Anteromesial Temporal Lobectomy for Medically Intractable Temporal Lobe Epilepsy: An Operative Study.

Anteromesial temporal lobectomy, including surgical resection of the mesial temporal structures, is an important surgical procedure for the treatment of medically refractory temporal lobe epilepsy. Given the widespread use of this technique in appropriately screened patients with intractable focal epilepsy (not to mention other non-epileptic neurosurgical conditions, including brain tumors and vascular lesions), it is important for the treating neurosurgeon to have a comprehensive understanding of the complex anatomy and surgical technique for performing a successful resection. Here, we describe the key steps and important technical pearls for a standard anteromesial temporal lobectomy procedure.

Robotic-Guided Stereoelectroencephalography for Invasive Epilepsy Monitoring.

Stereoelectroencephalography (sEEG) describes a precise method for the stereotactic implantation of intracerebral electrodes. Electrode implantation plans are made according to a localization hypothesis formulated using semiological, electrophysiological, anatomical, and imaging data. The placement of these electrodes is an invasive procedure commonly performed during pre-surgical investigation in patients with drug-resistant epilepsy who are undergoing work-up for potential surgical treatment.

Disconnective hemispherotomy: technique and operative highlights.

Hemispherectomy is an effective procedure used in the treatment of drug-resistant hemispheric epilepsy, especially in the pediatric population. A number of resective and disconnective techniques are used, and selection of surgical strategy is paramount to achieving successful results. Notably, disconnective (or functional) hemispherotomy maximizes the benefits of safe, surgical disconnection while minimizing hemispheric tissue resection, thereby avoiding some of the perioperative factors contributing to morbidity in traditional anatomical hemispherectomy procedures.

Loss of Efficacy in Ventral Intermediate Nucleus Stimulation for Essential Tremor.

Objective: The primary aim of this study is to report long-term outcomes associated with deep brain stimulation (DBS) of the ventral intermediate nucleus (VIM) performed at our institution. We further aimed to elicit the factors associated with loss of efficacy and to discuss the need for exploring and establishing reliable rescue targets.

Methods: To study long-term outcomes, we performed a retrospective chart review and extracted tremor scores of 43 patients who underwent VIM DBS lead implantation for essential tremor at our center.

Seizure Outcomes and Reoperation in Surgical Rasmussen Encephalitis Patients.

Background: Rasmussen encephalitis (RE) is a rare inflammatory disease affecting one hemisphere, causing progressive neurological deficits and intractable seizures.

Objective: To report long-term seizure outcomes, reoperations, and functional outcomes in patients with RE who underwent hemispherectomy at our institution.

Methods: Retrospective review was performed for all patients with RE who had surgery between 1998 and 2020.

Subthalamic Nucleus Activity Influences Sensory and Motor Cortex during Force Transduction.

The subthalamic nucleus (STN) is proposed to participate in pausing, or alternately, in dynamic scaling of behavioral responses, roles that have conflicting implications for understanding STN function in the context of deep brain stimulation (DBS) therapy. To examine the nature of event-related STN activity and subthalamic-cortical dynamics, we performed primary motor and somatosensory electrocorticography while subjects (n = 10) performed a grip force task during DBS implantation surgery. Phase-locking analyses demonstrated periods of STN-cortical coherence that bracketed force transduction, in both beta and gamma ranges.

Dynamics of human subthalamic neuron phase-locking to motor and sensory cortical oscillations during movement.

Coupled oscillatory activity recorded between sensorimotor regions of the basal ganglia-thalamocortical loop is thought to reflect information transfer relevant to movement. A neuronal firing-rate model of basal ganglia-thalamocortical circuitry, however, has dominated thinking about basal ganglia function for the past three decades, without knowledge of the relationship between basal ganglia single neuron firing and cortical population activity during movement itself. We recorded activity from 34 subthalamic nucleus (STN) neurons, simultaneously with cortical local field potentials and motor output, in 11 subjects with Parkinson's disease (PD) undergoing awake deep brain stimulator lead placement.

Effects of hippocampal low-frequency stimulation in idiopathic non-human primate epilepsy assessed via a remote-sensing-enabled neurostimulator.

Individuals with pharmacoresistant epilepsy remain a large and under-treated patient population. Continued technologic advancements in implantable neurostimulators have spurred considerable research efforts directed towards the development of novel antiepileptic stimulation therapies. However, the lack of adequate preclinical experimental platforms has precluded a detailed understanding of the differential effects of stimulation parameters on neuronal activity within seizure networks.

Detection of high-frequency oscillations by hybrid depth electrodes in standard clinical intracranial EEG recordings.

High-frequency oscillations (HFOs) have been proposed as a novel marker for epileptogenic tissue, spurring tremendous research interest into the characterization of these transient events. A wealth of continuously recorded intracranial electroencephalographic (iEEG) data is currently available from patients undergoing invasive monitoring for the surgical treatment of epilepsy. In contrast to data recorded on research-customized recording systems, data from clinical acquisition systems remain an underutilized resource for HFO detection in most centers.