Francesco Cardinale

Azienda Ospedaliera Niguarda Ca' Granda | Niguarda · Epilepsy Surgery Center

Objective To identify predisposing factors for hyperkinetic seizure occurrence in a representative cohort of surgically treated patients with drug-resistant focal epilepsy. Methods We retrospectively recruited all seizure-free patients after epilepsy surgery with a postoperative follow-up ≥12 months. Patients were classified as presenting with hyp...

Purpose This study aimed to identify risk factors of postoperative seizure outcome in a consecutive cohort of patients operated on for TSC-related focal epilepsy, by evaluating several presurgical and surgical variables, including also MRI-visible brain abnormalities other than cortical tubers. Methods This retrospective study included 51 patients...

COVER ILLUSTRATION The image presents a high-definition reconstruction obtained from an MRI that was de-identified using our novel method. The artwork aims to show that with current techniques it is possible to recreate with outstanding accuracy not only the brain but also the face of a subject, putting privacy at risk. In our study we present a ne...

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Deidentifying MRIs constitutes an imperative challenge, as it aims at precluding the possibility of re-identification of a research subject or patient, but at the same time it should preserve as much geometrical information as possible, in order to maximize data reusability and to facilitate interoperability. Although several deidentification metho...

Electrical source imaging (ESI) aims at reconstructing the electrical brain activity from measurements of the electric field on the scalp. Even though the localization of single focal sources should be relatively straightforward, different methods provide diverse solutions due to the different underlying assumptions. Furthermore, their input parame...

Simultaneous EEG-fMRI can contribute to identify the epileptogenic zone (EZ) in focal epilepsies. However, fMRI maps related to Interictal Epileptiform Discharges (IED) commonly show multiple regions of signal change rather than focal ones. Dynamic causal modeling (DCM) can estimate effective connectivity, i.e. the causal effects exerted by one bra...

Deidentifying MRIs constitutes an imperative challenge, as it aims at precluding the possibility of re-identification of a research subject or patient, but at the same time it should preserve as much geometrical information as possible, in order to maximize data reusability and to facilitate interoperability. Although several deidentification metho...

The functional anatomy of the antero-mesial portion of the temporal lobe and its involvement in epilepsy can be explored by means of intracerebral electrical stimulations. Here, we aimed to expand the knowledge of its physiological and pathophysiological symptoms by conducting the first large-sample systematic analysis of 1529 electrical stimulatio...

Purpose Accurate segmentation of brain resection cavities (RCs) aids in postoperative analysis and determining follow-up treatment. Convolutional neural networks (CNNs) are the state-of-the-art image segmentation technique, but require large annotated datasets for training. Annotation of 3D medical images is time-consuming, requires highly trained...

Accurate segmentation of brain resection cavities (RCs) aids in postoperative analysis and determining follow-up treatment. Convolutional neural networks (CNNs) are the state-of-the-art image segmentation technique, but require large annotated datasets for training. Annotation of 3D medical images is time-consuming, requires highly-trained raters,...

The SEEG International Course, organised in 2017, focused on the investigation and surgery of insulo-perisylvian epilepsies. We present one representative complex case that was discussed. The patient had seizures displaying startle/reflex components. He was MRI negative, while other non-invasive investigations offered only partially concordant data...

Surgical planning of percutaneous interventions has a crucial role to guarantee the success of minimally invasive surgeries. In the last decades, many methods have been proposed to reduce clinician work load related to the planning phase and to augment the information used in the definition of the optimal trajectory. In this survey, we include 113...

Objective Direct electrical stimulations of cerebral cortex are a traditional part of stereoelectroencephalography (SEEG) practice, but their value as a predictive factor for seizure outcome has never been carefully investigated. Patients and method We retrospectively analysed a cohort of 346 patients operated on for drug-resistant focal epilepsy a...

Inter-areal synchronization of neuronal oscillations at frequencies below~100 Hz is a pervasive feature of neuronal activity and is thought to regulate communication in neuronal circuits. In contrast, faster activities and oscillations have been considered to be largely local-circuit-level phenomena without large-scale synchronization between brain...

Background Formalin-fixed, paraffin-embedded brain specimens are a potentially rich resource to identify somatic variants, but their DNA is characterised by low yield and extensive degradation, and matched peripheral samples are usually unavailable for analysis.Methods We designed single-molecule molecular inversion probes to target 18 MTOR somatic...

Background: Accurate localization of the probable Epileptogenic Zone (EZ) from presurgical studies is crucial for achieving good prognosis in epilepsy surgery. Objective: To evaluate the degree of concordance at a sublobar localization derived from noninvasive studies (video electroencephalography, EEG; magnetic resonance imaging, MRI; 18-fluoro...

Objective We evaluated four imaging techniques, i.e. Electroencephalography (EEG)-functional Magnetic Resonance Imaging (MRI) (EEG-fMRI), High-resolution EEG (HR-EEG), Magnetoencephalography (MEG) and 2-[18F]fluoro-2-deoxy-D-glucose positron emission tomography (PET), for the identification of the epileptogenic zone (EZ) in 41 patients with negativ...

Surgical planning for StereoElectroEncephaloGraphy (SEEG) is a complex and patient specific task, where the experience and medical workflow of each institution may influence the final planning choices. To account for this variability, we developed a data-based Computer Assisted Planning (CAP) solution able to exploit the knowledge extracted by past...

Here we describe a rare case of Capgras delusion – a misidentification syndrome characterized by the belief that a person has been replaced by an imposter – in a patient without evident neurological or psychiatric symptoms. Intriguingly, delusional belief was selective for both person and modality, as the patient believed that his son – not his dau...

Precisely localizing the sources of brain activity as recorded by EEG is a fundamental procedure and a major challenge for both research and clinical practice. Even though many methods and algorithms have been proposed, their relative advantages and limitations are still not well established. Moreover, these methods involve tuning multiple paramete...

Precisely localizing the sources of brain activity as recorded by EEG is a fundamental procedure and a major challenge for both research and clinical practice. Even though many methods and algorithms have been proposed, their relative advantages and limitations are still not well established. Moreover, these methods involve tuning multiple paramete...

Unequivocally demonstrating the presence of multisensory signals at the earliest stages of cortical processing remains challenging in humans. In our study, we relied on the unique spatio-temporal resolution provided by intracranial stereotactic electroencephalographic (SEEG) recordings in patients with drug-resistant epilepsy to characterize the si...

This retrospective description of a surgical series is aimed at reporting on indications, methodology, results on seizures, outcome predictors and complications from a 20-year stereoelectroencephalography (SEEG) activity performed at a single epilepsy surgery centre. Prospectively collected data from a consecutive series of 742 SEEG procedures carr...

Three dimensional visualization of vascular structures can assist clinicians in preoperative planning, intra-operative guidance, and post-operative decision-making. The goal of this work is to provide an automatic, accurate and fast method for brain vessels segmentation in Contrast Enhanced Cone Beam Computed Tomography (CE-CBCT) dataset based on a...

[New task data: ver 2019-04-25] Inter-areal synchronization of neuronal oscillations below 100 Hz is ubiquitous in cortical circuitry and thought to regulate neuronal communication. In contrast, faster activities are generally considered to be exclusively local-circuit phenomena. We show with human intracerebral recordings that 100-300 Hz high-gamm...

OBJECTIVE Surgical treatment of drug-resistant epilepsy originating from the posterior quadrant (PQ) of the brain often requires large multilobar resections, and disconnective techniques have been advocated to limit the risks associated with extensive tissue removal. Few previous studies have described a tailored temporoparietooccipital (TPO) disco...

Objectives Sleep‐related hypermotor epilepsy (SHE), formerly nocturnal frontal lobe epilepsy, is characterized by abrupt and typically sleep‐related seizures with motor patterns of variable complexity and duration. They seizures arise more frequently in the frontal lobe than in the extrafrontal regions but identifying the seizure onset‐zone (SOZ) m...

Unequivocally demonstrating the presence of multisensory signals at the earliest stages of cortical processing remains challenging in humans. In our study, we relied on the unique spatio-temporal resolution provided by intracranial stereotactic electroencephalographic (SEEG) recordings in patients with drug-resistant epilepsy to characterize the si...

Musicogenic epilepsy is rare focal epilepsy in which seizures are triggered by music. Both spontaneous and reflexes seizures may occur. To date there are limited data about this epilepsy, particularly about its etiopathogenesis. We report the clinical, neurophysiological and imaging data about musicogenic epilepsy in a patient who underwent Stereo-...

Purpose: Direct electrical stimulations (ES) of the cerebral cortex (with the aim of triggering seizures) have been per- formed from the beginning of SEEG practice. However, few data exist for proving the actual usefulness of this diagnostic procedure. The present study aims to determine whether seizures induced by ES during SEEG exploration are a...

Defining the extent of the epileptogenic zone is particularly problematic in posterior cortex epilepsies (PCEs). Non-invasive information is frequently insufficient for surgical planning, and individually tailored surgery is likely to be curative only when guided by invasive investigation. Stereotactic placement of intracerebral multicontact electr...

StereoElectroEncephaloGraphy (SEEG) is a minimally invasive technique that consists of the insertion of multiple intracranial electrodes to precisely identify the epileptogenic focus. The planning of electrode trajectories is a cumbersome and time-consuming task. Current approaches to support the planning focus on electrode trajectory optimisation...

The cingulate cortex is a mosaic of different anatomical fields, whose functional characterization is still a matter of debate. In humans, one method that may provide useful insights on the role of the different cingulate regions, and to tackle the issue of the functional differences between its anterior, middle and posterior subsectors, is intraco...

Object To compare the occurrence of surgery-related complications in patients with childhood-onset focal epilepsy operated on in the paediatric or in the adult age. To investigate risk factors for surgery-related complications in the whole cohort, with special attention to age at surgery and severe morbidity. Methods A cohort of 1282 patients oper...

Several neurosurgical procedures, such as ArteroVenous Malformations (AVMs) and StereoElectroEncephaloGraphy (SEEG) require accurate reconstruction of the cerebral vascular tree, as well as the classification of arteries and veins, to increase the safety of the intervention. We propose ART-3.5D, a novel approach to recover the dynamic information f...

Background: Several attempts have been made to coregister in vivo MRI with the histopathology of surgical samples, aiming to validate new MRI biomarkers and improve the detection of epileptogenic lesions. As a further implementation, we propose a method to reconstruct the anatomical localization of the intracerebral electrodes on the histological...

Pathological High-Frequency Oscillations (HFOs) have been recently proposed as potential biomarker of the seizure onset zone (SOZ) and have shown superior accuracy to interictal epileptiform discharges in delineating its anatomical boundaries. Characterization of HFOs is still in its infancy and this is reflected in the heterogeneity of analysis an...

Background: Recent literature strongly challenged indications to perform preventive surgery in unruptured arteriovenous malformation (AVM) claiming that invasive AVM treatment is associated with a significant risk of complications and thus conservative management may be a preferable alternative in many patients. On the other hand, the recent impro...

Objective: Periventricular nodular heterotopias (PNHs) are malformations of cortical development related to neuronal migration disorders, frequently associated with drug-resistant epilepsy (DRE). Stereo-electroencephalography (SEEG) is considered a very effective step of the presurgical evaluation, providing the recognition of the epileptogenic zo...

Objective: To analyze the attitude and results of Italian epilepsy surgery centers in the surgical management of "low grade epilepsy associated neuroepithelial tumors" (LEATs). Methods: We conducted a retrospective study enrolling 339 consecutive patients with LEATs who underwent surgery between January 2009 and June 2015 at eight Italian epilep...

Purpose: Focal epilepsy is a neurological disease that can be surgically treated by removing area of the brain generating the seizures. The stereotactic electroencephalography (SEEG) procedure allows patient brain activity to be recorded in order to localize the onset of seizures through the placement of intracranial electrodes. The planning phase...

Purpose Surgery is an effective treatment for drug resistant focal epilepsy. Predictors of seizure outcome have been extensively addressed in the general population but similar data on older patients are still lacking. The aim of this study is to evaluate effectiveness and safety of surgery for patients over 50 years and to investigate variables as...

Objective: Focal Cortical Dysplasias (FCDs) represent a common architectural cortical disorder underlying drug-resistant focal epilepsy. So far, studies aimed at evaluating whether age at surgery is a factor influencing surgical outcome are lacking, so that data on the comparison between patients harboring Type II FCD operated at younger age and t...

OBJECTIVE The purpose of this study was to compare the accuracy of Neurolocate frameless registration system and frame-based registration for robotic stereoelectroencephalography (SEEG). METHODS The authors performed a 40-trajectory phantom laboratory study and a 127-trajectory retrospective analysis of a surgical series. The laboratory study was...

The rationale and the surgical technique of stereo-electroencephalography (SEEG)–guided radiofrequency thermocoagulation (RF-TC) in the epileptogenic zone (EZ) of patients with difficult-to-treat focal epilepsy are described in this article. The application of the technique in pediatric patients is also detailed. Stereotactic ablative procedures by...

Background In the evaluation of Stereo-Electroencephalography (SEEG) signals, the physicist’s workflow involves several operations, including determining the position of individual electrode contacts in terms of both relationship to grey or white matter and location in specific brain regions. These operations are (i) generally carried out manually...

Stereo-ElectroEncephaloGraphy (SEEG) is a surgical procedure that allows brain exploration of patients affected by focal epilepsy by placing intra-cerebral multi-lead electrodes. The electrode trajectory planning is challenging and time consuming. Various constraints have to be taken into account simultaneously, such as absence of vessels at the el...

Background: Stereoelectroencephalography (SEEG) was developed by Talairach and Bancaud in Paris in the late 1950s. Subsequently, the Talairach methodology was adopted at a number of additional centers in Europe and Canada. Technical aspects remained essentially unchanged for the following 30 years. Only in the last two decades, because of advancem...

Type II focal cortical dysplasia (FCD II) is a malformation of cortical development, frequently associated with intractable epilepsy, characterised by cortical dyslamination, dysmorphic neurons (DNs) and balloon cells (BCs). We investigated the expression of pS6 (downstream target) and pPDK1-pAkt (upstream targets) as evidence for mTOR pathway acti...

Preoperative three-dimensional (3-D) visualization of brain vasculature by digital subtraction angiography from computerized tomography (CT) in neurosurgery is gaining more and more importance, since vessels are the primary landmarks both for organs at risk and for navigation. Surgical embolization of cerebral aneurysms and arteriovenous malformati...

Objective To assess factors associated with favorable seizure outcome after surgery for symptomatic epileptic spasms and improve knowledge on pathophysiology of this seizure type. Methods Inclusion criteria were: (1) age between 6 months and 15 years at surgery; (2) active epileptic spasms; (3) follow‐up after surgery >1 year. Results We retrospe...

Data S1. Supplementary results.

Table S1. Invasive recordings: Initial ictal activity at onset of spasms and of focal seizures and pattern of ictal spread.