American Society for Stereotactic and Functional Neurosurgery

American Society for Stereotactic and Functional Neurosurgery

https://www.assfn.org/

Magnetic resonance image-guided laser interstitial thermal therapy (MRgLITT) is a tool in the neurosurgical armamentarium for the management of drug-resistant epilepsy. Given the introduction of this technology, the American Society for Stereotactic and Functional Neurosurgery (ASSFN), which acts as the joint section representing the field of stereotactic and functional neurosurgery on behalf of the Congress of Neurological Surgeons and the American Association of Neurological Surgeons, provides here the expert consensus opinion on evidence-based best practices for the use and implementation of this treatment modality. Indications for treatment are outlined, consisting of failure to respond to, or intolerance of, at least 2 appropriately chosen medications at appropriate doses for disabling, localization-related epilepsy in the setting of well-defined epileptogenic foci, or critical pathways of seizure propagation accessible by MRgLITT. Applications of MRgLITT in mesial temporal lobe epilepsy and hypothalamic hamartoma, along with its contraindications in the treatment of epilepsy, are discussed based on current evidence. To put this position statement in perspective, they detailed the evidence and authority on which this ASSFN position statement is based 1)

A persistent underuse of epilepsy surgery exists. Neuromodulation treatments including deep brain stimulation (DBS) expand the surgical options for patients with epilepsy and provide options for patients who are not candidates for resective surgery. DBS of the bilateral anterior nucleus of the thalamus is an Food and Drug Administration-approved, safe, and efficacious treatment option for patients with refractory focal epilepsy. The purpose of this consensus position statement is to summarize evidence, provide recommendations, and identify indications and populations for future investigation in Deep Brain Stimulation for epilepsy. The recommendations of the American Society for Stereotactic and Functional Neurosurgery are based on several randomized and blinded clinical trials with high-quality data to support the use of DBS to the anterior nucleus of the thalamus for the treatment of refractory focal-onset seizures.

Cabrera et al. designed a 51-question online survey comprising Likert-type, multiple-choice, and rank-order questions and distributed it to members of the American Society for Stereotactic and Functional Neurosurgery (ASSFN). Descriptive and inferential statistical analyses were performed on the data.

They received 38 completed surveys. Half (n = 19) of responders reported devoting at least a portion of their clinical practice to psychiatric neurosurgery, utilizing DBS and treating obsessive compulsive disorder (OCD) most frequently overall. Respondents indicated that psychiatric neurosurgery is more medically effective (OR 0, p = 0.03242, two-sided Fisher’s exact test) and has clearer clinical indications for the treatment of OCD than for the treatment of depression (OR 0.09775, p = 0.005137, two-sided Fisher’s exact test). Seventy-one percent of all respondents (n = 27) supported the clinical utility of ablative surgery in modern neuropsychiatric practice, 87% (n = 33) agreed that ablative procedures constitute a valid treatment alternative to DBS for some patients, and 61% (n = 23) agreed that ablative surgery may be an acceptable treatment option for patients who are unlikely to comply with postoperative care.

This up-to-date account of practices, perceptions, and predictions about psychiatric neurosurgery contributes to the knowledge about evolving attitudes over time and informs priorities for education and further surgical innovation on the psychiatric neurosurgery landscape 2).

2022 AMERICAN SOCIETY FOR STEREOTACTIC AND FUNCTIONAL NEUROSURGERY BIENNIAL MEETING

2016 Biennial Meeting of the American Society for Stereotactic and Functional Neurosurgery, Chicago, IL, USA, June 18-21, 2016: Abstracts 3)


1)

Wu C, Schwalb JM, Rosenow JM, McKhann GM 2nd, Neimat JS; American Society for Stereotactic and Functional Neurosurgeons. The American Society for Stereotactic and Functional Neurosurgery Position Statement on Laser Interstitial Thermal Therapy for the Treatment of Drug-Resistant Epilepsy. Neurosurgery. 2022 Feb 1;90(2):155-160. doi: 10.1227/NEU.0000000000001799. PMID: 34995216.
2)

Cabrera LY, Courchesne C, Kiss ZHT, Illes J. Clinical Perspectives on Psychiatric Neurosurgery. Stereotact Funct Neurosurg. 2019;97(5-6):391-398. doi: 10.1159/000505080. Epub 2020 Jan 17. PMID: 31955163.
3)

2016 Biennial Meeting of the American Society for Stereotactic and Functional Neurosurgery, Chicago, IL, USA, June 18-21, 2016: Abstracts. Stereotact Funct Neurosurg. 2017 Jan 16;94 Suppl 2:1-77. doi: 10.1159/000455386. [Epub ahead of print] PubMed PMID: 28092908.

A brief review of technical nuances of functional hemispherotomy

Join us today, Monday, at noon EST for a brief review of technical nuances of functional hemispherotomy.

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Based on the request of the residents and faculty, the Atlas will start a series of Virtual Operating Room live lectures every Mon at noon EST. During each session, one procedure will be reviewed using an HD video broadcasting platform while the participants can chat their questions. Virtual reality technology will be utilized for the OR setup and the surgical video will be reviewed. Space is limited to the first 300 participants.

Virtual OR webconference info: cohen.omnovia.com/room1 Use the Google Chrome browser, login as attendee and download the Flash Player. A strong Internet connection is required for these HD presentations.

Aaron Cohen-Gadol, MD, MSc, MBA
Indiana University Department of Neurosurgery
CEO, The Neurosurgical Atlas

Functional Neurosurgery (Neurosurgery by Example)

Functional Neurosurgery (Neurosurgery by Example)

by Ahmed Raslan (Editor), Ashwin Viswanathan (Editor)

List Price: $95.95

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Part of the Neurosurgery by Example series, this volume on functional neurosurgery presents exemplary cases in which renowned authors guide readers through the assessment and planning, decision making, surgical procedure, aftercare and complication management of common and uncommon disorders. The cases explore the spectrum of clinical diversity and complexity within functional neurosurgery, including essential tremorthalamotomyParkinson’s diseaseepilepsydystonia, and more.

Each chapter also contains ‘pivot points’ that illuminate changes required to manage patients in alternate or atypical situations, and pearls for accurate diagnosis, successful treatment, and effective complication management. Containing a focused review of medical evidence and expected outcomes, Functional Neurosurgery is appropriate for neurosurgeons who wish to learn more about a subspecialty, and those preparing for the American Board of Neurological Surgery oral examination.

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