Authors :
Presenting Author: Catherine Gwinn, – University of Washington School of Medicine
Shahin Hakimian, MD – University of Washington
Kurt Weaver, PhD – University of Washington
Adriel Barrios-Anderson, MD – University of Washington
Benjamin Grannan, MD – University of Washington
Rationale:
For patients with medically refractory epilepsy that is multifocal or involving eloquent cortex, complete surgical resection is not possible and partial resection is unlikely to result in meaningful seizure reduction. In such cases, a combination of resection and neuromodulation may offer improved outcomes. One such neuromodulatory approach is with responsive neuromodulation (RNS), a closed-loop device that provides both stimulation and electrocorticogram monitoring. Here we describe indications, technical considerations, and outcomes of three patients in whom resection and RNS implantation was performed in the same operation.Methods:
A retrospective chart review at the University of Washington was conducted of patients who have received both craniotomy for resection and RNS implantation within one operation. The electronic medical record, multidisciplinary epilepsy conference notes, and the patient data management system were utilized for data extraction and figure generation.Results:
Three patients met inclusion criteria for this study. All three patients underwent intracranial monitoring with stereo-EEG prior to surgery, which demonstrated multifocal or eloquent cortex-involving seizure onset zones. Two patients were implanted with one depth electrode in the contralateral hippocampus to the resection and a cortical strip electrode ipsilateral to the resection. One patient received bilateral hippocampal depth electrodes in addition to resection. Notable technical considerations were made in each case, including prioritization of stereotactic accuracy, avoiding pulse generator discharge by monopolar cautery, and location of the generator relative to craniotomy site for resection. At 1 year follow up, two patients achieved worthwhile improvement in seizure frequency, and one had rare disabling seizures.
Conclusions:
Concurrent surgical resection and RNS placement can be a safe and effective treatment for patients with multifocal, medically refractory epilepsy or in patients with eloquent area involvement. We suggest consideration of this combined approach when intracranial data suggests a role for resection in decreasing seizure frequency and severity but is unlikely to achieve seizure freedom.
Funding: No funding was received in support of this abstract.