Letter to the Editor: Minimally invasive technique for epilepsy surgery

Hana Malikova MD, PhD, Roman Liscak MD, PhD and Zdeněk Vojtěch MD, PhD
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  • Epilepsy Center Na Homolce Hospital, Prague, Czech Republic
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TO THE EDITOR: We read with great interest the article by Quigg and Harden7 (Quigg M, Harden C: Minimally invasive techniques for epilepsy surgery: stereotactic radiosurgery and other technologies. J Neurosurg 121 (Suppl 2):232–240, December 2014). Surprisingly, the authors completely missed the recent progress of stereotactic radiofrequency amygdalohippocampectomy for mesial temporal lobe epilepsy (MTLE), a recently modified method that is the only one having seizure control results comparable with anterior temporal resection. Only less effective stereotactic treatments for MTLE published by Parrent and Blume6 in 1999 and by Guénot et al.1 are mentioned.

We would like to focus readers' attention on our stereotactic radiofrequency method, which has been used since 2004. For radiofrequency amygdalohippocampectomy the occipital access is used and thermolesions are administered by an electrode with a 10-mm bold active tip; usually 24 lesions are made in 8 segments. Thermocoagulative lesions are made in the long axis of the amygdalohippocampal complex (AHC).2 After surgery, thermocoagulative necrosis affects nearly the whole AHC. One year after surgery an irregular pseudocyst developed in the AHC, which caused partial destruction of AHC, the entorhinal and perirhinal cortices included.5 As of this writing we have treated 63 patients with MTLE, and we recently published long-term clinical seizure outcomes in the group of 61 patients. The mean clinical seizure follow-up was 5.3 years, and 70.5% of our treated patients have been seizure free since surgery (Engel I).8 Neuropsychological outcomes were very good; patients did not decline in any memory parameters 1 and 2 years after therapy, despite the fact that two-thirds of patients were treated on the left side.3,4 We are not aware of any other stereotactic method that achieves similar clinical outcomes that are fully comparable with open surgery procedures.

References

  • 1

    Guénot M, , Isnard J, , Ryvlin P, , Fischer C, , Mauguiére F, & Sindou M: SEEG-guided RF thermocoagulation of epileptic foci: feasibility, safety, and preliminary results. Epilepsia 45:13681374, 2004

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  • 2

    Liscak R, , Malikova H, , Kalina M, , Vojtech Z, , Prochazka T, & Marusic P, : Stereotactic radiofrequency amygdalohippocampectomy in the treatment of mesial temporal lobe epilepsy. Acta Neurochir (Wien) 152:12911298, 2010

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  • 3

    Malikova H, , Kramska L, , Vojtech Z, , Liscak R, , Sroubek J, & Lukavsky J, : Different surgical approaches for mesial temporal epilepsy: resection extent, seizure, and neuropsychological outcomes. Stereotact Funct Neurosurg 92:372380, 2014

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  • 4

    Malikova H, , Kramska L, , Vojtech Z, , Lukavsky J, & Liscak R: Stereotactic radiofrequency amygdalohippocampectomy: two years of good neuropsychological outcomes. Epilepsy Res 106:423432, 2013

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  • 5

    Malikova H, , Liscak R, , Vojtech Z, , Prochazka T, , Vymazal J, & Vladyka V, : Stereotactic radiofrequency amygdalohippocampectomy: does reduction of entorhinal and perirhinal cortices influence good clinical seizure outcome?. Epilepsia 52:932940, 2011

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  • 6

    Parrent AG, & Blume WT: Stereotactic amygdalohippocampotomy for the treatment of medial temporal lobe epilepsy. Epilepsia 40:14081416, 1999

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  • 7

    Quigg M, & Harden C: Minimally invasive techniques for epilepsy surgery: stereotactic radiosurgery and other technologies. J Neurosurg 121:Suppl 2 232240, 2014

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  • 8

    Vojtéch Z, , Malíková H, , Krámská L, , Anýž J, , Syrůček M, & Zámečník J, : Long-term seizure outcome after stereotactic amygdalohippocampectomy. Acta Neurochirurgica (Wien) 156:15291537, 2014

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Keywords:

Response

No response was received from the authors of the original article.

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Contributor Notes

DISCLOSURE The authors report no conflict of interest.

INCLUDE WHEN CITING Published online April 10, 2015; DOI: 10.3171/2014.12.JNS142834.

  • 1

    Guénot M, , Isnard J, , Ryvlin P, , Fischer C, , Mauguiére F, & Sindou M: SEEG-guided RF thermocoagulation of epileptic foci: feasibility, safety, and preliminary results. Epilepsia 45:13681374, 2004

    • Search Google Scholar
    • Export Citation
  • 2

    Liscak R, , Malikova H, , Kalina M, , Vojtech Z, , Prochazka T, & Marusic P, : Stereotactic radiofrequency amygdalohippocampectomy in the treatment of mesial temporal lobe epilepsy. Acta Neurochir (Wien) 152:12911298, 2010

    • Search Google Scholar
    • Export Citation
  • 3

    Malikova H, , Kramska L, , Vojtech Z, , Liscak R, , Sroubek J, & Lukavsky J, : Different surgical approaches for mesial temporal epilepsy: resection extent, seizure, and neuropsychological outcomes. Stereotact Funct Neurosurg 92:372380, 2014

    • Search Google Scholar
    • Export Citation
  • 4

    Malikova H, , Kramska L, , Vojtech Z, , Lukavsky J, & Liscak R: Stereotactic radiofrequency amygdalohippocampectomy: two years of good neuropsychological outcomes. Epilepsy Res 106:423432, 2013

    • Search Google Scholar
    • Export Citation
  • 5

    Malikova H, , Liscak R, , Vojtech Z, , Prochazka T, , Vymazal J, & Vladyka V, : Stereotactic radiofrequency amygdalohippocampectomy: does reduction of entorhinal and perirhinal cortices influence good clinical seizure outcome?. Epilepsia 52:932940, 2011

    • Search Google Scholar
    • Export Citation
  • 6

    Parrent AG, & Blume WT: Stereotactic amygdalohippocampotomy for the treatment of medial temporal lobe epilepsy. Epilepsia 40:14081416, 1999

    • Search Google Scholar
    • Export Citation
  • 7

    Quigg M, & Harden C: Minimally invasive techniques for epilepsy surgery: stereotactic radiosurgery and other technologies. J Neurosurg 121:Suppl 2 232240, 2014

    • Search Google Scholar
    • Export Citation
  • 8

    Vojtéch Z, , Malíková H, , Krámská L, , Anýž J, , Syrůček M, & Zámečník J, : Long-term seizure outcome after stereotactic amygdalohippocampectomy. Acta Neurochirurgica (Wien) 156:15291537, 2014

    • Search Google Scholar
    • Export Citation

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