Lawrence Daniels, M.D., a neurosurgeon at Hackensack Meridian Health Jersey Shore University Medical Center, has performed the hospital’s first craniotomy for placement of subdural grids leading to a successful temporal lobectomy. The procedure involves placing electrode grids on the surface of the brain to more accurately measure and localize the onset of seizure activity, followed by the complete removal of the anterior portion of the temporal lobe of the brain, an option reserved for individuals in whom anticonvulsant medications are unable to control epileptic seizures. Performed on a 57 year old Wall Township woman who had been suffering from 100 seizures a day, the successful surgery has dramatically improved her life by stopping her seizures completely.
“This life-changing surgery has the ability to lower the number of seizures a person has, make them less severe, or even stop them from happening all together,” says Dr. Daniels, who treats adults as well as children, and is the medical director of pediatric neurosurgery at K. Hovnanian Children’s Hospital at Jersey Shore University Medical Center. “We offer remarkable capabilities to the local community. I truly believe that there are many people in our community who can benefit from this team approach and may be surgical candidates to help reduce or even cure their seizures.”
In this case, the patient has lived with epilepsy for 15 years. The past decade has been especially challenging, with partial surgery and medications not able to fully manage her seizures. In the past year, her seizures increased significantly, and she was eventually brought to the Emergency Department at Jersey Shore University Medical Center, where she met Dr. Daniels and multiple members of the epilepsy team. She was admitted to the epilepsy monitoring unit at the medical center, where specially trained technicians carefully observed her brain activity and found that she was having more than 100 seizures a day.
Dr. Daniels knew that surgery could be an option and reviewed the case with colleagues from the Neuroscience Institute at Jersey Shore University Medical Center. A comprehensive team was involved with this complex case, which included neurosurgeons Dr. Daniels and Pinakin Jethwa, M.D., epileptologist Rajesh Sachdeo, M.D., neuropsychologists for cognitive testing, monitoring technicians, physical therapists, Magnet nurses, social workers and other members of the Neurosurgical Intensive Care Unit (NeuroICU) team.
The team determined to move forward with a two phased approach. The first step was a surgical procedure called craniotomy for placement of subdural grids and interoperative cortigraphy. During a four hour procedure, Dr. Daniels removed part of the skull, opened the dura (a membrane that covers the brain) and placed 32 tiny electrodes on the brain. Each electrode was connected to ultrathin wire leads. The dura, skull and scalp were replaced, with a small opening for the leads to come out and connect to monitoring technology.
The patient spent 24 hours in a special unit where data about her seizures was collected and showed that the seizures were originating from the temporal lobe. The doctors were also able to conduct interoperative cortigraphy, or brain mapping. This step pinpointed the motor cortex and sensory cortex, which are areas of the brain responsible for movement and feeling.
The next day, the patient was taken back to the operating room where her scalp, skull and dura were once again removed. The electrode grids were taken off the brain and then surgery was performed to remove the temporal lobe, a procedure referred to as craniotomy for anterior temporal lobectomy. The patient spent two days recovering in the NeuroICU, and then went home and participated in outpatient physical therapy. Improvement was immediate. Since having her surgery in November 2017, she has not experienced any seizures. Her family has even noticed improvement in her cognitive performance and language.
Dr. Daniels explains the reason for these additional improvements. “When seizure impulses are traveling through the brain, it is like having ‘noise’ that prevents the rest of the brain from working optimally. Now that the noise has been removed, the brain is able to work more normally,” he says.
“I truly believe that one of the strengths and differentiators of our program is the comprehensive Epilepsy Conference, which takes place each month,” says Alan Colicchio, M.D., medical director of Hackensack Meridian Health Neuroscience. “Experts from a variety of disciplines gather for multidisciplinary case evaluations and identify those individuals who could benefit from various treatments and procedures.”
“The conference is a dedicated time to review the case and have a meeting of the minds. The best decisions come out of that process,” says Dr. Daniels. “I’m extremely proud of the system that we’ve developed at Jersey Shore University Medical Center.”
Kenneth N. Sable, M.D. MBA, FACEP, president of Jersey Shore University Medical Center and K. Hovnanian Children’s Hospital, notes, “The Neuroscience Institute at Jersey Shore University Medical Center offers the region’s most complete lineup of neuroscience services and is equipped to handle the most complex cases involving neurological disorders. Intricate procedures such as this demonstrate that our clinical teams are equipped to care for the most intricate cases and offer the best treatment options possible.”
To connect with a physician from the Neuroscience Institute at Jersey Shore University Medical Center, call the free physician referral line at 1-800-560-9990.