Obaid Sami, Guillemette Albert, Lapalme-Remis Samuel, Yang Joseph Yuan-Mou, Weil Alexander G, Bouthillier Alain
University of Montreal Hospital Center Research Center (CRCHUM), Montréal, Québec, Canada.
Division of Neurosurgery, University of Montreal Hospital Center (CHUM), Montréal, Québec, Canada.
Neurosurg Focus Video. 2024 Jul 1;11(1):V15. doi: 10.3171/2024.4.FOCVID2417. eCollection 2024 Jul.
Surgical management of drug-resistant epilepsy (DRE) in patients with multiple periventricular nodular heterotopias (PVNHs) is challenging. Identifying the location of seizure onset within these complex epileptic networks is difficult, and open resection carries risks of injury to surrounding functional white matter tracts such as optic radiations (ORs). The authors demonstrate tractography-assisted laser ablation of a single nodule in a patient with DRE and multiple PVNHs. Following surgery, visual fields were intact, highlighting the benefits of OR tractographic reconstruction. At 12 months postoperatively, the patient remained seizure free, suggesting the potential efficacy of targeting a single heterotopia within complex networks in well-selected cases. The video can be found here: https://stream.cadmore.media/r10.3171/2024.4.FOCVID2417.
多灶性脑室周围结节性异位（PVNHs）患者耐药性癫痫（DRE）的外科治疗具有挑战性。在这些复杂的癫痫网络中确定癫痫发作起始部位很困难，而开放性切除术有损伤周围功能性白质束（如视辐射（ORs））的风险。作者展示了在一名患有DRE和多个PVNHs的患者中，利用纤维束成像辅助对单个结节进行激光消融。手术后，视野保持完整，突出了视辐射纤维束成像重建的益处。术后12个月，患者无癫痫发作，表明在精心挑选的病例中，针对复杂网络内单个异位灶进行治疗具有潜在疗效。视频可在此处查看：https://stream.cadmore.media/r10.3171/2024.4.FOCVID2417 。
