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Results for “Temporal Lobe Resection”

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PubMed1996

Postsurgical outcome of patients with uncontrolled complex partial seizures and temporal lobe hypometabolism on 18FDG-positron emission tomography.

RATIONAL AND OBJECTIVE: The purpose of this study is to evaluate the relation between a focus of temporal lobe hypometabolism, including comparison between mesial and lateral asymmetry on fluorine-18-labeled-deoxyglucose-positron emission tomography (18FDG-PET) and surgical outcome in patients with uncontrolled partial seizures. METHODS: Case histories, electroencephalogram (EEG) findings, radiographic findings, and surgical outcome (36 +/- 11 months of follow-up) were reviewed in 38 consecutive patients who had a interictal 18FDG-PET scan and subsequent temporal resection. RESULTS: Among the 36 patients who had a temporal lobe focus of hypometabolism (more than 15% asymmetry to contralateral side), 61% (22 of 36) became seizure-free, 33% (12 of 36) markedly improved and 6% (2 of 36) did not improve. The focus of hypometabolism on PET was in agreement with the epileptic focus on the noninvasive EEG in 30 of 36 patients and in 19 of the 22 patients who underwent an invasive EEG. The asymmetry index for the mesial temporal lobe was significantly higher in the group of patients who became seizure-free compared with the other patients. CONCLUSION: This study confirms that a focus of interictal temporal hypometabolism on PET is associated with marked improvement of seizure control after surgery in 94% (34 of 36) of the patients. Hypometabolism in the mesial temporal lobe appears to be associated with a seizure-free outcome.

Adolescent↗

PubMed1994

Cortical localization of temporal lobe language sites in patients with gliomas.

In a series of 40 patients undergoing an awake craniotomy for the removal of a glioma of the dominant hemisphere temporal lobe, cortical stimulation mapping was used to localize essential language sites. These sites were localized to distinct temporal lobe sectors and compared with 83 patients without tumors who had undergone language mapping for the treatment of intractable epilepsy. In patients with and without temporal lobe gliomas, the superior temporal gyrus contained significantly more language sites than the middle temporal gyrus. Both patient populations also had language sites anterior to the central sulcus in the superior temporal gyrus (12-16%). The patients without tumors had significantly more language sites in the superior temporal gyrus, compared with the superior temporal gyrus of patients with temporal lobe tumors. Multiple variables were studied for their effect on preoperative and postoperative language deficits and included age, sex, number of language sites, histology, size of the tumor, and the distance of tumor resection margins from the nearest language site. The distance of the resection margin from the nearest language site was the most important variable in determining the improvement in preoperative language deficits, the duration of postoperative language deficits, and whether the postoperative language deficits were permanent. If the distance of the resection margin from the nearest language site was > 1 cm, significantly fewer permanent language deficits occurred. Cortical stimulation mapping for the identification of essential language sites in patients with gliomas of the dominant hemisphere temporal lobe will maximize the extent of tumor resection and minimize permanent language deficits.

Adolescent↗

PubMed2003

Postoperative magnetic resonance imaging findings after transtemporal and translabyrinthine vestibular schwannoma resection.

OBJECTIVES/HYPOTHESIS: Magnetic resonance imaging (MRI) has become the investigation of choice to follow up patients after vestibular schwannoma resection. STUDY DESIGN: Retrospective. METHODS: Postoperative MRI findings of 70 patients after vestibular schwannoma resection through a transtemporal (n = 48) and a translabyrinthine (n = 22) approach were reviewed. Time-dependent changes in intensity, size, and shape of enhancement in the internal auditory canal before and after contrast administration, postoperative temporal lobe gliosis, and changes of fat grafts were evaluated. RESULTS: After vestibular schwannoma resection, all patients showed signal enhancements in the internal auditory canal ranging from a faint to high signal intensity in the first postoperative MRI, 3 to 6 months after surgery. In the next MRI at 12 to 24 months after surgery, 30 patients (43%) showed a decreased signal, 35 patients (50%) a stable enhancement, and 5 patients (7%) an increased enhancement in the internal auditory canal depicted as an intense nodular or mass-like pattern. In patients with decreased or stable enhancement, a residual tumor could be excluded in the following MRI scans, whereas in all patients with increased enhancements after 12 to 24 months, signal enhancement further increased and residual tumors were detected. Different degrees of temporal lobe gliosis were found in 15 of 48 cases (31%) after transtemporal tumor removal. Enhancement of fat grafts used in 22 cases decreased to different degrees in 14 cases (64%). CONCLUSIONS: Differentiation of residual tumor from scar tissue in the internal auditory canal after vestibular schwannoma resection requires close, long-term follow-up. Nodular and progressive enhancements in the internal auditory canal indicate residual tumor. Linear enhancement in the internal auditory canal has been found to be a common finding after vestibular schwannoma resection not associated with residual tumor.

Adipose Tissue↗

PubMed1993

Okadaic acid induces hyperphosphorylated forms of tau protein in human brain slices.

Hyperphosphorylated forms of the microtubule-associated protein tau are components of the paired helical filaments (PHFs) seen in patients with Alzheimer's disease. Slices of human lateral temporal cortex were obtained from tissues removed incidental to resections for intractable hippocampal epilepsy. Tau phosphorylation in temporal lobe slices was determined using mobility shifts after sodium dodecyl sulfate-polyacrylamide gel electrophoresis and immunodetection with the monoclonal antibodies Alz-50, 5E2, and Tau-1. The results indicate that tau phosphorylation was altered in a dose-dependent manner by the phosphatase inhibitor okadaic acid, but not by N-methyl-D-aspartate, quisqualate, or kainate. The slowest mobility forms of tau, termed "PHF-like tau," produced by okadaic acid treatment were dephosphorylated by purified protein phosphatase 2B (calcineurin). Formation of PHF-like tau peptides was blocked by KN-62, 1[N,O-bis(1,5-isoquinolinesulfonyl)-N-methyl-L-tyrosyl]-4-phenylpiperazi ne, an inhibitor of Ca2+/calmodulin-dependent protein kinase II. The protein kinase inhibitor staurosporine also prevented formation of PHF-like tau. These data suggest that phosphorylation of tau is regulated by Ca(2+)-dependent protein kinases and okadaic acid-sensitive protein phosphatases, alterations of which may be implicated in the pathogenesis of Alzheimer's disease.

Adult↗

PubMed1992

A longitudinal assessment of seizure outcome and overall benefit from 100 cortectomies for epilepsy.

Results of 100 cortical resections for 76 temporal, 23 frontal and one parietal lobe epilepsies were studied in terms of seizure relief and overall benefit. A non-homogenous Markov chain model was used to take into account both the intravariability of post-surgical outcome and the differences in duration of follow-up in a group of patients consecutively operated. The seizure free (SF) state was defined as no seizure in the previous five months at first follow up visit and none in the preceding 12 months at subsequent annual visits. For the whole of the population the SF probability was 82%, 66%, 61%, and 62% at six months, one year, two and five years respectively. A better outcome was found for temporal lobe epilepsy (SF probability: 68% at the fifth postoperative year) than for frontal lobe epilepsy (SF probability: 42% at the fifth postoperative year) with a statistically significant difference. Pre- and postoperative interictal signs and symptoms were classified according to their clinical significance: (a) mild handicap--symptoms recognisable but no interference with usual life, and (b) moderate or severe handicap--interference with some or all daily activities. The interictal state was considered more impaired after surgery than before in two situations: (a) either symptoms, absent before surgery, appeared in the postoperative period involving a moderate or severe handicap, or (b) symptoms present before surgery and answerable for a mild or moderate handicap that increased to involve a moderate or severe handicap respectively in the postoperative period. Surgery was considered a major benefit when two conditions were fulfilled-namely, a SF state and no deterioration of the interictal stage when compared with the preoperative period. The probability of obtaining such a benefit was 58%, 51%, 48% and 56% at six months, one year, two and five years respectively. The results suggest that surgery is an effective treatment for more than 50% of long lasting medically intractable epilepsies.

Adolescent↗

PubMed2003

[A dura-based intracranial schwannoma in the temporal fossa: a case report].

We report a rare case of a dura-based intracranial schwannoma in the temporal fossa. A 77-year-old man admitted to our hospital with a 5 months history of mild recent memory disturbance. Magnetic resonance imaging (MRI) revealed a slight enhanced solid mass with a cystic mass in the right temporal lobe. Preoperative diagnosis was glioma and then total resection was performed by the transsylvian approach. Dense adhesion of the tumor to dura matter of the middle cranial fossa was confirmed during surgery. Microscopic examination of the tumor showed biphasic pattern with cellular Antoni A and hypocellular Antoni B areas. Immunohistochemically, the tumor was positive for S-100, vimentin and Schwann/2E and was negative for GFAP. From these findings, the tumor was diagnosed as a schwannoma arising from the dura matter of the middle fossa. The patient was discharged from our hospital with no neurological deficits. Intracranial schwannomas, which are not associated with cranial nerves, are rare. Our case was classified according to the origin into dura-based intracranial schwannoma. To our knowledge, only 14 cases of dura-based intracranial schwannoma have been reported, mostly in children and young adults. This represents the oldest case in the literature of dura-based intracranial schwannoma.

Aged↗

PubMed1990

[Extradural intracavernous epidermoid cyst. Apropos of 2 cases].

The authors report two cases of intracranial, extradural, intracavernous epidermoid cyst. In one case the cyst was ruptured into the subarachnoid space and in the substance of the temporal lobe. The two cysts had to be subtotally resected because of dense adherences with the internal carotid artery. In both cases the post-operative periods were uneventful.

Adult↗

PubMed2005

Complex behavioral automatism arising from insular cortex.

We describe two cases of complex partial seizures with ictal violent movements arising from the insular cortex. The first patient, a 14-year-old girl, presented with hyperkinetic behavior such as rolling, thrashing, and pedaling, and the second case, a 38-year-old woman, had been suffering from frequent daytime hyperkinetic seizures characterized by bizarre vocalization, jumping, and violent bimanual movements. Both patients showed a slight high signal change in the right posterior ventral insular cortex in fluid-attenuated inversion recovery (FLAIR) studies involving magnetic resonance imaging, and extensive subdural electroencephalographic monitoring revealed EEG seizure onset from the temporal lobe. The posterior ventral insular and lateral temporal cortices were resected, resulting in complete seizure freedom in both cases. The histological diagnoses were focal cortical dysplasia in the first case and gliosis in the second case. There may exist a group of patients with complex partial seizures with ictal violent automatism that can be ameliorated by the resection of epileptogenic lesions in the insular cortex. Careful inspection of the insular cortex is necessary to diagnose this type of epileptic seizure.

Adolescent↗

PubMed1991

Predictive value of intraoperative electrocorticograms in resective epilepsy surgery.

The preresection and postresection intraoperative electrocorticograms of 76 consecutive patients undergoing resective surgery for intractable epilepsy were analyzed to see if location, configuration, and discharge rate of epileptiform activity correlated with type and location of pathology of the resected specimens and outcome in regard to seizure control. The location of the predominant spike focus did not correlate with either type of location of pathology or with seizure outcome from temporal lobe surgery (n = 58). The presence of spontaneous or activated spikes outside the resected area did not correlate with outcome from any surgery type. Positive spikes recorded from the amygdala and anterior hippocampus (n = 37) were not associated with type or location of pathology, but bursts of fast repetitive spikes on these needle recordings tended to associate with mesiotemporal pathology (p = less than 0.02) and with mesial temporal sclerosis (p = less than 0.04). A preresection spike discharge rate of 1 per 4 minutes or less was associated with a poor outcome in 5 of 6 patients (p = 0.03), whereas a rate of 18 or more per minute was associated with a good outcome in 15 of 18 patients (p less than 0.06). Persistence of 50% or more of the preresection epileptiform activity in the postresection electrocorticogram after temporal lobectomy correlated with poor outcome in 80% (p = less than 0.03), although the absolute amount of epileptiform activity remaining in the postresection electrocorticogram did not correlate with outcome. Further studies are needed to define the role of intraoperative electrocorticograms in resective epilepsy surgery.

Action Potentials↗

PubMed1990

Temporal lobe ganglioglioma in refractory epilepsy: CT and MR in three cases.

Three patients (ages 5, 16 and 21 years) with chronic, refractory, partial epilepsy and temporal lobe ganglioglioma were evaluated for surgical treatment. Noncontrast CT revealed a low attenuation, cystic temporal lesion in 2 patients. One neoplasm demonstrated focal calcification and temporal altrophy, while the other had mass effect and surrounding edema. Contrast enhancement of the mass was seen in one instance. Non-contrast and post-contrast CT were completely normal in the remaining patient. MR was abnormal in both patients in which it was performed (including the patient with a normal CT examination). Lesions were hyperintense on T2W inmages and iso-to-hypointense on T1W images when compared to normal parenchyma. Regions of calcification were missed on standard spin-echo sequences. Continuous video EEG monitoring captured habitual partial seizures in all patients; focal onset correlated with tumor location in each instance. Intraoperative electrocorticography corroborated the EEG results. Two of three patients underwent gross total resection. Pathologic features were characteristic of ganglioglioma in all instances. All patients have been seizure-free postoperatively [mean follow-up: 16 months (range 13-18 months)] and without evidence of tumor recurrence. Although ganglioglioma is an unusual cause of refractory temporal lobe epilepsy, our short term follow-up suggests excellent outcome with both partial and gross total resection.

Adolescent↗

PubMed2000

The surgical treatment of intractable epilepsy.

The author reviewed the various surgical approaches for intractable epilepsy and proposes that any surgical operation for the treatment of intractable epilepsy be performed actively but prudently. It is important to identify the operation indication and to use combinations of anterior callosotomy, epileptogenic focus resection and multiple subpial transection (MST), tailored to the individual patient. Selective temporal lobe removal can also provide a fairly good result in temporal lobe seizures. For epileptogenic foci in functional areas, MST was an effective approach that protected neural function and blocked epileptic discharge. For epileptogenic foci in the free-functional areas, however, epileptogenic focus resection was still the best therapy. Hemisphere removal should be chosen cautiously and only for patients with intractable epilepsy with progressive neurological deficits in the hemisphere. The author notes that using minimally invasive neurosurgery techniques to treat epilepsy and to protect neural function will become more widely recommended.

Anticonvulsants↗

PubMed1991

Complex partial seizures and small posterior temporal or extratemporal structural lesions: surgical management.

Twenty patients with small, indolent, relatively inaccessible posterior temporal or extratemporal lesions had complex partial seizures presumably related to anterior and inferomesial temporal lobe epileptic activity. All underwent anterior temporal corticectomies, and in six the resection was extended at a second operation. There was sclerosis of mesial temporal structures in seven of the surgical specimens. Two patients became seizure free for more than 2 years; three others showed more than 95% reduction in seizure frequency, and five had moderate (greater than 50%) reduction. While cessation of seizures or improved control may occur following this surgical strategy, the results are strikingly inferior to those obtained when the lesion, as well as the epileptogenic area, can be resected. Review of this group of patients suggests that the lesion should be included in the resection if at all possible.

Adolescent↗

PubMed2004

Temporal lobe epilepsy: analysis of patients with dual pathology.

OBJECTIVES: To determine the frequency and types of dual pathology in patients with temporal lobe epilepsy (TLE) and to analyze the clinical manifestations and surgical outcome. MATERIAL AND METHODS: A total of 240 patients with TLE underwent temporal resections following a comprehensive pre-surgical evaluation. Thirty-seven (15.4%) of these had hippocampal sclerosis (HS) or temporal lobe gliosis in association with another lesion (dual pathology). RESULTS: Eighteen of 37 patients with dual pathology had heterotopia of the temporal lobe, nine had cortical dysplasia, four had cavernous angiomas or arteriovenous malformations, one had a dysembryoplastic neuroepithelial tumor, one had a contusion and four patients had cerebral infarctions in childhood. 68.5% had abnormal head magnetic resonance imagings, 91.3% had abnormal positron emission tomography scans, and 96% had abnormal ictal SPECT. The intracarotid amobarbital procedure (IAP) showed impaired memory of the epileptogenic side in 72% of the patients. Twenty patients had left and 17 had right-sided en bloc temporal resections, including the lesion and mesial temporal structures. Twenty-six (70.2%) became seizure-free, eight (21.6%) had rare seizures, two (5.4%) had worthwhile seizure reduction and one (2.7%) had no improvement (range of follow-up 1-16 years, mean = 7.4 years). CONCLUSIONS: 15.4% had dual pathology. The dual pathology was almost exclusively seen in patients whose lesions were congenital, or occurred early in life, suggesting that the hippocampus is more vulnerable and more readily develops HS in early childhood. Resections, including the lateral and mesial temporal structures led to a favorable outcome with no mortality and little morbidity.

Adolescent↗

PubMed1993

[Circadian rhythm disturbance after radiotherapy for brain tumor in infantile period--clinical effect of L-thyroxine and vitamin B12].

We reported here 19-year-old man suffering from circadian sleep-wake (S-W) rhythm disturbance after total tumor resection and whole brain irradiation. This 19-year-old man was diagnosed as having astrocytoma in the right temporal lobe by CT scan and angiography at the age of 6 months. After total tumor resection and whole brain irradiation (60Co 60 Gy), he showed profound psychomotor retardation, endocrinologic dysfunction including hypothyroidism and growth hormone deficiency, and sleep-wake rhythm disturbance. At the age of 19, brain MRI revealed asymmetrical low intensity in the hypothalamic region. On endocrinological examination panhypopituitarism due to primary hypothalamic lesion was evident. His S-W rhythm was disturbed showing a dispersed type sleep, i.e., sleep periods were dispersedly distributed throughout the 24 hours. So he showed a lethargic tendency in the daytime. All-day polysomnography revealed abnormal sleep structure such as the absence of sleep spindle and hump, peripheral apnea, snoring and low oxygen saturation. After L-thyroxine supplementation his daily activity improved gradually. The decrease in short time sleep and tendency of a free-running rhythm were observed and oxygen saturation improved remarkably. Peripheral apnea and snoring disappeared. The wakening effect of L-thyroxine administration may be due to improvement of hypothyroidism symptom such as myxoedematous pharynx. In addition, it seems related to the alteration of the central S-W rhythm regulation, because free-running rhythm appeared after L-thyroxine administration. Vitamin B12 (VB12), which has been reported to be effective for sleep-wake rhythm disorders, was not effective for our patient's free-running rhythm.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1990

Resection of the epileptogenic area in critical cortex with the aid of a subdural electrode grid.

Electrode grids were implanted subdurally in 28 patients with epilepsy. In 16 of the 28 patients, an epileptogenic area was located in the speech-dominant left temporal lobe. Recordings made with the grid revealed that the epileptogenic areas in the patients varied widely in extent: the area was confined within the first 10 mm of the temporal lobe in some patients or it was scattered throughout the entire anterior to posterior 80-mm extend in others. Resection of the epileptogenic area was adjusted accordingly in each case. In 6 of 16 patients who were left-hemisphere-dominant for language, up to 55-80 mm from the tip of the temporal lobe was removed, a measure that exceeds the conventional limit of 50 mm from the tip of the dominant hemisphere. In the remaining 12 of the 28 patients, epileptogenic areas were located in a combination of several lobes. In 7 of these 12 patients, the epileptogenic area encompassed the rolandic area; it was removed without deficit in 4 patients and with expected deficit in 3. Of the latter 3 patients, 1 patient underwent hemispherectomy, and a large portion of the epileptogenic rolandic cortex in the frontal and parietal lobes was removed from the other 2. There were 2 cases of grid-related infection, which cleared with antibiotic treatment; there were no lasting complications of grid implantation in any patient. There was no mortality. Electroencephalographic recording and functional mapping using subdural electrode grids allow a tailored, maximal resection of epileptogenic tissue with minimal injury to critical cortex.

Brain Diseases↗

PubMed1999

Indications and outcome of ictal recording with intracerebral and subdural electrodes in refractory complex partial seizures.

Intracranial electrophysiologic recording has often been used to localize ictal onset zones in presurgical evaluation of refractory complex partial seizures. Specific indications for intracranial ictal monitoring have not been analyzed in detail, however. The authors designed this study to test the utility of intracranial monitoring in specific indications and considered six specific indications for intracranial monitoring. They compared prospectively determined indications and outcomes of chronic intracerebral and subdural electrophysiologic recording in 50 consecutive patients whose ictal onset zones had been inadequately localized with interictal and ictal EEG using extracranial electrodes, magnetic resonance imaging, interictal[18F]fluorodeoxyglucose positron emission tomography, and neuropsychological testing. In 47 patients ictal onset zones were localized with intracranial recordings, leading to resections in 38 patients. Each indication for intracranial monitoring selected a group in which the majority went on to have efficacious epilepsy surgery (5-year follow-up). Definitive diagnosis of bilateral independent ictal onset zones in temporal lobe epilepsy required intracranial ictal EEG. Intracranial EEG localization supported efficacious resection in most patients, despite contradictory or nonlocalizing extracranial ictal EEG and neuroimaging abnormalities. Critical analysis of these specific indications for intracranial monitoring may be useful in multicenter evaluation of these techniques.

Brain↗

PubMed1996

Undifferentiated tumor originating in the cerebral dysgenetic lesion resembling fibrous cartilage: case report.

A 33-year-old woman had an undifferentiated tumor originating in the cerebral dysgenetic lesion resembling fibrous cartilage. She had a headache, vomiting, late-onset epilepsy and left hemiparesis. The lesion was located in the right temporal lobe on computed tomographic (CT) scan. It was totally resected and only local irradiation was performed postoperatively. Normal cortical architectures were lost in the resected specimens. Straight or curved fasciculi composed of fine collagen fibers were distributed in parallel and perpendicular to the cortical surface in the mildly eosinophilic hyaline matrix. Hypertrophic astrocytes were scattered with low cellularity in these abnormal cortices. Clusters of tumor cells were observed in a few areas. The tumor cells, having oval and relatively vesicular nuclei with a few prominent nucleoli and basophilic well-circumscribed narrow cytoplasm, had proliferated diffusely with a cobblestone appearance. Immunohistochemical and electron microscopic investigations demonstrated no evidence of specific differentiation, either. There were 14.5 mitotic figures/high power field on average and most nuclei of the tumor cells were strongly positive for proliferating cell nuclear antigen (PCNA). Moreover, subarachnoid dissemination of the tumor cells were apparent in a few areas. Nevertheless the patient returned to work and no recurrence was observed for 10 years postoperatively. We concluded that neoplastic transformation occurred de novo in the dysgenetic cortex.

Adult↗

PubMed2007

A new clinico-pathological classification system for mesial temporal sclerosis.

We propose a histopathological classification system for hippocampal cell loss in patients suffering from mesial temporal lobe epilepsies (MTLE). One hundred and seventy-eight surgically resected specimens were microscopically examined with respect to neuronal cell loss in hippocampal subfields CA1-CA4 and dentate gyrus. Five distinct patterns were recognized within a consecutive cohort of anatomically well-preserved surgical specimens. The first group comprised hippocampi with neuronal cell densities not significantly different from age matched autopsy controls [no mesial temporal sclerosis (no MTS); n = 34, 19%]. A classical pattern with severe cell loss in CA1 and moderate neuronal loss in all other subfields excluding CA2 was observed in 33 cases (19%), whereas the vast majority of cases showed extensive neuronal cell loss in all hippocampal subfields (n = 94, 53%). Due to considerable similarities of neuronal cell loss patterns and clinical histories, we designated these two groups as MTS type 1a and 1b, respectively. We further distinguished two atypical variants characterized either by severe neuronal loss restricted to sector CA1 (MTS type 2; n = 10, 6%) or to the hilar region (MTS type 3, n = 7, 4%). Correlation with clinical data pointed to an early age of initial precipitating injury (IPI < 3 years) as important predictor of hippocampal pathology, i.e. MTS type 1a and 1b. In MTS type 2, IPIs were documented at a later age (mean 6 years), whereas in MTS type 3 and normal appearing hippocampus (no MTS) the first event appeared beyond the age of 13 and 16 years, respectively. In addition, postsurgical outcome was significantly worse in atypical MTS, especially MTS type 3 with only 28% of patients having seizure relief after 1-year follow-up period, compared to successful seizure control in MTS types 1a and 1b (72 and 73%). Our classification system appears suitable for stratifying the clinically heterogeneous group of MTLE patients also with respect to postsurgical outcome studies.

Adult↗