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Article ; Online: Recurrent abdominal dislodgement of intrathecal pump and utility of infraclavicular site for patients with elevated body mass index: illustrative case.

Buxton, Kristin / Morgan, Ann / Northam, Weston T / Stone, Scellig S D

Journal of neurosurgery. Case lessons

2023 Volume 5, Issue 4

Abstract: Background: Intrathecal baclofen, delivered via implanted pump, has been used to manage spasticity for approximately 40 years. The device is typically subcutaneously or subfascially implanted in the abdominal wall. There are very few cases reported of ... ...

Abstract	Background: Intrathecal baclofen, delivered via implanted pump, has been used to manage spasticity for approximately 40 years. The device is typically subcutaneously or subfascially implanted in the abdominal wall. There are very few cases reported of the pump being implanted in other locations. Observations: This case describes the complicated course of a patient presenting with multiple episodes of catheter malfunction related to pump flipping in the abdominal pocket. The patient was successfully treated with repositioning of the pump into the infraclavicular fossa. Lessons: Infraclavicular placement of the implanted pump allowed for a more secure pocket base for this patient and less strain applied to the pump, minimizing the risk of disruption of pump positioning and interruption of drug delivery.
Language	English
Publishing date	2023-01-23
Publishing country	United States
Document type	Journal Article
ISSN	2694-1902
ISSN (online)	2694-1902
DOI	10.3171/CASE22472
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Article ; Online: Endoscope-assisted microsurgical resection of intrinsic brainstem epidermoid: technical note and review of the literature.

Cohen, Alan R / Stone, Scellig S D

Journal of neurosurgery. Pediatrics

2020 Volume 26, Issue 6, Page(s) 654–660

Abstract: Intrinsic epidermoid tumors of the brainstem are rare, histologically benign lesions associated with high surgical morbidity and mortality due to their eloquent location. The authors report a child with progressive severe neurological deterioration from ... ...

Abstract	Intrinsic epidermoid tumors of the brainstem are rare, histologically benign lesions associated with high surgical morbidity and mortality due to their eloquent location. The authors report a child with progressive severe neurological deterioration from a large midline intrinsic brainstem epidermoid at the pontomedullary junction. The mass was removed through a posterior fossa craniotomy and midline endoscope-assisted microsurgical corridor through the floor of the fourth ventricle, using neurophysiological monitoring. Postoperatively, there was dramatic improvement in the patient's symptoms. Early recurrence of the mass necessitated reoperation with more aggressive resection of the cyst capsule, which led to complete radiographic reconstitution of the brainstem. The patient remains well with a durable recovery 7 years after presentation. The authors review the literature on brainstem epidermoids and discuss the differential diagnosis and management strategies for approaching these lesions, advocating for conservative surgery with resection of as much of the tumor capsule as is safely possible.
MeSH term(s)	Brain/diagnostic imaging ; Brain Stem Neoplasms/diagnostic imaging ; Brain Stem Neoplasms/surgery ; Carcinoma, Squamous Cell/diagnostic imaging ; Carcinoma, Squamous Cell/surgery ; Endoscopy/methods ; Female ; Humans ; Infant ; Magnetic Resonance Imaging ; Microsurgery/methods ; Neurologic Examination ; Neurosurgical Procedures/methods ; Postoperative Period ; Treatment Outcome
Language	English
Publishing date	2020-10-02
Publishing country	United States
Document type	Case Reports ; Journal Article
ZDB-ID	2403985-8
ISSN	1933-0715 ; 1933-0707
ISSN (online)	1933-0715
ISSN	1933-0707
DOI	10.3171/2020.6.PEDS20482
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Article ; Online: Influence of extent and age at corpus callosotomy on seizure outcomes. A single center experience.

Chourasia, Nitish / Stone, Scellig S D / Tsuboyama, Melissa / Madsen, Joseph R / Ryan, Morgan / Zhang, Bo / Libenson, Mark H / Bolton, Jeffrey / Harini, Chellamani

Epilepsia open

2023 Volume 8, Issue 4, Page(s) 1596–1601

Abstract: Corpus callosotomy (CC) is a palliative treatment for drop seizures in patients with drug-resistant nonlocalizable epilepsy. We compared drop seizure outcomes between patients undergoing anterior CC versus complete CC and examined factors impacting ... ...

Abstract	Corpus callosotomy (CC) is a palliative treatment for drop seizures in patients with drug-resistant nonlocalizable epilepsy. We compared drop seizure outcomes between patients undergoing anterior CC versus complete CC and examined factors impacting outcomes for drop seizures including age at CC and duration of epilepsy. A retrospective review of patients who underwent CC between 2003 and 2022 with a minimum of 6 months postsurgical follow-up was included. Outcome measure for drop seizures included seizure reduction ≥50% from baseline as well as elimination of drop seizures. Thirty-eight patients were included. Overall, ≥50% reduction in drop seizures occurred in nearly 70% (23 out of 33) patients with complete elimination in 58% (19 out of 33). Compared with anterior CC (n = 13), patients undergoing complete CC (n = 25) had increased likelihood of ≥50% reduction (p = 0.006) or elimination (p = 0.024) of drop seizures. Regression analysis showed that complete CC was the primary predictor for improved drop seizure outcomes (elimination, p = 0.014 or ≥50% reduction, p = 0.006), while age at CC and duration of epilepsy did not impact the outcomes. Compared to anterior CC, complete CC was significantly more likely to lead to improvement/freedom from drop seizures. Age at CC or duration of epilepsy did not influence drop seizure outcomes.
MeSH term(s)	Humans ; Treatment Outcome ; Corpus Callosum/surgery ; Seizures/surgery ; Epilepsy ; Drug Resistant Epilepsy/surgery
Language	English
Publishing date	2023-10-18
Publishing country	United States
Document type	Journal Article
ISSN	2470-9239
ISSN (online)	2470-9239
DOI	10.1002/epi4.12819
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Article ; Online: Interictal EEG source connectivity to localize the epileptogenic zone in patients with drug-resistant epilepsy: A machine learning approach.

Ntolkeras, Georgios / Makaram, Navaneethakrishna / Bernabei, Matteo / De La Vega, Aime Cristina / Bolton, Jeffrey / Madsen, Joseph R / Stone, Scellig S D / Pearl, Phillip L / Papadelis, Christos / Grant, Ellen P / Tamilia, Eleonora

Epilepsia

2024 Volume 65, Issue 4, Page(s) 944–960

Abstract: Objective: To deconstruct the epileptogenic networks of patients with drug-resistant epilepsy (DRE) using source functional connectivity (FC) analysis; unveil the FC biomarkers of the epileptogenic zone (EZ); and develop machine learning (ML) models to ... ...

Abstract	Objective: To deconstruct the epileptogenic networks of patients with drug-resistant epilepsy (DRE) using source functional connectivity (FC) analysis; unveil the FC biomarkers of the epileptogenic zone (EZ); and develop machine learning (ML) models to estimate the EZ using brief interictal electroencephalography (EEG) data. Methods: We analyzed scalp EEG from 50 patients with DRE who had surgery. We reconstructed the activity (electrical source imaging [ESI]) of virtual sensors (VSs) across the whole cortex and computed FC separately for epileptiform and non-epileptiform EEG epochs (with or without spikes). In patients with good outcome (Engel 1a), four cortical regions were defined: EZ (resection) and three non-epileptogenic zones (NEZs) in the same and opposite hemispheres. Region-specific FC features in six frequency bands and three spatial ranges (long, short, inner) were compared between regions (Wilcoxon sign-rank). We developed ML classifiers to identify the VSs in the EZ using VS-specific FC features. Cross-validation was performed using good outcome data. Performance was compared with poor outcomes and interictal spike localization. Results: FC differed between EZ and NEZs (p < .05) during non-epileptiform and epileptiform epochs, showing higher FC in the EZ than its homotopic contralateral NEZ. During epileptiform epochs, the NEZ in the epileptogenic hemisphere showed higher FC than its contralateral NEZ. In good outcome patients, the ML classifiers reached 75% accuracy to the resection (91% sensitivity; 74% specificity; distance from EZ: 38 mm) using epileptiform epochs (gamma and beta frequency bands) and 62% accuracy using broadband non-epileptiform epochs, both outperforming spike localization (accuracy = 47%; p < .05; distance from EZ: 57 mm). Lower performance was seen in poor outcomes. Significance: We present an FC approach to extract EZ biomarkers from brief EEG data. Increased FC in various frequencies characterized the EZ during epileptiform and non-epileptiform epochs. FC-based ML models identified the resection better in good than poor outcome patients, demonstrating their potential for presurgical use in pediatric DRE.
MeSH term(s)	Humans ; Child ; Electroencephalography/methods ; Drug Resistant Epilepsy/surgery ; Magnetic Resonance Imaging ; Biomarkers
Chemical Substances	Biomarkers
Language	English
Publishing date	2024-02-06
Publishing country	United States
Document type	Journal Article
ZDB-ID	216382-2
ISSN	1528-1167 ; 0013-9580
ISSN (online)	1528-1167
ISSN	0013-9580
DOI	10.1111/epi.17898
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Zs.A 517: Show issues			Location: Je nach Verfügbarkeit (siehe Angabe bei Bestand) bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular Jg. 1995 - 2021: Lesesall (1.OG) ab Jg. 2022: Lesesaal (EG)
Zs.MO 475: Show issues

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Article ; Online: Anesthetic management and outcomes for MRI-guided laser interstitial thermal therapy (LITT) for seizure focus in pediatrics: A single-centre experience with 10 consecutive patients.

Levin, David Neville / McClain, Craig D / Stone, Scellig S D / Madsen, Joseph R / Soriano, Sulpicio

Paediatric anaesthesia

2020 Volume 31, Issue 2, Page(s) 234–236

MeSH term(s)	Anesthetics ; Child ; Humans ; Laser Therapy ; Lasers ; Magnetic Resonance Imaging ; Pediatrics ; Seizures
Chemical Substances	Anesthetics
Language	English
Publishing date	2020-12-19
Publishing country	France
Document type	Journal Article
ZDB-ID	1086049-6
ISSN	1460-9592 ; 1155-5645
ISSN (online)	1460-9592
ISSN	1155-5645
DOI	10.1111/pan.13929
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Zs.A 3306: Show issues

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Article ; Online: Intrathecal catheter and port placement for nusinersen infusion in children with spinal muscular atrophy and spinal fusion.

Shashi, Kumar K / Stone, Scellig S D / Berde, Charles B / Padua, Horacio M

Pediatric radiology

2021 Volume 51, Issue 13, Page(s) 2588–2595

Abstract: Background: Spinal administration of medications is challenging in patients with complete posterior spinal fusion. We describe percutaneous image-guided intrathecal port placement for administration of the antisense oligonucleotide nusinersen for ... ...

Abstract	Background: Spinal administration of medications is challenging in patients with complete posterior spinal fusion. We describe percutaneous image-guided intrathecal port placement for administration of the antisense oligonucleotide nusinersen for children and young adults with spinal muscular atrophy. Objective: To describe and present our initial experience with a new technique for administering nusinersen in patients with spinal muscular atrophy and posterior spinal fusion. Materials and methods: We reviewed medical records of 13 patients who received intrathecal ports using DynaCT, biplane fluoroscopy and iGuide from April 2018 through June 2019, and we describe the clinical course over 1 year. Results: Image-guided catheter and port implantation was successful in all cases. Two ports were subsequently removed, one for persistent cerebrospinal fluid leak and one for superficial infection. The other 11 have functioned successfully for a minimum of 23 months. Conclusion: We report our experience with image-guided intrathecal port placement in children with complete posterior spine fusion. The implanted port permits dosing in an outpatient setting and avoids the need for multiple future radiologic procedures, and it reduces discomfort, procedural costs and potential risks and sequelae of multiple anesthetics and radiation exposures. Further studies are needed to define the relative risks and benefits of intrathecal ports compared to other approaches such as repeated transforaminal lumbar punctures.
MeSH term(s)	Catheters ; Child ; Humans ; Injections, Spinal ; Muscular Atrophy, Spinal/diagnostic imaging ; Muscular Atrophy, Spinal/drug therapy ; Oligonucleotides ; Spinal Fusion
Chemical Substances	Oligonucleotides ; nusinersen (5Z9SP3X666)
Language	English
Publishing date	2021-07-12
Publishing country	Germany
Document type	Journal Article
ZDB-ID	124459-0
ISSN	1432-1998 ; 0301-0449
ISSN (online)	1432-1998
ISSN	0301-0449
DOI	10.1007/s00247-021-05126-4
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Zs.A 927: Show issues

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Article ; Online: Epidural analgesia for reduction of postoperative systemic opioid use following selective dorsal rhizotomy in children.

Karsten, Madeline B / Staffa, Steven J / McClain, Craig D / Amon, Jennifer / Stone, Scellig S D

Journal of neurosurgery. Pediatrics

2021 Volume 27, Issue 5, Page(s) 594–599

Abstract: Objective: Selective dorsal rhizotomy (SDR) requires significant postoperative pain management, traditionally relying heavily on systemic opioids. Concern for short- and long-term effects of these agents has generated interest in reducing systemic ... ...

Abstract	Objective: Selective dorsal rhizotomy (SDR) requires significant postoperative pain management, traditionally relying heavily on systemic opioids. Concern for short- and long-term effects of these agents has generated interest in reducing systemic opioid administration without sacrificing analgesia. Epidural analgesia has been applied in pediatric patients undergoing SDR; however, whether this reduces systemic opioid use has not been established. In this retrospective cohort study, the authors compared postoperative opioid use and clinical measures between patients treated with SDR who received postoperative epidural analgesia and those who received systemic analgesia only. Methods: All patients who underwent SDR at Boston Children's Hospital between June 2013 and November 2019 were reviewed. Treatment used the same surgical technique. Postoperative systemic opioid dosage (in morphine milligram equivalents per kilogram [MME/kg]), pain scores, need for respiratory support, vomiting, bowel movements, and length of hospital and ICU stay were compared between patients who received postoperative epidural analgesia and those who did not, by using the Wilcoxon rank-sum test or Fisher's exact test. Results: A total of 35 patients were identified, including 18 females (51.4%), with a median age at surgery of 6.1 years. Thirteen patients received postoperative epidural and systemic analgesia and 22 patients received systemic analgesia only. Groups were otherwise similar, with treatment selection based solely on surgeon routine. Patients who received epidural analgesia required less systemic morphine milligram equivalents/kg on postoperative days (PODs) 0-4 (p ≤ 0.042). Patients who did not receive epidural analgesia were more likely to require respiratory support on POD 1 (45% vs 8%; p = 0.027). Reported pain scores did not differ between groups, although patients receiving epidural analgesia trended toward less severe pain on PODs 1 and 2. Groups did not differ with respect to postoperative vomiting or time to first bowel movement, although epidural analgesia use was associated with a longer hospital stay (median 7 vs 5 days; p < 0.001). Conclusions: Patients who received postoperative epidural analgesia required less systemic opioid use and had at least equivalent reported pain scores on PODs 1-4, and they required less respiratory support on POD 1, although they remained in the hospital longer when compared to patients who received systemic analgesia only. A larger prospective study is needed to confirm whether epidural analgesia lowers systemic opioid use in children, contributes to a safer postoperative hospital stay, and results in better pain control following SDR.
MeSH term(s)	Analgesia, Epidural/methods ; Analgesics, Opioid/therapeutic use ; Cerebral Palsy/surgery ; Child ; Child, Preschool ; Cohort Studies ; Female ; Humans ; Male ; Pain Management/methods ; Pain, Postoperative/etiology ; Pain, Postoperative/therapy ; Retrospective Studies ; Rhizotomy/adverse effects
Chemical Substances	Analgesics, Opioid
Language	English
Publishing date	2021-03-12
Publishing country	United States
Document type	Journal Article
ZDB-ID	2403985-8
ISSN	1933-0715 ; 1933-0707
ISSN (online)	1933-0715
ISSN	1933-0707
DOI	10.3171/2020.9.PEDS20501
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Uk I Zs.135 -Pediatrics-: Show issues

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Article ; Online: Functional connectivity discriminates epileptogenic states and predicts surgical outcome in children with drug resistant epilepsy.

Rijal, Sakar / Corona, Ludovica / Perry, M Scott / Tamilia, Eleonora / Madsen, Joseph R / Stone, Scellig S D / Bolton, Jeffrey / Pearl, Phillip L / Papadelis, Christos

Scientific reports

2023 Volume 13, Issue 1, Page(s) 9622

Abstract: Normal brain functioning emerges from a complex interplay among regions forming networks. In epilepsy, these networks are disrupted causing seizures. Highly connected nodes in these networks are epilepsy surgery targets. Here, we assess whether ... ...

Abstract	Normal brain functioning emerges from a complex interplay among regions forming networks. In epilepsy, these networks are disrupted causing seizures. Highly connected nodes in these networks are epilepsy surgery targets. Here, we assess whether functional connectivity (FC) using intracranial electroencephalography can quantify brain regions epileptogenicity and predict surgical outcome in children with drug resistant epilepsy (DRE). We computed FC between electrodes on different states (i.e. interictal without spikes, interictal with spikes, pre-ictal, ictal, and post-ictal) and frequency bands. We then estimated the electrodes' nodal strength. We compared nodal strength between states, inside and outside resection for good- (n = 22, Engel I) and poor-outcome (n = 9, Engel II-IV) patients, respectively, and tested their utility to predict the epileptogenic zone and outcome. We observed a hierarchical epileptogenic organization among states for nodal strength: lower FC during interictal and pre-ictal states followed by higher FC during ictal and post-ictal states (p < 0.05). We further observed higher FC inside resection (p < 0.05) for good-outcome patients on different states and bands, and no differences for poor-outcome patients. Resection of nodes with high FC was predictive of outcome (positive and negative predictive values: 47-100%). Our findings suggest that FC can discriminate epileptogenic states and predict outcome in patients with DRE.
MeSH term(s)	Humans ; Child ; Drug Resistant Epilepsy/diagnosis ; Drug Resistant Epilepsy/surgery ; Seizures/surgery ; Brain/diagnostic imaging ; Brain/surgery ; Electrocorticography ; Transforming Growth Factor beta ; Treatment Outcome
Chemical Substances	Transforming Growth Factor beta
Language	English
Publishing date	2023-06-14
Publishing country	England
Document type	Journal Article ; Research Support, N.I.H., Extramural
ZDB-ID	2615211-3
ISSN	2045-2322 ; 2045-2322
ISSN (online)	2045-2322
ISSN	2045-2322
DOI	10.1038/s41598-023-36551-0
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Article ; Online: Focal drug-resistant temporal lobe epilepsy associated with an ipsilateral anterior choroidal artery aneurysm: illustrative case.

Phillips, H Westley / Rangwala, Shivani D / Papadakis, Joanna / Segar, David J / Tsuboyama, Melissa / Pinto, Anna L R / Harmon, Joseph P / Soriano, Sulpicio G / Munoz, Carlos J / Madsen, Joseph R / See, Alfred P / Stone, Scellig S

Journal of neurosurgery. Case lessons

2023 Volume 5, Issue 26

Abstract: Background: The occurrence of both an intracranial aneurysm and epilepsy, especially drug-resistant epilepsy (DRE), is rare. Although the overall incidence of aneurysms associated with DRE is unclear, it is thought to be particularly infrequent in the ... ...

Abstract	Background: The occurrence of both an intracranial aneurysm and epilepsy, especially drug-resistant epilepsy (DRE), is rare. Although the overall incidence of aneurysms associated with DRE is unclear, it is thought to be particularly infrequent in the pediatric population. Surgical ligation of the offending aneurysm has been reported in conjunction with resolving seizure activity, although few cases have cited a combined approach of aneurysm ligation and resection of an epileptogenic focus. Observations: We present the case of a 14-year-old female patient with drug-resistant temporal lobe epilepsy and an ipsilateral supraclinoid internal carotid artery aneurysm. Seizure semiology, electroencephalography monitoring, and magnetic resonance imaging all indicated a left temporal epileptogenic focus, in addition to an incidental aneurysm. The authors recommended a combined surgery involving resection of the temporal lesion and surgical clip ligation of the aneurysm. Near-total resection and successful ligation were achieved, and the patient has remained seizure free since surgery at 1 year postoperatively. Lessons: In patients with focal DRE and an adjacent intracranial aneurysm, a combined surgical approach involving both resection and surgical ligation can be used. Several surgical timing and neuroanesthetic considerations should be made to ensure the overall safety and efficacy of this procedure.
Language	English
Publishing date	2023-06-26
Publishing country	United States
Document type	Journal Article
ISSN	2694-1902
ISSN (online)	2694-1902
DOI	10.3171/CASE23156
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Article ; Online: Sleep Spindle Generation Before and After Epilepsy Surgery: A Source Imaging Study in Children with Drug-Resistant Epilepsy.

Chericoni, Assia / Ricci, Lorenzo / Ntolkeras, Georgios / Billardello, Roberto / Stone, Scellig S D / Madsen, Joseph R / Papadelis, Christos / Grant, P Ellen / Pearl, Phillip L / Taffoni, Fabrizio / Rotenberg, Alexander / Tamilia, Eleonora

Brain topography

2023 Volume 37, Issue 1, Page(s) 88–101

Abstract: Introduction: Literature lacks studies investigating the cortical generation of sleep spindles in drug-resistant epilepsy (DRE) and how they evolve after resection of the epileptogenic zone (EZ). Here, we examined sleep EEGs of children with focal DRE ... ...

Abstract	Introduction: Literature lacks studies investigating the cortical generation of sleep spindles in drug-resistant epilepsy (DRE) and how they evolve after resection of the epileptogenic zone (EZ). Here, we examined sleep EEGs of children with focal DRE who became seizure-free after focal epilepsy surgery, and aimed to investigate the changes in the spindle generation before and after the surgery using low-density scalp EEG and electrical source imaging (ESI). Methods: We analyzed N2-sleep EEGs from 19 children with DRE before and after surgery. We identified slow (8-12 Hz) and fast spindles (13-16 Hz), computed their spectral features and cortical generators through ESI and computed their distance from the EZ and irritative zone (IZ). We performed two-way ANOVA testing the effect of spindle type (slow vs. fast) and surgical phase (pre-surgery vs. post-surgery) on each feature. Results: Power, frequency and cortical activation of slow spindles increased after surgery (p < 0.005), while this was not seen for fast spindles. Before surgery, the cortical generators of slow spindles were closer to the EZ (57.3 vs. 66.2 mm, p = 0.007) and IZ (41.3 vs. 55.5 mm, p = 0.02) than fast spindle generators. Conclusions: Our data indicate alterations in the EEG slow spindles after resective epilepsy surgery. Fast spindle generation on the contrary did not change after surgery. Although the study is limited by its retrospective nature, lack of healthy controls, and reduced cortical spatial sampling, our findings suggest a spatial relationship between the slow spindles and the epileptogenic generators.
MeSH term(s)	Child ; Humans ; Retrospective Studies ; Epilepsy/diagnostic imaging ; Epilepsy/surgery ; Drug Resistant Epilepsy/diagnostic imaging ; Drug Resistant Epilepsy/surgery ; Epilepsies, Partial ; Sleep/physiology ; Electroencephalography/methods
Language	English
Publishing date	2023-09-22
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't ; Research Support, N.I.H., Extramural
ZDB-ID	1078442-1
ISSN	1573-6792 ; 0896-0267
ISSN (online)	1573-6792
ISSN	0896-0267
DOI	10.1007/s10548-023-01007-1
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