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Results for “Temporal Lobe Resection”

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PubMed1999

[Temporal lobe epilepsy associated with old intracerebral hemorrhage due to capillary telangiectasis in the temporal lobe: case report].

A case of 45-year-old female, who presented with temporal lobe epilepsy was reported. The patient was found to have old intracerebral hemorrhage due to capillary telangiectasis in the temporal lobe. On the intraoperative electrocorticography, frequent paroxysmal activities were recorded independently both on the medial and lateral aspects of the temporal lobe. Even after resection of the lateral temporal lobe, frequent paroxysmal discharges were noted on the hippocampus. Histologically, there are astrogliosis and hemosiderin deposits in the white matter around the telangiectasis and the old hematoma. It is postulated that the hippocampus gained secondary epileptogenicity.

Adult↗

PubMed2002

[A case of intractable epilepsy: diagnosis of tuberous sclerosis based on histopathological findings and immunohistochemical expression of hamartin and tuberin].

We report here a 14-year-old boy suffering from intractable epilepsy since the age of 2. Neuroimaging showed a lesion in the left temporal lobe. He underwent resection of the left temporal lobe and multiple subpial transection of the left frontal lobe at the age of 8. Histopathological findings of surgical specimens were similar to those of tubers of tuberous sclerosis (TSC), although he had no other TSC stigmata. To discriminate from cortical dysplasia grade III, we examined the immunohistochemical expression of hamartin and tuberin, the TSC1 and TSC2 gene products. Based on results, we diagnosed this case as having TSC. He has been seizure free since the operation. Although lower than preoperatively, his intelligence quotient has not been declining progressively.

Adolescent↗

PubMed2002

Memory deficits after resection from left or right anterior temporal lobe in humans: a meta-analytic review.

PURPOSE: Memory deficits in epileptic patients have been found in some, but not all studies assessing the effects of side of seizures and resection from a temporal lobe on cognitive performance. The purpose of this study was to provide a quantitative review of previous studies on this issue. METHODS: Based on conventional meta-analytic procedures, we identified 33 studies that assessed verbal and nonverbal memory performance before and after anterior temporal lobectomy. The Logical Memory and Visual Reproduction subtests from the Wechsler Memory Scale were used. These studies were then subjected to two levels of analyses: (a) vote-counting procedure, and (b) effect-size calculations and comparisons. RESULTS: Overall, the data confirmed previous findings that verbal memory tasks are sensitive to left hemisphere dysfunction. The efficacy of a "nonverbal" task for tapping function in the nondominant (right) hemisphere was not confirmed, although a trend supporting this speculation was observed. With regard to the comparison of changes in verbal and nonverbal memory before and after resection from a temporal lobe, a clear trend was observed for decline in verbal memory function after resection from the left, especially significant for immediate verbal recall. A trend for contralateral improvement on nonverbal memory also was observed. The pattern of memory change after resection from the right temporal lobe was less clear. CONCLUSIONS: The findings of this study suggest that side of epileptic seizure and surgical resection from a temporal lobe affect verbal memory functions. The relations between the laterality of epileptic seizure, surgical resection from the temporal lobe, and nonverbal memory are to be verified by further research.

Humans↗

PubMed2005

Evaluative conditioning is intact after unilateral resection of the anterior temporal lobe in humans.

Several lesion and functional imaging studies conducted in animals and humans suggest that structures within the amygdaloid nuclear complex (ANC) are important for the occurrence of fear conditioning. Whether this brain structure is also critical for evaluative conditioning, has been investigated less frequently. In the current experiment, a group of participants with unilateral resection of the anterior temporal lobe and a control group received a differential evaluative flavor-taste conditioning task. In the pre-acquisition phase, two fruit flavors (the conditioned stimuli (CSs)) were presented and participants were instructed to evaluate both. In the subsequent acquisition phase, one of these fruit flavors (CS+) was presented together with a bad tasting substance Tween20 (polysorbate 20, the US), while the other flavor (CS-) was never paired with Tween20. Finally, in the post-acquisition phase, the two flavors were presented again without Tween20 and participants were asked to evaluate both of them for a last time. The control group as well as the lesion group rated the CS+ in the post-acquisition phase less favorable than in the pre-acquisition phase, while the ratings of the CS- remained the same in both phases. We clearly demonstrated evaluative conditioning in both test groups. Because the lesion group had still one intact ANC it would be premature, however, to conclude that the ANC is not involved in evaluative conditioning. We conclude that despite evidence for impaired fear conditioning, unilateral damage to the ANC does not impair evaluative conditioning.

Adult↗

PubMed1980

Temporal double inversion method in reshaping the temporal bulging in a case of Apert's syndrome.

A case is reported of Apert's syndrome with severe bilateral balloonings of the temporal region in addition to other typical craniofacial deformities. He had had three previous strip craniectomies. His mentality and intelligence were normal. In order to improve his deformities, the following steps were carried out: 1. 1.5 cm frontal advancement with reshaping the horizontal arc of the supraorbital ridge by out-fracturing. 2. Bilateral temporal double turnover method with internal decompression of the temporal lobe by resection of the sphenoid wing abnormally roofing the temporal lobe. 3. Reduction of the height of the cranial vault. The result was gratifying.

Acrocephalosyndactylia↗

PubMed1996

["Tailoring" resections in drug refractory temporal lobe epilepsy].

On the basis of results obtained from extensive pre- and intraoperative diagnostic investigations of 69 patients, minimalisation of epileptogenic brain tissue resection was strived for. The extent of resection ranged from selective amygdalohippocampectomy up to "en bloc" standard resections, and in rare cases even beyond these. In the majority of cases however, tailoring allowed smaller resections than the standard "en bloc" resections. The outcome of tailoring in regard to seizure control as well as verbal memory and visual performance show that this method should be favoured in epilepsy surgery of temporal lobe epilepsies.

Adolescent↗

PubMed2003

GABA(B1a), GABA(B1b) AND GABA(B2) mRNA variants expression in hippocampus resected from patients with temporal lobe epilepsy.

The aim of this study was to investigate the mRNA expression of the two GABA(B1) receptor isoforms and the GABA(B2) subunit, in human postmortem control hippocampal sections and in sections resected from epilepsy patients using quantitative in situ hybridisation autoradiography. Utilising human control hippocampal sections it was shown that the oligonucleotides employed were specific to the receptor. Hippocampal slices from surgical specimens obtained from patients with hippocampal sclerosis and temporal lobe epilepsy were compared with neurologically normal postmortem control subjects for neuropathology and GABA(B) mRNA expression. Neuronal loss was observed in most of the hippocampal subregions, but in the subiculum no significant difference was detected. The localisation of GABA(B1a) and GABA(B1b) isoform mRNAs in human control hippocampal sections supported and extended earlier studies using the GABA(B1) pan probe, which does not distinguish between the two GABA(B1) isoforms. Moreover, the GABA(B2) mRNA location confirmed the heterodimerisation of the receptor. Thus, although there was an apparent correlation between GABA(B1b) and GABA(B2), GABA(B1a) exhibited no such relationship. GABA(B1b) and GABA(B2) showed a similar intensity of expression whilst GABA(B1a) displayed a lower hybridisation signal. Comparison of the expression of the three mRNAs between control and epileptic subjects showed significant decreases or increases in different hippocampal subregions.GABA(B) isoforms and subunit mRNA expression per remaining neuron was significantly increased in the hilus and dentate gyrus. These results demonstrate that altered GABA(B) receptor mRNA expression occurs in human TLE; possibly the observed changes may also serve to counteract ongoing hyperexcitability.

Adult↗

PubMed1996

Performance of healthy subjects and patients with resection from the anterior temporal lobe on matched tests of verbal and visuoperceptual learning.

We examined the equivalence of three matched forms of the Rey Auditory Verbal Learning Test (RAVLT) and three parallel forms of a new nonverbal analog, the Aggie Figures Learning Test (AFLT). One hundred and fourteen healthy subjects, primarily college students, were administered corresponding forms of the two tasks. For both tasks the three forms proved to be well-matched; as well, overall performance on the RAVLT was comparable to that on the AFLT. The two tasks were also administered to 23 patients with anterior resection from the left or right temporal lobe (ATL). Findings showed that right ATL patients were significantly impaired on the learning trials of the AFLT as compared to their learning on the RAVLT; they showed little forgetting of figures or words over a 20-min delay interval. By contrast, left ATL patients showed severe forgetting of words as compared to figures, but their learning curve for the RAVLT did not differ from that on the AFLT.

Adolescent↗

PubMed2002

Epilepsy surgery within the temporal lobe and its short-term and long-term effects on memory.

In patients with pharmacologically intractable, complex-partial seizures, surgical excision of the involved temporal lobe may have significant therapeutic benefit. Resection of mesial structures of the temporal lobes, however, entails a significant risk of decreased memory function. Recent advances in the assessment of memory changes following temporal lobectomy surgery emphasize the complexity of subjective ratings of memory functioning in this population. Neuroimaging tools useful in the diagnostic evaluation of epilepsy surgical candidates have now been shown to be useful in predicting memory change in the post-surgical period. Functional magnetic resonance imaging appears to provide significant information regarding hemispheric representation of language in the temporal lobe epilepsy patient, and the use of this technique to predict memory status following surgery appears promising. Clinical studies involving patients who had temporal lobectomy surgeries have also revealed changes in emotional learning related to the degree of amygdala involvement. Moreover, there is increasing evidence to suggest that differential changes in emotional learning occur among patients with right versus left temporal lobe resections.

Amobarbital↗

PubMed2001

Lobar and multilobar resections for medically intractable pediatric epilepsy.

Pediatric epilepsy surgery patients are different than adult epilepsy surgery patients by having a higher proportion of extratemporal than temporal lobe lesions, and by having cortical dysplasia as the most frequent pathology. We analyzed 111 pediatric epilepsy patients who received lobar or multilobar resections at the University of California, Los Angeles, between the years 1986 and 2000 to determine if there were differences in seizure outcome by lobe of resection and tissue pathology. Results showed that temporal lobe resection patients had lower pre- and postoperative seizure frequencies compared with extratemporal single lobe resection patients (p < 0.05). Furthermore, single lobe resection patients from any brain region had lower pre- and postoperative seizure frequencies compared with multilobar resection patients (p < 0.05), an effect which was due to the better seizure outcomes in temporal lobe resection cases. Patients with mass lesions had the best postoperative seizure control, followed by cortical dysplasia patients and other pathologies (p < 0.05). In all patient groups, there was a significant reduction in pre- to postoperative seizure frequencies (p < 0.0001). These results indicate that postsurgery seizure outcomes in pediatric epilepsy surgery patients vary by lesion location and pathology, with the best outcomes in temporal lobe patients with mass lesions. However, surgical resections of epileptogenic lesions, regardless of lobe, were associated with significant postoperative improvements in seizure frequency.

Adolescent↗

PubMed2005

[Clinical feature of hippocampal lesion: report of 21 cases].

OBJECTIVE: To explore the clinical features of hippocampal lesions. METHODS: the clinical data of 21 patients with hippocampal lesions, 15 males and 6 females, aged 19 (8-42), with a duration of mesial temporal lobe epilepsy (MTLE), underwent resection of the anterior temporal lobe, amygdaloid nucleus, and hippocampus. The resected hippocampal tissues were examined pathologically. Before the operation 24-hour EEG and MRI scan were performed. The patients were followed up for 1-2 years. RESULTS: The clinical manifestations included complex partial seizure (11 cases), absence seizure (5 cases), tonic-clonic seizure (4 cases), and simple partial seizure (1 case). EEG showed spike waves in 18 patients. MRI scan showed full hippocampus and long T2 signal in 10 cases, enlarged temporal horn, hyperintense signal in T2, and decreased volume of hippocampus in 8 cases, long T1 and T2 signals and obvious space-occupying lesion in hippocampus in one case, and normal images in 2 cases. Pathological examination revealed sclerosis of hippocampus in 11 cases, astrocytoma in 6 cases, paraganglioma in 1 case, embryonic tumor of neuroepithelial tissue in 1 case, atypical hyperplasia in 1 case, and radiation necrosis in 1 case. Sixteen of the eighteen followed-up patients remained seizure-free. Statistical analysis demonstrated significant difference in MRI between hippocampal tumor and hippocampal sclerosis. CONCLUSION: MTLE patients with T2 signal and hippocampus larger than that of the contralateral side should be considered as with hippocampal tumor and as indication of operation.

Adolescent↗

PubMed2001

Surgical treatment of medically refractory epilepsy in childhood.

Twenty-five percent of children with epilepsy continue to seize despite the best medical management and may be defined as medically refractory. Many children with medically refractory localization-related epilepsy, i.e. seizures which originate in a particular area of the brain and secondarily spread to involve other brain regions, may benefit from a variety of surgical treatments including hemispherectomy, corpus callosotomy, focal cortical resection of the temporal lobe, focal cortical resection of extratemporal regions of the brain, and multiple subpial resections. A successful outcome from epilepsy surgery is generally defined as a seizure-free state with no imposition of neurologic deficit. In order to achieve these twin goals two criteria must be fulfilled. First, precise localization of the epileptogenic zone in the brain is necessary. The epileptogenic zone may be defined as the region of epileptogenic cerebral cortex whose removal will result in a seizure-free state. Second, one must determine the anatomic localization of eloquent cortex in the brain in order to spare these areas during any planned cortical excision of epileptogenic cortex. Several diagnostic measures may be used to achieve a successful surgical outcome. A clinical history to ascertain the earliest symptom in the clinical progression of the seizure (semiology) is imperative as is ictal and interictal scalp EEG, neuropsychological testing, magnetic resonance imaging, positron emission tomography, single photon emission computerized tomography, and interictal magnetoencephalography. In the typical child undergoing evaluation for epilepsy surgery, if the clinical, neuropsychological, EEG, and radiological data are all concordant and point to the same area of epileptogenicity in the brain, cortical excision of the suspected epileptogenic zone is undertaken. However, if the data are discordant, and/or the epileptogenic zone resides wholly or in part within eloquent cortex, invasive intracranial monitoring from depth and/or subdural electrodes during a seizure is required to map out the areas of epileptogenicity in the brain. The assessment of potential risks and benefits for this type of epilepsy surgery in children involves complex age-related issues, including the possible impact of uncontrolled seizures, medication, or surgery on learning and development.

Child↗

PubMed1984

Access to the posterior medial temporal lobe structures in the surgical treatment of temporal lobe epilepsy.

The authors describe a surgical technique that allows access to the posterior temporal horn of the lateral ventricle with preservation of the most functional lateral temporal cortex. Development of the technique was stimulated by the need to resect posteromedial temporal lobe structures in patients with intractable complex partial epilepsy and well-identified unilateral posterior hippocampal foci. This technique has also been of value in the resection of some lateral ventricular and posteromedial temporal lobe masses. The operation consists of three steps. No more than 4.5 cm of the anterolateral temporal lobe is removed en bloc such that the most anterior aspect of the temporal horn is entered. An incision is carried from the floor of the temporal horn through the inferior longitudinal fasciculus to the middle fossa dura mater and posteriorally into the lateral ventricular atrium. The lateral temporal cortex and white matter are then elevated with a self-retaining retractor. This exposes the posteromedial temporal horn or intraaxial mass for excision or allows en bloc resection of the entire hippocampus and medial temporal lobe structures while preserving the functional association areas of the lateral temporal cortex, including speech and visual spatial function.

Epilepsy, Temporal Lobe↗

PubMed2001

[Surgical treatment of medically refractory epilepsy in childhood].

Twenty five percent of children with epilepsy continue to seize despite best medical management and may be defined as medically refractory. Many children with medically refractory localization-related epilepsy, i.e. seizures which originate in a particular area of brain and secondarily spread to involve other brain regions, may benefit from a variety of surgical treatments including hemispherectomy, corpus callosotomy, focal cortical resection of the temporal lobe, focal cortical resection of extratemporal regions of brain, and multiple subpial resections. A successful outcome from epilepsy surgery is generally defined as a seizure-free state with no imposition of neurologic deficit. In order to achieve these twin goals two criteria must be fulfilled. First, precise localization of the epileptogenic zone in the brain is necessary. The epileptogenic zone may be defined as the region of epileptogenic cerebral cortex whose removal will result in a seizure-free state. Second, one must determine the anatomic localization of eloquent cortex in brain in order to spare these areas during any planned cortical excision of epileptogenic cortex. Several diagnostic measures may be used to achieve a successful surgical outcome. A clinical history to ascertain the earliest symptom in the clinical progression of the seizure (semiology) is imperative as is ictal and interictal scalp EEG, neuropsychological testing, magnetic resonance imaging (MRI), positron emission tomography (PET), single photon emission computerized tomography (SPECT), interictal magnetoencephalography (MEG). In the typical child undergoing evaluation for epilepsy surgery, if the clinical, neuropsychological, EEG, and radiological data are all concordant and point to the same area of epileptogenicity in brain, cortical excision of the suspected epileptogenic zone is undertaken. However, if the data are discordant, and/or the epileptogenic zone resides wholly or in part within eloquent cortex, invasive intracranial monitoring from depth and/or subdural electrodes during a seizure is required to map out the areas of epileptogenicity in brain. The assessment of potential risks and benefits for this type of epilepsy surgery in children involve complex age-related issues, including the possible impact of uncontrolled seizures, medication, or surgery, on learning and development.

Brain↗

PubMed2003

Differential features of metabolic abnormalities between medial and lateral temporal lobe epilepsy: quantitative analysis of (18)F-FDG PET using SPM.

UNLABELLED: Because limited resection could yield an equally good surgical outcome as standard anterior resection in temporal lobe epilepsy (TLE), the differentiation of medial from lateral TLE is important. We tried to find the differential features in metabolic abnormalities between medial and lateral TLE groups using quantitative analysis including statistical parametric mapping (SPM). METHODS: We examined 113 (18)F-FDG PET scans of TLE patients who had surgically and pathologically proven lesions and a good surgical outcome (78 medial TLE, 35 lateral TLE). Each scan was compared with those of 22 healthy control subjects to detect hypometabolic regions using a t test of the SPM method and interhemispheric asymmetry using 2-group, 2-condition analysis on SPM. Group analysis was performed between medial and lateral TLE using mirrored PET images. The sensitivity was defined as the detection rate of hypometabolism in the ipsilateral temporal lobes, and the specificity was defined as the nondetection rate in the contralateral lobes. The extent of the hypometabolism was calculated as the number of significant voxels, and the severity was calculated by the asymmetry index (ASI), in the medial or lateral temporal lobes on Statistical Probabilistic Anatomical Map template images. RESULTS: The hypometabolism in the temporal lobes was detected ipsilateral to the seizure focus in 76% of the TLE patients (76% in medial TLE, 77% in lateral TLE) but on the contralateral temporal lobes in 32% of the patients. After considering interhemispheric temporal asymmetry, the sensitivity was found to be 89%, and the specificity was 91% without differences between the medial and lateral TLE groups. In both medial and the lateral TLE, the hypometabolism was more prominent in the lateral cortical structures than in the medial structures. The hypometabolism in the medial temporal structures was found less frequently in the lateral TLE group, and the extent of the hypometabolism was significantly larger in the medial TLE group. ASIs of the medial temporal structure and superior temporal gyrus of lateral temporal structure were significantly higher in the medial TLE. CONCLUSION: SPM analysis of (18)F-FDG PET in TLE patients could localize accurately the seizure focus and helped in the discrimination of the medial TLE from the lateral TLE. We suggest the lateral TLE, rather than the medial TLE, should be considered when glucose metabolism is relatively preserved in the medial temporal structures.

Adult↗

PubMed1991

Bilateral pathological damage in temporal lobe epilepsy.

Patients with drug-refractory temporal lobe epilepsy can be treated successfully with surgical resection of one temporal lobe, especially when the resection includes the hippocampus. Although intrahippocampal recordings usually localize seizure onsets to one hippocampus, there are bilaterally-independent interictal spikes, occasional contralateral seizure onsets and post-resection seizures that implicate contralateral damage and epileptogenicity. Post-mortem non-quantified studies of both hippocampi in epileptics have revealed incidences of bilateral hippocampal sclerosis, mostly being asymmetric. The present paper reports on two post-mortem cases of bilateral, asymmetric cell loss in patients with physiologically-verified hippocampal epilepsy. In one patient the damage was severe bilaterally, but only slightly greater damage in one hippocampus. In the second patient, damage in one hippocampus was as severe as in the first patient; however the contralateral hippocampus appeared undamaged. However, cell counts revealed losses of over 30% in three different hippocampal subregions, indicating a mild form of asymmetric bilateral damage in patient two.

Adult↗

PubMed2002

Studies of GABA(B) receptors labelled with [(3)H]-CGP62349 in hippocampus resected from patients with temporal lobe epilepsy.

1 The aim of this study was to investigate the binding of a novel GABA(B) receptor radioligand, [(3)H]-CGP62349, to human post-mortem control and epileptic hippocampal sections using quantitative receptor autoradiography. Utilizing human control hippocampal sections it was shown that [(3)H]-CGP62349 bound with high affinity (K(D) 0.5 nM) to this tissue. 2 Hippocampal slices from surgical specimens obtained from patients with hippocampal sclerosis (HS) and temporal lobe epilepsy (TLE) were compared with neurologically normal post-mortem control subjects for neuropathology and GABA(B) receptor density and affinity. Neuronal loss was observed in most of the hippocampal subregions, but in the subiculum no significant difference was detected. 3 The localization of GABA(B) receptors with the antagonist [(3)H]-CGP62349 in human control hippocampal sections supported and extended earlier studies using the agonist ligand [(3)H]-GABA. 4 The kinetics of binding to the GABA(B) receptor in human hippocampus using this novel compound was comparable to previous data obtained in rat hippocampal membranes. 5 GABA(B) receptor density (B(max)) was significantly reduced in CA3, hilus, and dentate gyrus (DG); the affinity was increased exclusively in DG. The trend is identical in all the hippocampal subregions with the agonist and the antagonist, although significant differences with the antagonist where recorded in CA3 and hilus, whereas with the agonist a significant reduction was reported in all of the hippocampal subfields. 6 GABA(B) receptor expression per remaining neuron appeared significantly increased in CA3 and hilus. These results suggest altered GABA(B) receptor function may occur in human TLE, possibly as a result of synaptic reorganization, and may contribute to epileptogenesis.

Adult↗

PubMed1993

Control of temporal lobe epilepsy following en bloc resection of low-grade tumors.

Thirty-one patients with a mean age of 18.9 years (range 3 to 53 years) who underwent temporal lobe surgery for tumor-related epilepsy over a 14-year period are presented. All had suffered chronic drug-resistant temporal lobe seizures (mean age at onset 6.9 years, range 0 to 30 years; mean duration of condition 11.9 years, range 3 to 39 years). Preoperative interictal scalp electroencephalography tracings indicated unilateral localized epileptic foci in 90% of patients, and computerized tomography scans showed abnormalities within the temporal lobe in 87%. All patients underwent en bloc temporal lobectomy. No patient received adjuvant radiotherapy or chemotherapy. Review of the histological material showed dysembryoplastic neuroepithelial tumor in 27 (87%) of the specimens and microscopic evidence of incomplete removal of tumor in 22 (71%). At long-term follow-up evaluation (mean duration 5.8 years, range 1 to 14 years), 81% of patients were completely free of seizures (Engel grade I) and 10% were almost seizure free (Engel grade II) with no deaths reported in either early or late follow-up review. Only one patient in the series failed to benefit from the surgery. Four patients suffered permanent neurological deficit causing a mild disability. Psychological assessment showed no significant fall in verbal or performance intelligent quotient for the group, but a mild memory impairment was evident in 32%. Behavioral and social aspects improved in nearly all (94%) cases. Relief of seizures could not be predicted by intraoperative electrocorticography, and outcome was independent of the completeness of tumor resection. Postoperative electroencephalographic findings identified epileptiform potentials in 65% of patients, which were associated with a worse seizure-control outcome grade.

Adolescent↗