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Malformations of cortical development: New surgical advances
P Bourdillon1, S Rheims2, H Catenoix3
1Department of Neurosurgery, Hospices Civils de Lyon, Neurology & Neurosurgery Hospital Pierre Wertheimer, 59, boulevard Pinel, 69003 Lyon, France; Faculty of medicine Claude Bernard, University of Lyon, 69003 Lyon, France; Sorbonne university, 75005 Paris, France; Inserm U1127, CNRS, UMR7225, Brain and Spine Institute, 75013 Paris, France.
Revue Neurologique
|March 2, 2019
Summary
Stereotactic surgery offers advanced treatment options for drug-resistant epilepsy caused by cortical malformations. Techniques like radiosurgery, thermocoagulation, and Laser Interstitial Thermal Therapy (LiTT) show promise in seizure control and improving patient outcomes.
Area of Science:
- Neurosurgery
- Epileptology
- Medical Technology
Background:
- Epilepsy from cortical malformations is often drug-resistant, necessitating surgical intervention.
- Stereotactic surgery has revolutionized the diagnosis and treatment of focal cortical dysplasias (FCD), hypothalamic hamartomas (HH), and periventricular nodular heterotopias (PNH).
Purpose of the Study:
- To review the evolving role and efficacy of stereotactic surgical techniques in managing epilepsy associated with cortical malformations.
- To compare outcomes and complication rates of various stereotactic procedures for specific malformations.
Main Methods:
- Review of existing literature on stereotactic radiosurgery, Gammaknife, monopolar multiple stereotactic thermocoagulations, Laser Interstitial Thermal Therapy (LiTT), and SEEG-guided radiofrequency-thermocoagulation (SEEG-RF-TC).
- Analysis of seizure control rates, neuropsychological results, and complication profiles for each technique.
- Discussion of advancements in diagnostic procedures like 3D electrocorticography and surgical approaches such as the hodotopic method.
Main Results:
- Gammaknife radiosurgery for HH yields 60% seizure control with good neuropsychological outcomes.
- Monopolar thermocoagulation (>80% seizure control) and LiTT show higher seizure control rates for HH but with varying complication risks.
- SEEG-guided RF-TC for PNH demonstrates significant efficacy (38% seizure-free, 81% responders) with a very low complication rate (0.3%), establishing it as a first-line treatment.
- Conventional resection is enhanced by the hodotopic approach and functional mapping, expanding surgical possibilities.
Conclusions:
- Stereotactic techniques offer effective management for drug-resistant epilepsy due to cortical malformations.
- SEEG-guided RF-TC is a highly effective and safe first-line treatment for PNH.
- Further controlled studies are needed to establish evidence-based therapeutic algorithms for these complex conditions.
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