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Biomedical subjects

K Aronyk

Publications and source records attributed to K Aronyk.

8 recordsLinked to original sources
PubMed2003

Pediatric temporal lobectomy for epilepsy.

BACKGROUND: Temporal lobectomy in adults is an accepted form of treatment for patients with intractable complex partial seizures. There have been few long-term studies of children undergoing temporal lobectomy for epilepsy. METHODS: We reviewed the pediatric cases of temporal lobectomy for intractable epilepsy performed by the Comprehensive Epilepsy Program at the University of Alberta Hospitals between 1988 and 2000. All patients had preoperative and postoperative clinical evaluations, seizure charts, drug levels, EEG, CT/MRI, long-term video EEG monitoring and neuropsychological testing. The patients were reassessed at 6 weeks, 6 months and 1 year postoperatively, then yearly. The duration of follow up was 1-10 years (mean 5 years). RESULTS: Forty-two patients were studied (25 males and 17 females). Age at surgery ranged from 18 months to 16 years. The interictal EEG was abnormal in 38 of the 42 patients. Twenty-two patients had focal epileptic discharge and 1 had generalized epileptic discharge. Focal slowing was seen in 9 patients and diffuse slowing in 5 patients. CT scan was abnormal in 17 of 39 patients and normal in 22 of 39. MRI was abnormal in 34 of 42 patients and normal in 8 of 42. Pathology included brain tumors in 14 patients, mesial temporal sclerosis in 8, focal cortical dysplasia in 4, tuberous sclerosis in 4, dual pathology in 4, porencephalic cyst in 1 and normal pathology or gliosis in 6. Thirty-three of 42 patients (78%) were seizure-free following surgery and an additional 5 (12%) had a decrease in seizure frequency. Three patients had complications, but there were no deaths. CONCLUSION: Temporal lobectomy is a safe and effective treatment for children with intractable complex partial seizures. Seventy-eight percent of patients are seizure-free following the surgery and there are few complications. MRI is superior to CT scan for detection of temporal lobe pathology yet failed to detect abnormalities in some patients. The most common pathologies found were brain tumors, mesial temporal sclerosis and developmental lesions. In addition to seizure control, many patients experienced improvement in cognitive and psychosocial function following surgery.

Adolescent↗
PubMed2002

Resection of the lesion in patients with hypothalamic hamartomas and catastrophic epilepsy.

BACKGROUND: Patients with hypothalamic hamartomas (HH) often have severe refractory epilepsy, incapacitating behavioral abnormalities, and cognitive decline. Attempts to control the seizure disorder by resection of apparently epileptogenic mesial temporal or other cortical structures have failed consistently. OBJECTIVE: To report a series of 13 patients in whom the hamartoma itself was resected. METHODS: All patients underwent preoperative evaluation between ages 2 and 33 years and had subtotal or complete resection of the hamartoma. Follow-up ranged from 1 to 5.5 years (mean: 2.8 y). RESULTS: Preoperatively, all patients had variable combinations of gelastic, complex partial, and generalized seizures. Eight had drop attacks. In addition, all had marked behavior abnormalities and cognitive impairment. Postoperatively, two patients are completely seizure-free and 11 are either seizure-free or have achieved a greater than 90% reduction of drop attacks and generalized tonic-clonic seizures. However, minor gelastic, complex partial, and atypical absence seizures have persisted in 11 patients, although at significantly reduced rates. In addition, there has been a dramatic improvement in behavior and cognition. Three patients had an anterior thalamic and one a capsular infarct, which left only minimal long-term deficits. Exact location of the lesion in relation to the interpeduncular fossa and the walls of the third ventricle correlated with extent of excision, seizure control, and complication rate. CONCLUSION: Resection can alleviate both the seizures and the behavioral and cognitive abnormalities of hypothalamic hamartomas, but complications are frequent.

Adolescent↗
PubMed2001

Pathology and neuroimaging in pediatric temporal lobectomy for intractable epilepsy.

OBJECTIVES: Firstly, to study the pathology at surgery in children undergoing temporal lobectomy for intractable partial epilepsy. Secondly, to compare neuroimaging techniques (CT, MRI) in the preoperative detection of pathology. Lastly, to examine the surgical outcome in children. METHODS: Forty-two pediatric patients undergoing temporal lobectomy for intractable epilepsy at the Comprehensive Epilepsy Program at the University of Alberta Hospital between the years 1988-1998 were studied. Patients had extensive preoperative investigations including CT and MRI. The pathology at surgery was reviewed and compared to preoperative neuroimaging. Charts were reviewed to determine surgical outcome. RESULTS: Brain tumors were the most common pathology, found in 13/42 patients. Mesial temporal sclerosis (MTS) was found in 8 patients and dual pathology in an additional 5. Focal cortical dysplasia (FCD) was seen in 4 patients, 1 patient had a porencephalic cyst and 4 patients had tubers of tuberous sclerosis. Seven patients had no specific pathology detected. MRI was clearly more sensitive than CT in the detection of pathology. MRI was abnormal in 27/42 cases (64%), while CT scan was found to be abnormal in only 12/39 (31%). Surgical outcome was excellent, with 34/42 patients (80%) having an Engel class I outcome. One patient had significant improvement with an Engel class II outcome, 3 (7%) had little improvement (Engel class III) and 4 (10%) were unchanged (Engel class IV). Three patients (7%) had surgical complications. CONCLUSIONS: A wide variety of developmental pathology is seen following temporal lobectomy for intractable epilepsy of childhood. Brain tumors, FCD and MTS are common. MRI is superior to CT in the detection of pathology, which may be subtle in children. Surgical outcome is excellent, with most children being seizure free and few complications being seen.

Adolescent↗
PubMed1992

Management of the child with severe brain injury.

The pathophysiology and clinical management of acute brain injury in infancy and childhood are presented using acute traumatic brain injury as a model. The principles of stabilization, transport, and intensive care management are critically reviewed.

Brain Injuries↗
PubMed1991

The effects of labor and delivery on spinal cord function and ambulation in patients with meningomyelocele.

Two hundred and eight patients with meningomyeloceles were reviewed to assess the role of birth trauma in the pathogenesis of their neurological deficit. Vaginal breech-delivered patients appeared to have poorer neurological function in the newborn period. The factors responsible include: (1) a mid or upper lumbar level, that by sparing hip flexors and knee extensors, predisposes to breech presentation; (2) limb posturing due to residual neurological function and intrauterine positioning that limits the accurate neurological assessment of the newborn; (3) nervous system or soft tissue injury due to labor and delivery. Regardless of the mechanism, vaginal breech-delivered patients showed improvement in function, and eventually exhibited ambulatory function comparable to those infants born by cesarian section or vaginally after vertex presentation and labor. In our patient population, elective cesarian section did not offer a spinal cord or ambulatory advantage over vaginal delivery for those pregnancies presenting in a vertex fashion. Thus, it should be reserved for fetuses who are presenting breech or who have other obstetrical indications for operative delivery.

Birth Injuries↗
PubMed1982

Management and postoperative mortality related to time of clipping for supratentorial aneurysms: a personal series.

An analysis of all 197 consecutive cases of intracranial aneurysms treated by one of us (B. W.) was carried out. 82% were ruptured anterior circle aneurysms. 144 cases were analyzed with respect to post-operative and management mortality where patients were eligible for definitive clipping. Grade-time interactions on transfer to the neurosurgeon were considered. Early operation was not associated with significantly higher post-operative and management mortality. 116 cases clipped and discharged from hospital had longer follow-ups to see if earlier operation was associated with a poorer neurological and social outcome. This was not the case. We therefore believe that since the prime rationale for surgery following subarachnoid haemorrhage is the prevention of rebleeding and since this is more common immediately following the initial haemorrhage, early surgery is indicated whenever this is technically feasible. Since 1978, with a deliberate policy of trying to operate early, for all grades there has been a post-operative mortality of 3%, a case management mortality of 20% and 87% of patients operated upon have been able to go home.

Constriction↗
PubMed1981

Management mortality and the timing of surgery for supratentorial aneurysm.

A retrospective analysis of 224 patients with a ruptured supratentorial aneurysm, admitted to the care of one of six neurosurgeons on the day or or the day following their subarachnoid hemorrhage, was carried out. Both postoperative and management mortality rates were calculated by the grade of the patient on admission. There were no statistically significant differences in postoperative and management mortality rates when patients were categorized by time of operation, except for the increased management mortality for Grade 3 and 4 patients who were operated on late.

Humans↗