Advanced Insights into Epilepsy Surgery Outcomes
Explore the detailed outcomes and management strategies of epilepsy surgery based on SEEG results from November 2017, covering various aspects such as complex temporal lobe epilepsy, robotic stereo-EEG experiences, surgical indications, post-SEEG localization, and management approaches post-surgery.
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Presentation Transcript
SEEG RESULTS NOVEMBER 2017 NO R TH B R I STO L NHS TR U ST EPI LEPSY SU R GER Y SER VI C E
OUTCOME OF EPILEPSY SURGERY PRE ROBOTICS Temporal Lobectomy Extratemporal Seizure free 57% (68%)* Improved No change 14% (10%)* Seizure free 44% Improved 12% No change 44% 29% (22%)* *Palm desert data -1992
COMPLEX TEMPORAL LOBE EPILEPSY Complex temporal obe epilepsy Imaging negative Bitemporal origin Neocortical temporal origin Multiple lesions Pseudotemporal lobe epilepsy Extratemporal electrical onset Anterior quadrant Insula Cingulate Occipital Temporal lobe Epilepsy + Network epilepsy
ROBOTIC STEREO-EEG - SEEG Bristol Experience 61 studies in 57 patients Electrodes placed 793 Average 13 Range 6 20 Mean length of stay 13 days Range 1 31 Major Complications 2 (2.5%)* Haematoma 2 Intracerebral (evacuated) 1 Acute subdural (evacuated) - 1 Infection - 0 Benefit of planning in 3D *Cardinale 2012 1.5%
INDICATIONS FOR SEEG Complex temporal epilepsy Imaging negative Bitemporal physiology Neocortical semiology Multiple lesions Pseudotemporal epilepsy Frontal Insular Extra temporal Frontal Parietal Occipital Multiple 8 7 6 2 13 2 7 6 3 3 23 15 19 57 cases (4 re-implantations)
LOCALISATION POST SEEG Temporal Mesial temporal Bitemporal Neocortical temporal Extratemporal Insular Frontal Parietal Cingulate Occipital Network epilepsy + Not localised 18 5 7 3 8 5 2 1 30 19 2 6
MANAGEMENT AFTER SEEG Resection / Ablation Temporal Medial temporal resection Neocortical temporal resection Extra temporal Insular resection Frontal resection Parietal resection Occipital resection Second SEEG Performed Planned Modulation VNS DBS No further surgery Declined Planned 14 3 3 7 5 2 4 2 9 0 4 3 17 18 6 9 7
TEMPORAL LOBE SURGERY SEEG ERA Outcome Post SEEG No SEEG Total % % % Seizure Free (Engel 1) Improved (Engel 2) No Change (Engel ) Total 12 1 4 71% 39 5 5 80% 51 6 9 77% 17 49 66
OUTCOME AFTER EXTRATEMPORAL SURGERY SEEG ERA SEEG 6 No SEEG 8 Total 14 % Seizure free (Engel 1) Lesion 2 4 No lesion Lesion 1 4 1 0 62% Improved (Engel 2) No lesion Lesion 1 3 0 0 1 3 81% No change (Engel ) No lesion 2 0 9 2 Total 17 26 Pathology of lesional cases Focal cortical dysplasia Tumour / hamartoma Vascular Trauma 12 5 3 1
ADULT EPILEPSY SURGERY TEAM Neurology Dr Kasia Sieradzan Dr Howard Faulkner Dr Madhu Ramnamoorti Neuroradiology Dr Marcus Likeman Neuropsychology Dr Margaret Newsome Dr Helen Thorburn Neuropsychiatry Dr Monica Mohan Neurophysiology Dr Nick Kane Neurosurgery Mr David Sandeman Mr Nikunj Patel Mr Michael Carter Mr Angelo Pichierri Epilepsy Surgery Nurse Ms Sam Travis Ms Geri Watson Neurophysiology technicians Ms Clare Johnson Ms Abby Weeks Mr Philip Watson Ms Nadia Shkirat Admin / Secretarial Ms Katie Pearce Ms Katie Ball Research Mr Jonathan Lee Mr Liviu Nicolae
