PubMed Health⌕ Search

Biomedical subjects

W W Whisler

Publications and source records attributed to W W Whisler.

8 recordsLinked to original sources
PubMed1989

Multiple subpial transection: a new approach to the surgical treatment of focal epilepsy.

A new operative approach has been designed for the relief of medically intractable focal epilepsy. It is intended particularly to be used in those cases where the epileptogenic lesion lies in "unresectable" cortex; that is, those cerebral regions subserving speech, memory, and primary motor and sensory function. The procedure is based upon experimental evidence indicating 1) that epileptogenic discharge requires substantial side-to-side or horizontal interaction of cortical neurons, and 2) that the major functional properties of cortical tissue depend upon the vertical fiber connections of the columnar units. The technique requires severing of tangential intracortical fibers while preserving the vertical fiber connections of both incoming and outgoing nerve pathways and of the penetrating blood vessels which also have a vertical orientation. In this study, the effect of multiple subpial transection was assessed on both function and seizure control. The effect on function was reviewed in 32 cases; only 20 cases were evaluated with respect to seizure control, since a follow-up period of 5 years or more (5 to 22 years) is required before conclusions can be drawn. Multiple subpial transection was applied to the precentral gyrus in 16 cases, the postcentral gyrus in six, Broca's area in five, and Wernicke's area in five. With respect to function, the major finding was that none of the 32 patients has suffered a clinically significant behavioral deficit (although subtle deficits could be detected by careful neurological examination). Complete control of seizures has been obtained in 11 (55%) of the 20 cases evaluated. Nine patients developed recurrent seizures consequent to progressive disease unsuspected before operation (Rasmussen's encephalitis in five, tumor in three, and subacute sclerosing panencephalitis in one). In none of these cases, however, did the recurrent seizures arise in the transected zone. Thus, the results indicate that multiple subpial transection is about as effective as standard excisional therapy, and can be successfully employed when epileptogenic lesions encroach upon cortical territories, the removal of which would be functionally incapacitating.

Adolescent↗
PubMed1978

Mesencephalotomy for intractable pain due to malignant disease.

40 mesencephalotomies were carried out on 38 patients with intractable pain secondary to malignant disease. In 2 patients with bilateral pain, a bilateral mesencephalotomy was required. Most of the patients had pain in the head, neck or upper trunk secondary to carcinoma of the nasopharynx, jaw, tongue, or neck.

Female↗
PubMedDate not supplied

Magnetic resonance imaging as a sensitive and specific predictor of neoplasms removed for intractable epilepsy.

Twenty-three patients had magnetic resonance imaging (MRI) and computed tomography (CT) of the head prior to surgery for medically intractable epilepsy. Eleven patients had neoplasms, mostly astrocytomas. Six of the 11 tumors were seen on CT. In five of the six cases, the MRI showed a focal area of increased signal on T2-weighted images. All 11 tumors were detected by MRI. None of the non-neoplastic lesions produced an abnormal T2-weighted signal area on MRI. Only one of the non-neoplastic lesions was seen on both CT and on MRI. MRI allowed clear discrimination between tumors and non-neoplastic lesions in patients coming to surgery for intractable epilepsy.

Adult↗
PubMedDate not supplied

Stereotactic surgery with image processing of computerized tomographic scans.

The three-dimensional information from computerized tomographic scans has been transformed by image processing for use in stereotactic surgery. A lateral image of the target and calvarium can be superimposed on the lateral x-ray film taken at operation. Computer processing also eliminates extraneous data on the scan and gives the precise distance of the target from the midline. Testing the technique on a phantom shows it to be accurate to better than 0.5 cm. Application of the method for the stereotactic biopsy of a deep tumor is illustrated.

Adenocarcinoma↗