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Epilepsia. 2020 Mar 29. doi: 10.1111/epi.16489. [Epub ahead of print]
How technology is driving the landscape of epilepsy surgery.
Dorfer C1, Rydenhag B2,3, Baltuch G4, Buch V4, Blount J5, Bollo R6, Gerrard J7, Nilsson D2,3, Roessler K1,8, Rutka J9, Sharan A10, Spencer D7, Cukiert A11.
Author information
1Department of Neurosurgery, Medical University of Vienna, Vienna, Austria.2Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.3Department of Neurosurgery, Sahlgrenska University Hospital, Gothenburg, Sweden.4Center for Functional and Restorative Neurosurgery, University of Pennsylvania, Philadelphia, PA, USA.5Division of Neurosurgery, University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA.6Department of Neurosurgery, University of Utah School of Medicine, Salt Lake City, UT, USA.7Department of Neurosurgery, Yale University School of Medicine, New Haven, CT, USA.8Department of Neurosurgery, University of Erlangen, Erlangen, Germany.9Division of Pediatric Neurosurgery, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.10Department of Neurosurgery and Neurology, Thomas Jefferson University, Philadelphia, PA, USA.11Neurology and Neurosurgery Clinic Sao Paulo, Clinica Neurologica Cukiert, Sao Paulo, Brazil.
Abstract
This article emphasizes the role of the technological progress in changing the landscape of epilepsy surgery and provides a critical appraisal of robotic applications, laser interstitial thermal therapy, intraoperative imaging, wireless recording, new neuromodulation techniques, and high-intensity focused ultrasound. Specifically, (a) it relativizes the current hype in using robots for stereo-electroencephalography (SEEG) to increase the accuracy of depth electrode placement and save operating time; (b) discusses the drawback of laser interstitial thermal therapy (LITT) when it comes to the need for adequate histopathologic specimen and the fact that the concept of stereotactic disconnection is not new; (c) addresses the ratio between the benefits and expenditure of using intraoperative magnetic resonance imaging (MRI), that is, the high technical and personnel expertise needed that might restrict its use to centers with a high case load, including those unrelated to epilepsy; (d) soberly reviews the advantages, disadvantages, and future potentials of neuromodulation techniques with special emphasis on the differences between closed and open-loop systems; and (e) provides a critical outlook on the clinical implications of focused ultrasound, wireless recording, and multipurpose electrodes that are already on the horizon. This outlook shows that although current ultrasonic systems do have some limitations in delivering the acoustic energy, further advance of this technique may lead to novel treatment paradigms. Furthermore, it highlights that new data streams from multipurpose electrodes and wireless transmission of intracranial recordings will become available soon once some critical developments will be achieved such as electrode fidelity, data processing and storage, heat conduction as well as rechargeable technology. A better understanding of modern epilepsy surgery will help to demystify epilepsy surgery for the patients and the treating physicians and thereby reduce the surgical treatment gap.
https://www.ncbi.nlm.nih.gov/pubmed/?term=...pilepsy+surgery
https://onlinelibrary.wiley.com/doi/full/10.1111/epi.16489
https://onlinelibrary.wiley.com/doi/full/10.1111/epi.16489
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