First in Romania: surgery on the brain through the eyelid. The patient got rid of the epileptic seizures he had since childhood

An operation on the brain through the eyelid was performed for the first time in Romania, at the Central Military Emergency University Hospital “Dr. Carol Davila” from Bucharest. The patient, a 49-year-old man, got rid of the epileptic seizures that plagued him since childhood.

The operation was performed in December, for the first time in Romania PHOTO: Daniel Iancu/SUUMC

The operation was performed at the end of last year, thus overcoming a new barrier, say the hospital's representatives on its website. Central Military Emergency University Hospital “dr. Carol Davila” is the only state unit at the national level where, for about two years, epilepsy surgery has been frequently performed.

For the preparation of this highly complex intervention, the specialists resorted to three-dimensional reconstructions, practicing both in the virtual environment repeatedly and in specialized dissection courses held in Barcelona, ​​Spain.

This type of surgery requires a minimally invasive approach, by which an area of ​​the brain that is responsible for epileptic seizures is removed, but without creating new scars that are, in turn, seizure generators. It is a difficult target to achieve, but with modern work techniques the results are extremely promising”, psays Dr. Georgian Ciobotaru, specialist neurosurgeon, the author of the first intervention in Romania.

The patient had three to four epileptic seizures per week

The patient operated on for the first time nationally at the state hospital is 49 years old, had epileptic seizures since childhood and is known to have a major ischemic stroke in the left cerebral hemisphere (during the perinatal period). The frequency of seizures was three to four per week at the moment when he came to the attention of the team from the Central Military Emergency University Hospital.

The case investigated by the specialists proved to be extremely difficult to approach neurosurgically with the methods already used, and there is a risk that, if things do not turn out as in theory, the patient will have severe memory disorders. So it was decided to turn to a solution not yet tried in Romania, used strictly in oculoplastic surgery.

The operation was performed in December, for the first time in Romania PHOTO: Daniel Iancu/SUUMC

The operation was performed in December, for the first time in Romania PHOTO: Daniel Iancu/SUUMC

“The correlation between the scars associated with cerebral vascular accidents (AVC) and epilepsy is known, but the team of neuroepileptologists, based on the vast experience accumulated in the study of this disease, raised the hypothesis that although there is a major scar that could have produced these seizures, the focus responsible of epilepsy was in an area of ​​the brain that looked almost normal: the left temporomesial region, which normally includes the hippocampus, an essential part of the memory circuit. The hypothesis was confirmed by imaging (brain MRI with epilepsy protocol) and electrophysiological (video EEG with electrodes measured and glued to the scalp) studies, and an epilepsy surgery plan was issued. It proposed the resection of the temporal pole, the amygdala nucleus and the hippocampus, leaving the large afferent area of ​​the AVC untouched. If the plan had been wrong, the patient would have had severe memory impairment, which could have severely affected his quality of life.” neurosurgeon Georgian Ciobotaru further described the case.

A multidisciplinary team – included neuroepileptologists (prof. Dr. Ioana Mîndruță, Dr. Irina Oane), neurosurgeon (capt. Dr. Ciobotaru Georgian), anesthetist (prof. Dr. Dan Corneci) and ophthalmologist (col. dr. Horațiu Manole) – thus established that the best option for this case was an approach that has not been tried before in Romania, through an incision strictly used in oculoplastic surgery, at the level of the left eyelid.

The intervention lasted six hours, the neurosurgical team being made up of Capt. Dr. Georgian Ciobotaru – specialist neurosurgeon and Lt. Dr. Mădălina Ancuța – resident neurosurgeon. The neurosurgeons were assisted by an anesthetic team (Dr. Ligia Torsin, ATI specialist doctor and ATI resident doctors – Dr. Anca Raluca Achim and Dr. Andra Georgiana Nenciu, led by university professor Dr. Dan Corneci).

No crisis in three months

Three months have passed since the intervention, during which time the patient has not had any more seizures. However, the case can be considered cured after two years without seizures, elapsed since the operation.

Although the operative plan developed by the team of neuroepileptologists was strictly followed, the success of an epilepsy surgery is proven over time, by the disappearance of seizures. Thus, three months after the intervention, the frequency of seizures decreased from three to four seizures per week to … none in three months! The definition of a “cured case” however is the absence of seizures for two years after the intervention, the patient remaining closely monitored during this period by the neuroepileptology team”, mentioned Dr. Ciobotaru.

The operation was performed in December, for the first time in Romania PHOTO: Daniel Iancu/SUUMC

The operation was performed in December, for the first time in Romania PHOTO: Daniel Iancu/SUUMC

The neurosurgeon also explained how patients can benefit from such treatment.

“Patients need to be referred to a neuroepileptology team who can demonstrate that the epilepsy is due to a specific area of ​​the brain that can be safely removed, and then this team will refer the patient to a neurosurgeon. We are happy to have such a collaboration with renowned doctors outside the hospital, thus proving that the health of patients is everyone's priority!”, concluded Dr. Georgian Ciobotaru.

Epilepsy, a more common condition than we might think

Epilepsy is a chronic disease that consists of periodic dysfunctions of the brain's electrical activity caused by excessive electrical discharges at the level of the cerebral cortex. It is manifested by epileptic seizures – repetitive, sudden events, characterized by the same changes in motor behavior, with or without alteration of the state of consciousness. In the world, 50 million people have been diagnosed with epilepsy, while in Romania there are approximately 500,000 patients suffering from this condition, and their number is increasing.

Although it is an incurable disease, 70% of patients can control their seizures with medication. In those who do not have seizure control despite maximal treatment, neurosurgical intervention, with excision of the epileptogenic zone (epilepsy surgery), can be considered when there are precise indications, so that the benefit is greater than the risk.” states, on the SUUMC website, PhD student Aida Mihaela Manole, specialist in neurology at the Integrated Clinical Outpatient Clinic of the Central Military Emergency Hospital.

At the Central Military Emergency University Hospital, a young team of professionals dedicated to epileptology works in the Clinical Department of Neurology. Here there is the possibility of video-EEG monitoring, an investigation that simultaneously ensures the recording of the EEG path and the way the seizures unfold, very useful for supporting or refuting the diagnosis in certain cases, says Dr. Aida Mihaela Manole.