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Brain Sciences
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Application of Surgery in Epilepsy
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Application of Surgery in Epilepsy

A special issue of Brain Sciences (ISSN 2076-3425). This special issue belongs to the section "Neurosurgery and Neuroanatomy".

Deadline for manuscript submissions: closed (15 January 2025) | Viewed by 5224

Special Issue Editors

Dr. Benjamin C. Kennedy

E-Mail Website
Guest Editor
1. Neurosurgery, University of Pennsylvania, Philadelphia, PA 19104, USA
2. Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA
Interests: neurosurgery; epilepsy; brain tumor; movement disorders; spasticity
Special Issues, Collections and Topics in MDPI journals
Dr. Samuel Tomlinson

E-Mail Website
Guest Editor
Department of Neurosurgery, University of Pennsylvania, Philadelphia, PA 19104, USA
Interests: epilepsy surgery; pediatrics; ECoG signal processing
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

The surgical management of epilepsy is an ever-broadening field with intense controversies and new treatments that are already both commonplace and being utilized with widely different strategies from institution to institution. In this Special Issue, we aim to amplify recent developments in these treatments, insights from clinical experience, translational or relevant basic science research, or thorough reviews not recently covered elsewhere.

A large proportion of patients with drug-resistant epilepsy have multifocal, generalized, eloquent-onset, or broad onset epilepsy, and are poor candidates for traditional resective surgery. Beyond a ketogenic diet and vagus nerve stimulation, intracranial neuromodulation had demonstrated great promise and has become a rapidly growing field unto itself. Although early studies demonstrated the proof of principle that it is often effective, a wide range of stimulation strategies, targets, stimulation parameters, and technical nuances are currently being explored individually by many institutions. We encourage these strategies to be reported here.

The lessons learned from using temporarily or permanently implanted electrodes can give us remarkable insights into both epilepsy and cognition, and with the vast number of such electrodes implanted every day, we continue to be fascinated by these research experiences.

Reports on outcomes from all types of epilepsy surgery are similarly encouraged for submission to this Special Issue.

Sincerely,

Dr. Benjamin C. Kennedy
Dr. Samuel Tomlinson
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Brain Sciences is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2200 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • epilepsy surgery
  • neuromodulation
  • drug-resistant epilepsy
  • sEEG
  • DBS
  • RNS
  • LITT

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Published Papers (4 papers)

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Research

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12 pages, 1337 KiB  
Article
KEPPRA: Key Epilepsy Prognostic Parameters with Radiomics in Acute Subdural Hematoma Before Craniotomy
by Alexandru Guranda, Antonia Richter, Johannes Wach, Erdem Güresir and Martin Vychopen
Brain Sci. 2025, 15(2), 204; https://doi.org/10.3390/brainsci15020204 - 16 Feb 2025
Viewed by 610
Abstract
Background: Acute subdural hematoma (aSDH) is associated with a high risk of epilepsy, a complication linked to poor outcomes. Craniotomy is a known risk factor, with an epilepsy incidence of approximately 25%. This study evaluated radiomic features from preoperative CT scans to predict [...] Read more.
Background: Acute subdural hematoma (aSDH) is associated with a high risk of epilepsy, a complication linked to poor outcomes. Craniotomy is a known risk factor, with an epilepsy incidence of approximately 25%. This study evaluated radiomic features from preoperative CT scans to predict epilepsy risk in aSDH patients undergoing craniotomy. Methods: A retrospective analysis of 178 adult aSDH patients treated between 2016 and 2022 identified 64 patients meeting inclusion criteria. Radiomic features (e.g., Feret diameter, elongation, flatness, surface area, and volume) from preoperative CT scans within 24 h of surgery were analyzed alongside clinical factors, including cardiac comorbidities, pupillary response, SOFA score, age, and anticoagulation status. Results: Of the 64 patients, 18 (28%) developed generalized seizures. Univariate analysis showed significant associations with Feret diameter (p = 0.045), elongation (p = 0.005), cardiac comorbidities (p = 0.017), and SOFA score (p = 0.036). ROC analysis showed excellent discriminatory ability for elongation (AUC = 0.82). Multivariate analysis identified elongation as an independent predictor (p = 0.003); elongation ≥ 1.45 increased seizure risk 7.78-fold (OR = 7.778; 95% CI = 1.969–30.723). Conclusions: Radiomic features, particularly elongation, may help predict epilepsy risk in aSDH patients undergoing craniotomy. Prospective validation is needed. Full article
(This article belongs to the Special Issue Application of Surgery in Epilepsy)
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20 pages, 3739 KiB  
Article
Frameless Stereotaxy in Stereoelectroencephalography Using Intraoperative Computed Tomography
by Alexander Grote, Marko Gjorgjevski, Barbara Carl, Daniel Delev, Susanne Knake, Katja Menzler, Christopher Nimsky and Miriam H. A. Bopp
Brain Sci. 2025, 15(2), 184; https://doi.org/10.3390/brainsci15020184 - 12 Feb 2025
Cited by 1 | Viewed by 939
Abstract
Background: Pharmacoresistant epilepsy affects approximately one-third of all epilepsy patients, and resective surgery may offer favorable outcomes for carefully selected patients with focal epilepsy. The accurate identification of the epileptogenic zone (EZ) is essential for successful surgery, particularly in cases where non-invasive diagnostics [...] Read more.
Background: Pharmacoresistant epilepsy affects approximately one-third of all epilepsy patients, and resective surgery may offer favorable outcomes for carefully selected patients with focal epilepsy. The accurate identification of the epileptogenic zone (EZ) is essential for successful surgery, particularly in cases where non-invasive diagnostics are inconclusive. Invasive diagnostics with stereoelectroencephalography (SEEG) offer a reliable approach to localizing the EZ, especially in MRI-negative cases. Methods: This retrospective study analyzed the data of 22 patients with pharmacoresistant epilepsy who underwent frameless stereotactic SEEG electrode implantation with automated CT-based registration between September 2016 and November 2024. For measuring accuracy, Euclidean distance, radial deviation, angular deviation, and depth deviation were calculated for each electrode. Results: A total of 153 depth electrodes were implanted, targeting various cortical regions. The median Euclidean distance at the entry point was 1.54 mm (IQR 1.31), with a radial deviation of 1.33 mm (IQR 1.32). At the target level, the median Euclidean distance was 2.61 mm (IQR 1.53), with a radial deviation of 1.67 mm (IQR 1.54) and depth deviation of 0.95 mm (IQR 2.43). Accuracy was not significantly affected by electrode order, anatomical location, skull thickness, or intracranial length. Conclusions: These findings demonstrate that frameless stereotactic SEEG electrode implantation is safe and feasible for identifying the EZ. The integration of automatic intraoperative CT-based registration ensures precision. While maintaining workflow efficiency, it achieves accuracy comparable to frame-based methods. Further studies with larger cohorts are warranted to validate these results and assess their impact on surgical outcomes. Full article
(This article belongs to the Special Issue Application of Surgery in Epilepsy)
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Review

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12 pages, 262 KiB  
Review
Overcoming Graft Rejection in Induced Pluripotent Stem Cell-Derived Inhibitory Interneurons for Drug-Resistant Epilepsy
by Cameron P. Beaudreault, Richard Wang, Carrie Rebecca Muh, Ashley Rosenberg, Abigail Funari, Patty E. McGoldrick, Steven M. Wolf, Ariel Sacknovitz and Sangmi Chung
Brain Sci. 2024, 14(10), 1027; https://doi.org/10.3390/brainsci14101027 - 16 Oct 2024
Cited by 2 | Viewed by 2339
Abstract
Background: Cell-based therapies for drug-resistant epilepsy using induced pluripotent stem cell-derived inhibitory interneurons are now in early-phase clinical trials, building on findings from trials in Parkinson’s disease (PD) and Huntington’s disease (HD). Graft rejection and the need for immunosuppressive therapy post-transplantation pose potential [...] Read more.
Background: Cell-based therapies for drug-resistant epilepsy using induced pluripotent stem cell-derived inhibitory interneurons are now in early-phase clinical trials, building on findings from trials in Parkinson’s disease (PD) and Huntington’s disease (HD). Graft rejection and the need for immunosuppressive therapy post-transplantation pose potential barriers to more epilepsy patients becoming potential candidates for inhibitory interneurons transplantation surgery. Objectives: The present literature review weighs the evidence for and against human leukocyte antigen (HLA)-mediated graft rejection in PD and HD and examines the potential advantages and drawbacks to five broad approaches to cell-based therapies, including autologous cell culture and transplantation, in vivo reprogramming of glial cells using viral vectors, allogeneic transplantation using off-the-shelf cell lines, transplantation using inhibitory interneurons cultured from HLA-matched cell lines, and the use of hypoimmunogenic-induced pluripotent stem cell-derived inhibitory interneurons. The impact of surgical technique and associated needle trauma on graft rejection is also discussed. Methods: Non-systematic literature review. Results: While cell-based therapies have enjoyed early successes in treating a host of central nervous system disorders, the immunologic reaction against surgical procedures and implanted materials has remained a major obstacle. Conclusions: Adapting cell-based therapies using iPSC-derived inhibitory interneurons for epilepsy surgery will similarly require surmounting the challenge of immunogenicity. Full article
(This article belongs to the Special Issue Application of Surgery in Epilepsy)

Other

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14 pages, 6719 KiB  
Case Report
Motor Outcome After Posterior Insular Resection for Pediatric Epilepsy
by Michael E. Baumgartner, Samuel B. Tomlinson, Kathleen Galligan and Benjamin C. Kennedy
Brain Sci. 2025, 15(2), 177; https://doi.org/10.3390/brainsci15020177 - 11 Feb 2025
Viewed by 842
Abstract
The increasingly widespread use of stereo-EEG in the pre-surgical evaluation has led to greater recognition of the insula as both a source and surgical target for drug-resistant epilepsy. Clinicians have long appreciated the challenges of diagnosing and treating seizures arising from the insula. [...] Read more.
The increasingly widespread use of stereo-EEG in the pre-surgical evaluation has led to greater recognition of the insula as both a source and surgical target for drug-resistant epilepsy. Clinicians have long appreciated the challenges of diagnosing and treating seizures arising from the insula. Insular-onset seizures present with a wide variety of semiologies due to its dense and complex integration with other brain structures, resulting in the insula’s reputation as the “great mimicker.” Surgical access to the insula is guarded by the overlying frontal, temporal, and parietal opercula and requires careful negotiation of the Sylvian fissure, the vascular candelabra of the middle cerebral artery, and protection of crucial white matter structures (e.g., corona radiata). Despite these difficulties, open surgical intervention for insular epilepsy is associated with favorable seizure control rates, surpassing those achieved with less-invasive alternatives (e.g., laser ablation). Technical nuances that minimize the risk of adverse functional outcomes following open insular resection (especially hemiparesis) are of tremendous value to the epilepsy surgeon. Here, we review the literature on hemiparesis secondary to insular resection and detail strategies for achieving safe and thorough resection of the insula, with emphasis placed on the posterior insula. We supplement this review with four illustrative cases in which focal, drug-resistant epilepsy was managed via open insular resection with no resultant permanent hemiparesis. Technical insights accumulated through these cases are highlighted. Full article
(This article belongs to the Special Issue Application of Surgery in Epilepsy)
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