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1. Desynchronization Index: a New Approach for Exploring Complex Epileptogenic Networks in Stereoelectroencephalography

Author

Mason, Federico, Ferri, Lorenzo, Di Vito, Lidia, Alvisi, Lara, Zanuttini, Luca, Martinoni, Matteo, Mai, Roberto, Cardinale, Francesco, Tinuper, Paolo, Michelucci, Roberto, Pasini, Elena, and Bisulli, Francesca

Subjects
Electrical Engineering and Systems Science - Signal Processing, Quantitative Biology - Neurons and Cognition
Abstract

Stereoelectroencephalography (SEEG) is an invasive surgical procedure to record the electrical activities in cortical brain regions, aiming at identifying the Epileptogenic Zone (EZ) in patients with drug-resistant epilepsy. To improve the accuracy of the EZ definition, SEEG analysis can be supported by computational tools, among which the Epileptogenic Index (EI) represents the most common solution. However, the scientific community has still not found an agreement on which quantitative biomarkers can characterize the cortical sites within the EZ. In this work, we design a new algorithm, named Desynchronization Index (DI), to assist neurophysiologists in SEEG interpretation. Our algorithm estimates the effective connectivity between cortical sites and hypothesizes that the EZ is identified by those sites getting abnormally desynchronized from the network during the seizure generation. We test the proposed method over a SEEG dataset of 10 seizures, comparing its accuracy in terms of EZ definition against the EI algorithm and clinical ground truth. Our results indicate that the DI algorithm underscores specific connectivity dynamics that can hardly be identified with a pure visual analysis, increasing sensitivity in detecting epileptogenic cortical sites.

Published
2024

2. A self-supervised learning strategy for postoperative brain cavity segmentation simulating resections

Author

Pérez-García, Fernando, Dorent, Reuben, Rizzi, Michele, Cardinale, Francesco, Frazzini, Valerio, Navarro, Vincent, Essert, Caroline, Ollivier, Irène, Vercauteren, Tom, Sparks, Rachel, Duncan, John S., and Ourselin, Sébastien

Subjects
Electrical Engineering and Systems Science - Image and Video Processing, Computer Science - Computer Vision and Pattern Recognition
Abstract

Accurate segmentation of brain resection cavities (RCs) aids in postoperative analysis and determining follow-up treatment. Convolutional neural networks (CNNs) are the state-of-the-art image segmentation technique, but require large annotated datasets for training. Annotation of 3D medical images is time-consuming, requires highly-trained raters, and may suffer from high inter-rater variability. Self-supervised learning strategies can leverage unlabeled data for training. We developed an algorithm to simulate resections from preoperative magnetic resonance images (MRIs). We performed self-supervised training of a 3D CNN for RC segmentation using our simulation method. We curated EPISURG, a dataset comprising 430 postoperative and 268 preoperative MRIs from 430 refractory epilepsy patients who underwent resective neurosurgery. We fine-tuned our model on three small annotated datasets from different institutions and on the annotated images in EPISURG, comprising 20, 33, 19 and 133 subjects. The model trained on data with simulated resections obtained median (interquartile range) Dice score coefficients (DSCs) of 81.7 (16.4), 82.4 (36.4), 74.9 (24.2) and 80.5 (18.7) for each of the four datasets. After fine-tuning, DSCs were 89.2 (13.3), 84.1 (19.8), 80.2 (20.1) and 85.2 (10.8). For comparison, inter-rater agreement between human annotators from our previous study was 84.0 (9.9). We present a self-supervised learning strategy for 3D CNNs using simulated RCs to accurately segment real RCs on postoperative MRI. Our method generalizes well to data from different institutions, pathologies and modalities. Source code, segmentation models and the EPISURG dataset are available at https://github.com/fepegar/ressegijcars ., Comment: To be published in the International Journal of Computer Assisted Radiology and Surgery (IJCARS) - Special issue MICCAI 2020

Published
2021
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3. Enhancing Safety in Epilepsy Surgery (EASINESS): Study Protocol for a Retrospective, Multicenter, Open Registry

Author

Drexler, Richard, Ben-Haim, Sharona, Bien, Christian G, Borger, Valeri, Cardinale, Francesco, Carpentier, Alexandre, Cendes, Fernando, Chandra, Sarat, Clusmann, Hans, Colon, Albert, de Curtis, Marco, Delev, Daniel, Didato, Giuseppe, Dührsen, Lasse, Farah, Jibril Osman, Guenot, Marc, Ghatan, Saadi, Haegelen, Claire, Hamer, Hajo, Hauptmann, Jason S, Jeffree, Rosalind L, Kalbhenn, Thilo, Kegele, Josua, Krayenbühl, Niklaus, Lang, Johannes, Mathon, Bertrand, Naros, Georgios, Onken, Julia, Panov, Fedor, Raftopoulos, Christian, Ricklefs, Franz L, Rijkers, Kim, Rizzi, Michele, Rössler, Karl, Schijns, Olaf, Schneider, Ulf C, Spyrantis, Andrea, Strzelczyk, Adam, Stodieck, Stefan, Tripathi, Manjari, Vadera, Sumeet, Alonso-Vanegas, Mario A, Vaz, José Géraldo Ribero, Wellmer, Jörg, Wehner, Tim, Westphal, Manfred, and Sauvigny, Thomas

Subjects
Biomedical and Clinical Sciences, Clinical Sciences, Patient Safety, Brain Disorders, Epilepsy, Neurosciences, Clinical Research, Neurodegenerative, Clinical Trials and Supportive Activities, Evaluation of treatments and therapeutic interventions, 6.4 Surgery, epilepsy, epilepsy surgery, temporal lobe epilepsy, outcome, benchmark, seizure outcome, amygdalohippocampectomy, anteromedial resection, Psychology, Clinical sciences, Biological psychology
Abstract

Introduction: Optimizing patient safety and quality improvement is increasingly important in surgery. Benchmarks and clinical quality registries are being developed to assess the best achievable results for several surgical procedures and reduce unwarranted variation between different centers. However, there is no clinical database from international centers for establishing standardized reference values of patients undergoing surgery for mesial temporal lobe epilepsy. Design: The Enhancing Safety in Epilepsy Surgery (EASINESS) study is a retrospectively conducted, multicenter, open registry. All patients undergoing mesial temporal lobe epilepsy surgery in participating centers between January 2015 and December 2019 are included in this study. The patient characteristics, preoperative diagnostic tools, surgical data, postoperative complications, and long-term seizure outcomes are recorded. Outcomes: The collected data will be used for establishing standardized reference values ("benchmarks") for this type of surgical procedure. The primary endpoints include seizure outcomes according to the International League Against Epilepsy (ILAE) classification and defined postoperative complications. Discussion: The EASINESS will define robust and standardized outcome references after amygdalohippocampectomy for temporal lobe epilepsy. After the successful definition of benchmarks from an international cohort of renowned centers, these data will serve as reference values for the evaluation of novel surgical techniques and comparisons among centers for future clinical trials. Clinical trial registration: This study is indexed at clinicaltrials.gov (NT 04952298).

Published
2021

5. SWANe: Standardized workflow for advanced neuroimaging in epilepsy

Author

Genovese, Maurilio, primary, Arcasensa, Agostino, additional, Morbelli, Silvia, additional, Lenge, Matteo, additional, Barba, Carmen, additional, Mirandola, Laura, additional, Caligiuri, Maria Eugenia, additional, Caulo, Massimo, additional, Panzica, Ferruccio, additional, Cardinale, Francesco, additional, Rossi-Espagnet, Camilla, additional, Tortora, Domenico, additional, and Vaudano, Anna Elisabetta, additional

Published
2024
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6. Cortical Connectivity Response to Hyperventilation in Focal Epilepsy: A Stereo-EEG Study.

Author

Ferri, Lorenzo, Mason, Federico, Di Vito, Lidia, Pasini, Elena, Michelucci, Roberto, Cardinale, Francesco, Mai, Roberto, Alvisi, Lara, Zanuttini, Luca, Martinoni, Matteo, and Bisulli, Francesca

Subjects
PARTIAL epilepsy, NON-REM sleep, EPILEPTIFORM discharges, SEIZURES (Medicine), PEOPLE with epilepsy
Abstract

Hyperventilation (HV) is an activation technique performed during clinical practices to trigger epileptiform activities, supporting the neurophysiological evaluation of patients with epilepsy. Although the role of HV has often been questioned, especially in the case of focal epilepsy, no studies have ever assessed how cortical structures respond to such a maneuver via intracranial EEG recordings. This work aims to fill this gap by evaluating the HV effects on the Stereo-EEG (SEEG) signals from a cohort of 10 patients with drug-resistant focal epilepsy. We extracted multiple quantitative metrics from the SEEG signals and compared the results obtained during HV, awake status, non-REM sleep, and seizure onset. Our findings show that the cortical connectivity, estimated via the phase transfer entropy (PTE) algorithm, strongly increases during the HV maneuver, similar to non-REM sleep. The opposite effect is observed during seizure onset, as ictal transitions involve the desynchronization of the brain structures within the epileptogenic zone. We conclude that HV promotes a conductive environment that may facilitate the propagation of epileptiform activities but is not sufficient to trigger seizures in focal epilepsy. [ABSTRACT FROM AUTHOR]

Published
2024
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9. Language lateralization mapping (reversibly) masked by non-dominant focal epilepsy: a case report

Author

Abarrategui, Belén, primary, Mariani, Valeria, additional, Rizzi, Michele, additional, Berta, Luca, additional, Scarpa, Pina, additional, Zauli, Flavia Maria, additional, Squarza, Silvia, additional, Banfi, Paola, additional, d’Orio, Piergiorgio, additional, Cardinale, Francesco, additional, Del Vecchio, Maria, additional, Caruana, Fausto, additional, Avanzini, Pietro, additional, and Sartori, Ivana, additional

Published
2023
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11. Neurological morbidity of surgery for suprasylvian operculoinsular epilepsy.

Author

d'Orio, Piergiorgio, Squarza, Silvia, Revay, Martina, Cardinale, Francesco, Castana, Laura, Sartori, Ivana, Tassi, Laura, Lo Russo, Giorgio, and Cossu, Massimo

Abstract

Objective: The objective of this study was to identify risk factors associated with surgery‐related neurological morbidity in patients with drug‐resistant epilepsy undergoing suprasylvian operculoinsular resections. As secondary outcomes, we also analyzed the risk factors for ischemic lesion (IL) of corona radiata and seizure recurrence. Methods: A retrospective analysis was conducted on a cohort of patients who underwent suprasylvian operculoinsular resections for drug‐resistant epilepsy. The association of several presurgical, surgical, and postsurgical factors with both primary (persistent neurological deficits) and secondary (structural abnormalities on postoperative magnetic resonance imaging [MRI] and seizure recurrence) postoperative outcomes was investigated with univariate and multivariate statistical analysis. Results: The study included a total of 65 patients; 46.2% of patients exhibited postoperative neurological deficits, but only 12.3% experienced persistent deficits. On postoperative MRI, IL in the corona radiata and corticospinal tract Wallerian degeneration (CSTWd) were seen in 68% and 29% of cases, respectively. Only CSTWd was significantly associated with persistent neurological deficits (relative risk [RR] = 2.6). Combined operculoinsular resection (RR = 3.62) and surgery performed on the left hemisphere (RR =.37) were independently associated with IL in the corona radiata. Variables independently associated with CSTWd were the presence of malacic components in the IL (RR = 1.96), right central operculum resection (RR = 1.79), and increasing age at surgery (RR = 1.03). Sixty‐two patients had a postoperative follow‐up > 12 months (median = 56, interquartile range = 30.75–73.5), and 62.9% were in Engel class I at last outpatient control. The risk of seizure recurrence was reduced by selective opercular resection (RR =.25) and increased by the histological diagnosis of aspecific gliosis (RR = 1.39). Significance: This study provides insights into the risk factors associated with surgery‐related neurological morbidity, as well as further evidence on the postoperative occurrence of subcortical injury and seizure recurrence in epileptic patients undergoing suprasylvian operculoinsular resections. The findings highlighted in this study may be useful to better understand the processes supporting the increased surgical risk in the operculoinsular region. [ABSTRACT FROM AUTHOR]

Published
2024
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14. Epilepsy surgery of “low grade epilepsy associated neuroepithelial tumors”: A retrospective nationwide Italian study

Author

Giulioni, Marco, Marucci, Gianluca, Pelliccia, Veronica, Gozzo, Francesca, Barba, Carmen, Didato, Giuseppe, Villani, Flavio, Di Gennaro, Giancarlo, Quarato, Pier Paolo, Esposito, Vincenzo, Consales, Alessandro, Martinoni, Matteo, Vornetti, Gianfranco, Zenesini, Corrado, Efisio Marras, Carlo, Specchio, Nicola, De Palma, Luca, Rocchi, Raffaele, Giordano, Flavio, Tringali, Giovanni, Nozza, Paolo, Colicchio, Gabriella, Rubboli, Guido, Lo Russo, Giorgio, Guerrini, Renzo, Tinuper, Paolo, Cardinale, Francesco, and Cossu, Massimo

Published
2017
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19. Enhancing Safety in Epilepsy Surgery (EASINESS): Study Protocol for a Retrospective, Multicenter, Open Registry

Author

Drexler, Richard, primary, Ben-Haim, Sharona, additional, Bien, Christian G., additional, Borger, Valeri, additional, Cardinale, Francesco, additional, Carpentier, Alexandre, additional, Cendes, Fernando, additional, Chandra, Sarat, additional, Clusmann, Hans, additional, Colon, Albert, additional, Curtis, Marco de, additional, Delev, Daniel, additional, Didato, Giuseppe, additional, Dührsen, Lasse, additional, Farah, Jibril Osman, additional, Guenot, Marc, additional, Ghatan, Saadi, additional, Haegelen, Claire, additional, Hamer, Hajo, additional, Hauptmann, Jason S., additional, Jeffree, Rosalind L., additional, Kalbhenn, Thilo, additional, Kegele, Josua, additional, Krayenbühl, Niklaus, additional, Lang, Johannes, additional, Mathon, Bertrand, additional, Naros, Georgios, additional, Onken, Julia, additional, Panov, Fedor, additional, Raftopoulos, Christian, additional, Ricklefs, Franz L., additional, Rijkers, Kim, additional, Rizzi, Michele, additional, Rössler, Karl, additional, Schijns, Olaf, additional, Schneider, Ulf C., additional, Spyrantis, Andrea, additional, Strzelczyk, Adam, additional, Stodieck, Stefan, additional, Tripathi, Manjari, additional, Vadera, Sumeet, additional, Alonso-Vanegas, Mario A., additional, Vaz, José Géraldo Ribero, additional, Wellmer, Jörg, additional, Wehner, Tim, additional, Westphal, Manfred, additional, and Sauvigny, Thomas, additional

Published
2021
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20. Cover Image

Author

Mikulan, Ezequiel, primary, Russo, Simone, additional, Zauli, Flavia Maria, additional, d'Orio, Piergiorgio, additional, Parmigiani, Sara, additional, Favaro, Jacopo, additional, Knight, William, additional, Squarza, Silvia, additional, Perri, Pierluigi, additional, Cardinale, Francesco, additional, Avanzini, Pietro, additional, and Pigorini, Andrea, additional

Published
2021
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24. A comparative study between state‐of‐the‐art MRI deidentification and AnonyMI , a new method combining re‐identification risk reduction and geometrical preservation

Author

Mikulan, Ezequiel, primary, Russo, Simone, additional, Zauli, Flavia Maria, additional, d'Orio, Piergiorgio, additional, Parmigiani, Sara, additional, Favaro, Jacopo, additional, Knight, William, additional, Squarza, Silvia, additional, Perri, Pierluigi, additional, Cardinale, Francesco, additional, Avanzini, Pietro, additional, and Pigorini, Andrea, additional

Published
2021
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25. Enhancing Safety in Epilepsy Surgery (EASINESS): Study Protocol for a Retrospective, Multicenter, Open Registry.

Author

UCL - SSS/IONS/NEUR - Clinical Neuroscience, UCL - (SLuc) Service de neurochirurgie, UCL - (SLuc) Centre de référence pour l'épilepsie réfractaire, Drexler, Richard, Ben-Haim, Sharona, Bien, Christian G, Borger, Valeri, Cardinale, Francesco, Carpentier, Alexandre, Cendes, Fernando, Chandra, Sarat, Clusmann, Hans, Colon, Albert, de Curtis, Marco, Delev, Daniel, Didato, Giuseppe, Dührsen, Lasse, Farah, Jibril Osman, Guenot, Marc, Ghatan, Saadi, Haegelen, Claire, Hamer, Hajo, Hauptmann, Jason S, Jeffree, Rosalind L, Kalbhenn, Thilo, Kegele, Josua, Krayenbühl, Niklaus, Lang, Johannes, Mathon, Bertrand, Naros, Georgios, Onken, Julia, Panov, Fedor, Raftopoulos, Christian, Ricklefs, Franz L, Rijkers, Kim, Rizzi, Michele, Rössler, Karl, Schijns, Olaf, Schneider, Ulf C, Spyrantis, Andrea, Strzelczyk, Adam, Stodieck, Stefan, Tripathi, Manjari, Vadera, Sumeet, Alonso-Vanegas, Mario A, Vaz, José Géraldo Ribero, Wellmer, Jörg, Wehner, Tim, Westphal, Manfred, Sauvigny, Thomas, UCL - SSS/IONS/NEUR - Clinical Neuroscience, UCL - (SLuc) Service de neurochirurgie, UCL - (SLuc) Centre de référence pour l'épilepsie réfractaire, Drexler, Richard, Ben-Haim, Sharona, Bien, Christian G, Borger, Valeri, Cardinale, Francesco, Carpentier, Alexandre, Cendes, Fernando, Chandra, Sarat, Clusmann, Hans, Colon, Albert, de Curtis, Marco, Delev, Daniel, Didato, Giuseppe, Dührsen, Lasse, Farah, Jibril Osman, Guenot, Marc, Ghatan, Saadi, Haegelen, Claire, Hamer, Hajo, Hauptmann, Jason S, Jeffree, Rosalind L, Kalbhenn, Thilo, Kegele, Josua, Krayenbühl, Niklaus, Lang, Johannes, Mathon, Bertrand, Naros, Georgios, Onken, Julia, Panov, Fedor, Raftopoulos, Christian, Ricklefs, Franz L, Rijkers, Kim, Rizzi, Michele, Rössler, Karl, Schijns, Olaf, Schneider, Ulf C, Spyrantis, Andrea, Strzelczyk, Adam, Stodieck, Stefan, Tripathi, Manjari, Vadera, Sumeet, Alonso-Vanegas, Mario A, Vaz, José Géraldo Ribero, Wellmer, Jörg, Wehner, Tim, Westphal, Manfred, and Sauvigny, Thomas

Abstract

Optimizing patient safety and quality improvement is increasingly important in surgery. Benchmarks and clinical quality registries are being developed to assess the best achievable results for several surgical procedures and reduce unwarranted variation between different centers. However, there is no clinical database from international centers for establishing standardized reference values of patients undergoing surgery for mesial temporal lobe epilepsy. The Enhancing Safety in Epilepsy Surgery (EASINESS) study is a retrospectively conducted, multicenter, open registry. All patients undergoing mesial temporal lobe epilepsy surgery in participating centers between January 2015 and December 2019 are included in this study. The patient characteristics, preoperative diagnostic tools, surgical data, postoperative complications, and long-term seizure outcomes are recorded. The collected data will be used for establishing standardized reference values ("benchmarks") for this type of surgical procedure. The primary endpoints include seizure outcomes according to the International League Against Epilepsy (ILAE) classification and defined postoperative complications. The EASINESS will define robust and standardized outcome references after amygdalohippocampectomy for temporal lobe epilepsy. After the successful definition of benchmarks from an international cohort of renowned centers, these data will serve as reference values for the evaluation of novel surgical techniques and comparisons among centers for future clinical trials. This study is indexed at clinicaltrials.gov (NT 04952298).

Published
2021

38. Kurtosis-based detection of intracranial high-frequency oscillations for the identification of the seizure onset zone

Author

Quitadamo, Lucia Rita, Mai, Roberto, Gozzo, Francesca, Pelliccia, Veronica, Cardinale, Francesco, and Seri, Stefano

Abstract

Pathological High-Frequency Oscillations (HFOs) have been recently proposed as potential biomarker of the seizure onset zone (SOZ) and have shown superior accuracy to interictal epileptiform discharges in delineating its anatomical boundaries. Characterization of HFOs is still in its infancy and this is reflected in the heterogeneity of analysis and reporting methods across studies and in clinical practice. The clinical approach to HFOs identification and quantification usually still relies on visual inspection of EEG data. In this study, we developed a pipeline for the detection and analysis of HFOs. This includes preliminary selection of the most informative channels exploiting statistical properties of the pre-ictal and ictal intracranial EEG (iEEG) time series based on spectral kurtosis, followed by wavelet-based characterization of the time-frequency properties of the signal. We performed a preliminary validation analyzing EEG data in the ripple frequency band (80-250[Formula: see text]Hz) from six patients with drug-resistant epilepsy who underwent pre-surgical evaluation with stereo-EEG (SEEG) followed by surgical resection of pathologic brain areas, who had at least two-year positive post-surgical outcome. In this series, kurtosis-driven selection and wavelet-based detection of HFOs had average sensitivity of 81.94% and average specificity of 96.03% in identifying the HFO area which overlapped with the SOZ as defined by clinical presurgical workup. Furthermore, the kurtosis-based channel selection resulted in an average reduction in computational time of 66.60%.

Published
2018

40. Stereoelectroencephalography: retrospective analysis of 742 procedures in a single centre

Author

Cardinale, Francesco, primary, Rizzi, Michele, additional, Vignati, Elena, additional, Cossu, Massimo, additional, Castana, Laura, additional, d’Orio, Piergiorgio, additional, Revay, Martina, additional, Costanza, Martina Della, additional, Tassi, Laura, additional, Mai, Roberto, additional, Sartori, Ivana, additional, Nobili, Lino, additional, Gozzo, Francesca, additional, Pelliccia, Veronica, additional, Mariani, Valeria, additional, Lo Russo, Giorgio, additional, and Francione, Stefano, additional

Published
2019
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41. Clinical features of sleep‐related hypermotor epilepsy in relation to the seizure‐onset zone: A review of 135 surgically treated cases

Author

Gibbs, Steve A., primary, Proserpio, Paola, additional, Francione, Stefano, additional, Mai, Roberto, additional, Cardinale, Francesco, additional, Sartori, Ivana, additional, Castana, Laura, additional, Plazzi, Giuseppe, additional, Tinuper, Paolo, additional, Cossu, Massimo, additional, Russo, Giorgio Lo, additional, Tassi, Laura, additional, and Nobili, Lino, additional

Published
2019
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45. Epilepsy surgery of “low grade epilepsy associated neuroepithelial tumors”:A retrospective nationwide Italian study

Author

Giulioni, Marco, Marucci, Gianluca, Pelliccia, Veronica, Gozzo, Francesca, Barba, Carmen, Didato, Giuseppe, Villani, Flavio, Di Gennaro, Giancarlo, Quarato, Pier Paolo, Esposito, Vincenzo, Consales, Alessandro, Martinoni, Matteo, Vornetti, Gianfranco, Zenesini, Corrado, Efisio Marras, Carlo, Specchio, Nicola, De Palma, Luca, Rocchi, Raffaele, Giordano, Flavio, Tringali, Giovanni, Nozza, Paolo, Colicchio, Gabriella, Rubboli, Guido, Lo Russo, Giorgio, Guerrini, Renzo, Tinuper, Paolo, Cardinale, Francesco, Cossu, Massimo, Giulioni, Marco, Marucci, Gianluca, Pelliccia, Veronica, Gozzo, Francesca, Barba, Carmen, Didato, Giuseppe, Villani, Flavio, Di Gennaro, Giancarlo, Quarato, Pier Paolo, Esposito, Vincenzo, Consales, Alessandro, Martinoni, Matteo, Vornetti, Gianfranco, Zenesini, Corrado, Efisio Marras, Carlo, Specchio, Nicola, De Palma, Luca, Rocchi, Raffaele, Giordano, Flavio, Tringali, Giovanni, Nozza, Paolo, Colicchio, Gabriella, Rubboli, Guido, Lo Russo, Giorgio, Guerrini, Renzo, Tinuper, Paolo, Cardinale, Francesco, and Cossu, Massimo

Abstract

Objective: To analyze the attitude and results of Italian epilepsy surgery centers in the surgical management of “low grade epilepsy associated neuroepithelial tumors” (LEATs). Methods: We conducted a retrospective study enrolling 339 consecutive patients with LEATs who underwent surgery between January 2009 and June 2015 at eight Italian epilepsy surgery centers. We compared demographic, clinical, pathologic, and surgical features of patients with favorable (Engel class I) and unfavorable (Engel class II, III, and IV) seizure outcome. In addition, we compared patients with tumor-associated focal cortical dysplasia (FCD) and patients with solitary tumors to identify factors correlated with FCD diagnosis. Results: Fifty-five (98.2%) of 56 patients with medically controlled epilepsy were seizure-free after surgery, compared to 249 (88.0%) of 283 patients with refractory epilepsy. At multivariate analysis, three variables independently predict unfavorable seizure outcome in the drug-resistant group. Age at surgery is largely the most significant (p = 0.001), with an odds ratio (OR) of 1.04. This means that the probability of seizure recurrence grows by 4% for every waited year. The resection site is also significant (p = 0.039), with a relative risk (RR) of 1.99 for extratemporal tumors. Finally, the completeness of tumor resection has a trend toward significance (p = 0.092), with an RR of 1.82 for incomplete resection. Among pediatric patients, a longer duration of epilepsy was significantly associated with preoperative neuropsychological deficits (p < 0.001). A statistically significant association was observed between FCD diagnosis and the following variables: tailored surgery (p < 0.001), temporal resection (p = 0.001), and surgical center (p = 0.012). Significance: Our nationwide LEATs study gives important insights on factors predicting seizure outcome in refractory epilepsy and determining variability in FCD detection. Timely surgery, regardless of phar

Published
2017

46. Increasing volume and complexity of pediatric epilepsy surgery with stable seizure outcome between 2008 and 2014:A nationwide multicenter study

Author

Barba, Carmen, Specchio, Nicola, Guerrini, Renzo, Tassi, Laura, De Masi, Salvatore, Cardinale, Francesco, Pellacani, Simona, De Palma, Luca, Battaglia, Domenica, Tamburrini, Gianpiero, Didato, Giuseppe, Freri, Elena, Consales, Alessandro, Nozza, Paolo, Zamponi, Nelia, Cesaroni, Elisabetta, Di Gennaro, Giancarlo, Esposito, Vincenzo, Giulioni, Marco, Tinuper, Paolo, Colicchio, Gabriella, Rocchi, Raffaele, Rubboli, Guido, Giordano, Flavio, Russo, Giorgio Lo, Marras, Carlo Efisio, Cossu, Massimo, Barba, Carmen, Specchio, Nicola, Guerrini, Renzo, Tassi, Laura, De Masi, Salvatore, Cardinale, Francesco, Pellacani, Simona, De Palma, Luca, Battaglia, Domenica, Tamburrini, Gianpiero, Didato, Giuseppe, Freri, Elena, Consales, Alessandro, Nozza, Paolo, Zamponi, Nelia, Cesaroni, Elisabetta, Di Gennaro, Giancarlo, Esposito, Vincenzo, Giulioni, Marco, Tinuper, Paolo, Colicchio, Gabriella, Rocchi, Raffaele, Rubboli, Guido, Giordano, Flavio, Russo, Giorgio Lo, Marras, Carlo Efisio, and Cossu, Massimo

Abstract

Objective The objective of the study was to assess common practice in pediatric epilepsy surgery in Italy between 2008 and 2014. Methods A survey was conducted among nine Italian epilepsy surgery centers to collect information on presurgical and postsurgical evaluation protocols, volumes and types of surgical interventions, and etiologies and seizure outcomes in pediatric epilepsy surgery between 2008 and 2014. Results Retrospective data on 527 surgical procedures were collected. The most frequent surgical approaches were temporal lobe resections and disconnections (133, 25.2%) and extratemporal lesionectomies (128, 24.3%); the most frequent etiologies were FCD II (107, 20.3%) and glioneuronal tumors (105, 19.9%). Volumes of surgeries increased over time independently from the age at surgery and the epilepsy surgery center. Engel class I was achieved in 73.6% of patients (range: 54.8 to 91.7%), with no significant changes between 2008 and 2014. Univariate analyses showed a decrease in the proportion of temporal resections and tumors and an increase in the proportion of FCDII, while multivariate analyses revealed an increase in the proportion of extratemporal surgeries over time. A higher proportion of temporal surgeries and tumors and a lower proportion of extratemporal and multilobar surgeries and of FCD were observed in low (< 50 surgeries/year) versus high-volume centers. There was a high variability across centers concerning pre- and postsurgical evaluation protocols, depending on local expertise and facilities. Significance This survey reveals an increase in volume and complexity of pediatric epilepsy surgery in Italy between 2008 and 2014, associated with a stable seizure outcome.

Published
2017

48. A new tool for touch-free patient registration for robot-assisted intracranial surgery: application accuracy from a phantom study and a retrospective surgical series

Author

Cardinale, Francesco, primary, Rizzi, Michele, additional, d’Orio, Piergiorgio, additional, Casaceli, Giuseppe, additional, Arnulfo, Gabriele, additional, Narizzano, Massimo, additional, Scorza, Davide, additional, De Momi, Elena, additional, Nichelatti, Michele, additional, Redaelli, Daniela, additional, Sberna, Maurizio, additional, Moscato, Alessio, additional, and Castana, Laura, additional

Published
2017
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