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Fornicotomy for the Treatment of Epilepsy: An Examination of Historical Literature in the Setting of Modern Operative Techniques.

Authors
  • Kundu, Bornali1
  • Lucke-Wold, Brandon2
  • Foster, Chase3
  • Englot, Dario J4
  • Urhie, Ogaga5
  • Nwafor, Divine5
  • Rolston, John D1
  • 1 Department of Neurosurgery, Clinical Neurosciences Center, University of Utah School of Medicine, Salt Lake City, Utah.
  • 2 Department of Neurosurgery, University of Florida, Gainesville, Florida.
  • 3 Department of Neurosurgery, George Washington University, Washington, District of Columbia.
  • 4 Department of Neurosurgery, Vanderbilt University, Nashville, Tennessee.
  • 5 Department of Neurosurgery, West Virginia University, Morgantown, West Virginia.
Type
Published Article
Journal
Neurosurgery
Publication Date
Aug 01, 2020
Volume
87
Issue
2
Pages
157–165
Identifiers
DOI: 10.1093/neuros/nyz554
PMID: 31885037
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

Fornicotomy has been used to treat intractable temporal lobe epilepsy with mixed success historically; however, modern advances in stereotactic, neurosurgical, and imaging techniques offer new opportunities to target the fornix with greater precision and safety. In this review, we discuss the historical uses and quantify the outcomes of fornicotomy for the treatment of temporal lobe epilepsy, highlight the potential mechanisms of benefit, and address what is known about the side effects of the procedure. We find that fornicotomy, with or without anterior commissurotomy, resulted in 61% (83/136) of patients having some seizure control benefit. We discuss the potential operative approaches for targeting the fornix, including laser ablation and the use of focused ultrasound ablation. More work is needed to address the true efficacy of fornicotomy in the modern surgical setting. This review is intended to serve as a framework for developing this approach. Copyright © 2019 by the Congress of Neurological Surgeons.

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