robotic-guided-stereoelectroencephalography-for-invasive-epilepsy

Robotic-Guided Stereoelectroencephalography for Invasive Epilepsy Monitoring

Stereoelectroencephalography (sEEG) describes a precise method for the stereotactic implantation of intracerebral electrodes. Electrode implantation plans ...

anteromesial-temporal-lobectomy-for-medically-intractable-temporal

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 ...

University of Arizona, Tucson

Cleveland Clinic

University of Arizona

Cerebrospinal fluid shunt infection is associated with patient morbidity and high cost. We conducted a systematic review of the current evidence of comprehensive surgical protocols or individual interventions designed to reduce shunt infection incidence.

Evidence-based interventions to reduce shunt infections: a systematic review.

The circulating levels of soluble tumor necrosis factor receptor-1 (sTNF-R1) and sTNF-R2 are altered in numerous diseases, including several types of cancer. Correlations with the risk of progression in some cancers, as well as systemic manifestations of the disease and therapeutic side-effects, have been described. However, there is very little information on the levels of these soluble receptors in glioblastoma (GBM). Here, we report on an exploratory retrospective study of the levels of sTNF-Rs in the vascular circulation of patients with GBM. Banked samples were obtained from 112 GBM patients (66 untreated, newly-diagnosed patients and 46 with recurrent disease) from two institutions. The levels of sTNF-R1 in the plasma were significantly lower in patients with newly-diagnosed or recurrent GBM than apparently healthy individuals and correlated with the intensity of expression of TNF-R1 on the tumor-associated endothelial cells (ECs) in the corresponding biopsies. Elevated levels of sTNF-R1 in patients with recurrent, but not newly-diagnosed GBM, were significantly associated with a shorter survival, independent of age (p = 0.02) or steroid medication. In contrast, the levels of circulating sTNF-R2 were significantly higher in recurrent GBM than healthy individuals and there was no significant correlation with expression of TNF-R2 on the tumor-associated ECs or survival time. The results indicate that larger, prospective studies are warranted to determine the predictive value of the levels of sTNF-R1 in patients with recurrent GBM and the factors that regulate the levels of sTNF-Rs in the circulation in GBM patients.

Correlation of higher levels of soluble TNF-R1 with a shorter survival, independent of age, in recurrent glioblastoma.

Laser ablation (LA) is used as an upfront treatment in patients with deep seated newly diagnosed Glioblastoma (nGBM).

Upfront Magnetic Resonance Imaging-Guided Stereotactic Laser-Ablation in Newly Diagnosed Glioblastoma: A Multicenter Review of Survival Outcomes Compared to a Matched Cohort of Biopsy-Only Patients.

We describe patient-reported outcomes (PROs) in adults with CNS tumors and evaluate their correlation with physician-reported functional status.

Quality of life outcomes in patients presenting for evaluation of CNS tumors.

Brain metastases represent the most common intracranial neoplasm and pose a significant disease burden on the individual and the healthcare system. Although whole brain radiation therapy was historically a first line approach, subsequent research and technological advancements have resulted in a larger armamentarium of strategies for treatment of these patients. While chemotherapeutic options remain limited, surgical resection and stereotactic radiosurgery, as well as their combination therapies, have shifted the paradigms for managing intracranial metastatic disease. Ultimately, no single treatment is shown to be consistently effective across patient groups in terms of overall survival, local and distant control, neurocognitive function, and performance status. However, close consideration of patient and tumor characteristics may help delineate more favorable treatment strategies for individual patients. Here the authors present a review of the recent literature surrounding surgery, whole brain radiation therapy, stereotactic radiosurgery, and combination approaches.

Management Strategies for Large Brain Metastases.

Neuropsychological profiles are heterogeneous both across and within epilepsy syndromes, but especially in frontal lobe epilepsy (FLE), which has complex semiology and epileptogenicity. This study aimed to characterize the cognitive heterogeneity within FLE by identifying cognitive phenotypes and determining their demographic and clinical characteristics.

Cognitive phenotypes in frontal lobe epilepsy.

We developed, tested, and validated a novel, noninvasive, Leksell G frame-based fiducial attachment, for use in stereotactic registration for stereoelectroencephalography (sEEG). Use of the device increased the number of fixed reference points available for registration, while obviating the need for additional scalp incisions. We report here on our experience and safety profile of using the device.

Validation and Safety Profile of a Novel, Noninvasive Fiducial Attachment for Stereotactic Robotic-Guided Stereoelectroencephalography: A Case Series.

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. In this video, the authors outline the principal surgical steps of disconnective hemispherotomy and highlight important technical factors leading to optimal outcomes in patients with refractory, oftentimes catastrophic, hemispheric epilepsy. The video can be found here: https://stream.cadmore.media/r10.3171/2024.4.FOCVID2436.

Disconnective hemispherotomy: technique and operative highlights.

Hydrocephalus is a known complication following surgical resection of a cerebral hemisphere for refractory epilepsy, yet the pathological mechanism remains poorly understood. We present a case of refractory aseptic inflammatory hydrocephalus following cerebral hemispherectomy surgery for refractory epilepsy treated with a combination of cerebral spinal fluid (CSF) diversion and immunosuppression via IL-1 receptor agonist, Anakinra. At 6 month follow up, the patient had returned to neurologic baseline, with improvement in school and physical therapy performance. Further investigation into the beneficial role of immunosuppressive therapy is needed to better understand the relationship between neuro-inflammation and improving outcomes following epilepsy surgery.

Refractory inflammatory hydrocephalus: A case report of a rare and complicated delayed sequelae following cerebral hemispherectomy surgery for epilepsy.

Stereoelectroencephalography (SEEG) is an important method for invasive monitoring to establish surgical candidacy in approximately half of refractory epilepsy patients. Identifying factors affecting lead placement can mitigate potential surgical risks. This study applies multivariate analyses to identify perioperative factors affecting stereotactic electrode placement.

ArticleTotal : 2	Year
Publication title	2025
Publication title Cited by 1	2025

Article	Year
Evidence-based interventions to reduce shunt infections: a systematic review. Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery\| PubMed ID: 25686893	2015
Correlation of higher levels of soluble TNF-R1 with a shorter survival, independent of age, in recurrent glioblastoma. Journal of neuro-oncology\| PubMed ID: 27858267	2017
Upfront Magnetic Resonance Imaging-Guided Stereotactic Laser-Ablation in Newly Diagnosed Glioblastoma: A Multicenter Review of Survival Outcomes Compared to a Matched Cohort of Biopsy-Only P... Neurosurgery\| PubMed ID: 30476325	2019
Quality of life outcomes in patients presenting for evaluation of CNS tumors. Neurology. Clinical practice\| PubMed ID: 30859005	2019
Management Strategies for Large Brain Metastases. Frontiers in oncology\| PubMed ID: 35251995	2022
Cognitive phenotypes in frontal lobe epilepsy. Epilepsia\| PubMed ID: 35429174	2022
Validation and Safety Profile of a Novel, Noninvasive Fiducial Attachment for Stereotactic Robotic-Guided Stereoelectroencephalography: A Case Series. Operative neurosurgery (Hagerstown, Md.)\| PubMed ID: 38651866	2024
Disconnective hemispherotomy: technique and operative highlights. Neurosurgical focus: Video\| PubMed ID: 38957432	2024
Refractory inflammatory hydrocephalus: A case report of a rare and complicated delayed sequelae following cerebral hemispherectomy surgery for epilepsy. Epilepsy & behavior reports\| PubMed ID: 39099582	2024
A Multivariate Approach to Quantifying Risk Factors Impacting Stereotactic Robotic-Guided Stereoelectroencephalography. Operative neurosurgery (Hagerstown, Md.)\| PubMed ID: 39329517	2025

Nehaw Sarmey

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