The Swiss Neurological Society (SNS) has been organizing an annual conference on a regular basis for 113 years. Over the decades, the training event has reinvented itself time and again – but its core has remained the same: The focus is on the latest research findings and mutual exchange. This year’s focus was on functional neurosciences, neuro-oncology and cerebrovascular medicine.
Epilepsy is the most common pediatric neurological disorder. Early-onset focal epilepsy is usually due to developmental brain lesions. Surgery is the treatment of choice to avoid long-term epilepsy-associated tumors and focal cortical dysplasia. Electrocorticography (ECoG) can help to determine the extent of the resection. The aim of one study was to analyze the value of electrocorticography during epilepsy surgery for structural lesions in pediatric patients [1]. For this purpose, medical records of consecutive children were retrospectively reviewed. All patients were operated on with intraoperative ECG recording. The primary endpoint was the frequency of seizures, secondary endpoints were the rate of revision surgery, reduction in postoperative antiepileptic drugs (AED) and morbidity/mortality. It was found that the ECG changed the course of the operation in 46% of patients. After surgery, AED treatment was reduced in all cases with a follow-up period of more than 12 months, with either seizure freedom or a significant reduction in seizure frequency being achieved. Accordingly, ECoG appears to be a valuable tool for deciding on the extent of resection, which can lead to good outcomes in pediatric patients with lesional epilepsy.
Glioma surgery in the facial area
While preservation of function must be the goal in brain tumor surgery, there is increasing evidence that the extent of low-grade glioma (LGG) resection directly correlates with patient outcomes. The surgery of LGG in the facial area of the primary motor cortex (M1) is complicated because the exact motor organization of the cortex is largely unknown. New findings point to different motor projections to the facial motor nuclei. The neurological outcome after tumor resection in the M1 facial region was retrospectively analyzed [2]. Twelve LGG patients with a resection in the M1 facial area between 2012 and 2019 were included. The primary endpoint was postoperative facial motor function. Secondary endpoints were postoperative aphasia, dysarthria and dysphagia. Postoperatively, a total of 66.7% had a new facial nerve palsy (62.5% left LGG) and 41.7% (n=5) had aphasia (all left LGG). After one year, all patients had fully recovered from the facial paralysis, while two of the five patients had residual aphasia. This proves that a tumor resection in the M1 facial area did not lead to permanent motor deficits in the face.
Endoscopic treatment of intracerebral hemorrhages
Spontaneous intracerebral hemorrhage (SSICH) is the most severe form of stroke, which is associated with a high mortality rate and a high burden of disease. There is currently no sufficiently effective treatment that could improve not only survival but also functional outcome. Endoscopic surgery could potentially be superior to best medical treatment, the current gold standard, but no large confirmatory studies have been conducted to date. Furthermore, there is uncertainty about the ideal timing and the avoidance of secondary brain damage. The aim of one study was to investigate the feasibility of early endoscopic evacuation of SSICH [3]. Feasibility was defined as achieving sufficient hematoma evacuation below 15 ml. At the same time, the rate of good results (mRS ≤3) was assessed.
Ten patients admitted to the emergency room were admitted and underwent endoscopic surgery within 24 hours of the onset of symptoms. Patients were followed for five more visits until six months after SSICH. Biomarkers were collected before and after the operation up to six months after the procedure. It was shown that endoscopic hematoma evacuation appears to be feasible and safe. Although the improvement in favorable outcome was not significantly different from baseline, improvements in focal neurological defects were achieved, indicating a promising surgical approach for future patients. The results of this pilot study will serve as the basis for the design and implementation of the randomized controlled EMINENT-ICH study, which will begin in all stroke centers in Switzerland in the near future.
Congress: Gemeinsame Jahrestagung der SNG und SGNC
Literature:
- Frank NA, et al.: Early-onset focal epilepsy in children – resection in accordance with ECoG or lesion guidance? SSNS-02-Epilepsy and sleep disorders. P01. Gemeinsame Jahrestagung der SNG und SGNC, 23.–24.11.2023, Zürich.
- Lutz K, et al.: Resection of Low-Grade Gliomas in the Face Area of the Primary Motor Cortex and Neurological Outcome. SSNS-08-Neuro-oncology. P03. Gemeinsame Jahrestagung der SNG und SGNC, 23.–24.11.2023, Zürich.
- Hallenberger T, et al.: Early Minimally Invasive image-guided eNdoscopic Evacuation of iNTracerebral haemorrhage: A pilot trial (EMINENT-ICH Pilot Trial). SSNS-10-Stroke and cerebrovascular medicine. P05. Gemeinsame Jahrestagung der SNG und SGNC, 23.–24.11.2023, Zürich.
InFo NEUROLOGIE & PSYCHIATRIE 2023; 21(6): 26
