenital lesions of the hypothalamus, with a range of symptoms defined by lesion location. Common presenting symptoms include gelastic seizures and precocious puberty. When hamartoma-related seizures become resistant to medications, laser interstitial thermal therapy (LITT) has been shown to be an effective treatment. The authors present a case of robot-assisted LITT for a patient with an 11-year history of epilepsy due to hypothalamic hamartoma. In addition, they demonstrate the use of a stereotactic biopsy needle implemented during the procedure for possible biopsy of deep cranial lesions. The video can be found here: https://stream.cadmore.media/r10.3171/2024.4.FOCVID2415.
PubMed: 38957425
DOI: 10.3171/2024.4.FOCVID2415 -
Neurosurgical Focus: Video Jul 2024The supracerebellar transtentorial technique (SCTT) is a versatile approach that grants access to medial and basal temporal (MBT) regions without transgressing normal...
The supracerebellar transtentorial technique (SCTT) is a versatile approach that grants access to medial and basal temporal (MBT) regions without transgressing normal lateral cortex, damaging the hippocampus, or requiring significant brain retraction. This video illustrates the SCTT in resecting a cavernous malformation within the parahippocampal gyrus to alleviate associated epilepsy and preserve cognition. The authors outline the anatomical considerations, alternative approaches, positioning, craniotomy, and dural opening. They demonstrate how to access the supracerebellar space, elevate the dura toward the tentorial incisura, and resect the malformation. This video serves as a practical reference for management of MBT lesions via minimally invasive procedures.
PubMed: 38957424
DOI: 10.3171/2024.4.FOCVID2455 -
Neurosurgical Focus: Video Jul 2024Neurostimulation is an increasingly common treatment option for medically intractable epilepsy. SANTE (Stimulation of the Anterior Nucleus of the Thalamus for Epilepsy)...
Neurostimulation is an increasingly common treatment option for medically intractable epilepsy. SANTE (Stimulation of the Anterior Nucleus of the Thalamus for Epilepsy) and Responsive Neurostimulation (RNS) System are landmark neurostimulation trials that utilized either duty cycle or a responsive stimulation paradigm. A seizure-free outcome is rarely observed with responsive and duty cycle neurostimulation devices. Chronic subthreshold cortical stimulation (CSCS) is a promising treatment for adult drug-resistant epilepsy involving eloquent cortex and has demonstrated safety and efficacy. Herein, the authors describe the surgical technique as well as details of stimulation programming involved in CSCS placement to facilitate the adoption of this promising treatment. The video can be found here: https://stream.cadmore.media/r10.3171/2024.4.FOCVID2422.
PubMed: 38957423
DOI: 10.3171/2024.4.FOCVID2422 -
Neurosurgical Focus: Video Jul 2024Minimally invasive surgery is gaining increasing interest in epilepsy surgery. In this video, the authors present the endoscopic transorbital approach for an...
Minimally invasive surgery is gaining increasing interest in epilepsy surgery. In this video, the authors present the endoscopic transorbital approach for an epileptogenic lesion located at the temporal tip. The patient was a man in his 40s who has had intractable focal impaired awareness seizures and focal to bilateral tonic-clonic seizures since he was 31 years of age. According to the preoperative examination, including stereotactic electroencephalography, a cavernous angioma located at the tip of the right temporal lobe was diagnosed as an epileptogenic lesion. Lesionectomy for this lesion was performed using the endoscopic transorbital approach as minimally invasive surgery and a favorable outcome was achieved. The video can be found here: https://stream.cadmore.media/r10.3171/2024.4.FOCVID2414.
PubMed: 38957422
DOI: 10.3171/2024.4.FOCVID2414 -
Neurosurgical Focus: Video Jul 2024Cortico-amygdalo-hippocampectomy is the most common epilepsy surgery resection in adults and offers excellent outcomes. Seizure outcome benefits range from 75% to 88%...
Cortico-amygdalo-hippocampectomy is the most common epilepsy surgery resection in adults and offers excellent outcomes. Seizure outcome benefits range from 75% to 88% with a 2%-4% adverse event rate. The safety profile and outcomes could be enhanced further by clearly defining key surgical landmarks that could also aid tumoral resections in the mesial temporal lobe and selective mesial resections. The authors present their learnings of intraoperative landmarks (cisternal, parenchymal, and vascular) and surgical substeps through an index case of cortico-amygdalo-hippocampectomy with lessons from 820 resections. The video can be found here: https://stream.cadmore.media/r10.3171/2024.4.FOCVID2428.
PubMed: 38957421
DOI: 10.3171/2024.4.FOCVID2428 -
Neurosurgical Focus: Video Jul 2024Selective amygdalohippocampectomy via the pterional transsylvian approach is a feasible option for many patients with mediobasal temporal epilepsy. However, it may be...
Selective amygdalohippocampectomy via the pterional transsylvian approach is a feasible option for many patients with mediobasal temporal epilepsy. However, it may be insufficient for patients when the posterior hippocampal region is involved. The paramedian supracerebellar transtentorial approach offers precise anatomical orientation when exposing the entire length of the mediobasal temporal region, including the fusiform gyrus. In addition, this approach allows selective amygdalohippocampectomy without any neocortical damage. This video presents the successful treatment of a patient with posterior hippocampal sclerosis and mediobasal temporal epilepsy through the paramedian supracerebellar transtentorial approach.
PubMed: 38957420
DOI: 10.3171/2024.4.FOCVID2447 -
Neurosurgical Focus: Video Jul 2024Hypothalamic hamartomas (HHs) are benign masses, often associated with drug-refractory epilepsy (DRE). Open surgery as well as the endoscopic disconnection techniques...
Hypothalamic hamartomas (HHs) are benign masses, often associated with drug-refractory epilepsy (DRE). Open surgery as well as the endoscopic disconnection techniques are fraught with a high risk of morbidity and failure rates. The authors have been performing robotic-guided radiofrequency (RF) ablation for all types of HH presenting with DRE as a standard procedure at their institution. The authors have operated on 25 patients with HH using this technique over the last 8 years. This is a safe, effective, and minimally invasive technique. In this video article, the authors intend to demonstrate their technique of RF ablative disconnection under robotic guidance.
PubMed: 38957419
DOI: 10.3171/2024.4.FOCVID2450 -
Neurosurgical Focus: Video Jul 2024An accurate definition of the epileptogenic zone is critical to the success of epilepsy surgery. When noninvasive presurgical studies are insufficient,...
An accurate definition of the epileptogenic zone is critical to the success of epilepsy surgery. When noninvasive presurgical studies are insufficient, stereoelectroencephalography (SEEG) becomes indispensable. This study illustrates a systematic approach using an illustrative case of centroparietal epilepsy, detailing the stepwise workup, planning, and image-guided robot-assisted frameless stereotactic implantation of intracerebral electrodes. The video provides insights into technical aspects and a single-center experience. Demonstrating efficacy, safety, and feasibility, SEEG emerges as a valuable procedure for studying drug-resistant focal epilepsy. The video can be found here: https://stream.cadmore.media/r10.3171/2024.4.FOCVID2427.
PubMed: 38957418
DOI: 10.3171/2024.4.FOCVID2427 -
Neurosurgical Focus: Video Jul 2024Vagus nerve stimulation (VNS) is a neuromodulatory treatment involving chronic intermittent electrical stimulation of the left vagus nerve, administered through a...
Vagus nerve stimulation (VNS) is a neuromodulatory treatment involving chronic intermittent electrical stimulation of the left vagus nerve, administered through a programmable pulse generator implanted subcutaneously in the chest. This generator connects to a bipolar lead, with electrodes wrapped around the vagus nerve in the neck. Primarily used as an adjunct therapy for patients with refractory epilepsy who cannot undergo or have not benefitted from resective surgery, VNS is generally well tolerated with few severe side effects. Herein is presented an educational surgical video providing a detailed, step-by-step technical description of VNS implantation. The video can be found here: https://stream.cadmore.media/r10.3171/2024.4.FOCVID244.
PubMed: 38957417
DOI: 10.3171/2024.4.FOCVID244 -
Neurosurgical Focus: Video Jul 2024Epilepsy is a common symptom of pediatric cavernous malformations. In medically refractory patients, surgery can achieve high seizure freedom rates with low morbidity....
Epilepsy is a common symptom of pediatric cavernous malformations. In medically refractory patients, surgery can achieve high seizure freedom rates with low morbidity. This video depicts the use of a minipterional craniotomy and transsulcal resection of a frontal opercular cavernous malformation in a 13-year-old female with medically intractable epilepsy. At 1-year follow-up, she was evaluated as Engel class I with a significant improvement in her quality of life. Principles of cavernous malformation resection for the treatment of epilepsy are also reviewed. The video can be found here: https://stream.cadmore.media/r10.3171/2024.4.FOCVID2441.
PubMed: 38957416
DOI: 10.3171/2024.4.FOCVID2441