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PubMed1993

Patterns of memory dysfunction among children surviving temporal lobe tumors.

We compared the cognitive functioning of seven children with left and seven children with right temporal lobe tumors one year or more following completion of medical intervention (surgical resection + radiation therapy). No differences were found between the two groups with respect to verbal IQ, performance IQ.full scale IQ, verbal minus performance IQ, or verbal comprehension, perceptual organization, or freedom from distractability factor scores. After adjusting memory test results for variance attributable to general intelligence, three children with left and four children with right temporal tumors exhibited specific auditory-verbal memory dysfunction; five of these children had concurrent visual-verbal memory dysfunction. Children receiving radiation therapy to the tumor were at significantly greater risk for verbal memory problems. Reading and spelling achievement were significantly correlated with verbal memory performance. Inconsistent association between cerebral hemisphere of tumor and type of cognitive deficit may be related to the relatively slow progression of the tumor and regional interventions such as radiation therapy. Nevertheless, the results of the present report suggest that the majority of children diagnosed with temporal lobe tumors are at increased risk for memory dysfunction and academic failure.

Journal Article↗

PubMed2006

Relative localizing value of amygdalo-hippocampal MR biometry in temporal lobe epilepsy.

OBJECTIVES: The aims of the study were (i) to examine the localizing value of three MRI quantitative modalities (qMRI) currently used for the analysis of the hippocampus and amygdala in the context of pre-surgical screening and (ii) to propose a step-by-step protocol based on the sensitivity and performance of the different MR techniques. METHODS: Ninety-two adults with chronic mesial temporal lobe epilepsy (TLE) of which 28 underwent amygdalo-hippocampal resection, and 34 age-matched controls were included in the study. High-resolution qMRI was performed at 1.5 T, including a tilted T1-weighted 3D-dataset for volumetry and four-echoes T2 relaxometry (both for hippocampus and amygdala quantifications) and multi-voxel spectroscopy [NAA/(Cho+Cre)] (exclusively in the hippocampus). Individual qMRI data were compared with electroencephalography regarding the localization of the epileptogenic area, with the neuropathological data and with postoperative outcome. MRI pathology was defined based on 99% confidence ellipses. Ten controls were used to assess the quantitative MRI intra- and inter-observer variability for all variables. RESULTS: Volumetric measurements revealed unilateral damage in 77% of the patients, T2-relaxometry in 64% and spectroscopy in 53%. Additional measurements of the amygdalae (T2-relaxometry) allowed us to localize pathology that coexists with that of the hippocampus in 34%, and isolated unilateral amygdala damage in 8% of patients. Volumetry and T2-relaxometry (not spectroscopy) were associated with postoperative outcome, but accurate predictive models were computed based on hippocampal measures only. At least at 1-year follow-up, volumetry predicts outcome correctly in 100% of the cases, whilst T2-relaxometry classified 96.4% (27/28) of these patients. All operated patients had hippocampal sclerosis. CONCLUSIONS: Hippocampal structural damage is equivocally depicted by spectroscopy. For diagnostic and pre-operative evaluation, hippocampal volumetry and T2-relaxometry provide maximal accuracy. Amygdala quantifications are irrelevant in the pre-operative evaluation but may be useful for diagnostic purposes. Of the three qMRI modalities tested, T2-relaxometry provided the best balance between diagnosis accuracy and time-efficiency to lateralize a sclerotic lesion on the majority of the patients. Cases that remain undecided after T2-relaxometry may benefit from additional measurements based on hippocampal volumetry.

Adolescent↗

PubMed2001

Paramedian supracerebellar transtentorial approach for a medial tentorial meningioma with supratentorial extension: technical case report.

OBJECTIVE AND IMPORTANCE: The choice of surgical approach to treat medial tentorial meningiomas is crucial and sometimes difficult to make. Although the subtemporal approach is most commonly used for lesions that extend mostly supratentorially, it risks injury to the vein of Labbé or the veins coursing along the subtemporal surface. To avoid venous injury, a medial tentorial meningioma was removed transtentorially through the infratentorial space via the paramedian supracerebellar transtentorial (PSCTT) approach. CLINICAL PRESENTATION: A 35-year-old right-handed woman presented with a generalized convulsion. Magnetic resonance imaging scans revealed a left medial tentorial meningioma with supratentorial extension at the dominant hemisphere. The main venous drainage route from the ipsilateral temporal lobe was a sphenopetrosal vein. INTERVENTION: An operation was performed with the patient in a sitting position, and the tumor was resected totally via the paramedian supracerebellar transtentorial approach without perioperative complications. CONCLUSION: The paramedian supracerebellar transtentorial approach is useful for supratentorially located medial tentorial meningiomas without retraction of the temporal lobe and without damage to the vein of Labbé or the sphenopetrosal vein.

Adult↗

PubMed2004

Usefulness of [11C]methionine PET in the diagnosis of dysembryoplastic neuroepithelial tumor with temporal lobe epilepsy.

PURPOSE: We assessed the diagnostic value of [11C]methionine (MET) positron emission tomography (PET) in the differential diagnosis of dysembryoplastic neuroepithelial tumors (DNETs) among benign tumors associated with temporal lobe epilepsy (TLE). METHODS: This series consisted of seven TLE patients with benign tumors in the temporal lobe. After MET-PET study, all seven patients underwent tumor resection along with focus excision. The uptake of tracers was evaluated by the lesion-to-contralateral ratio (L/C ratio) and the standardized uptake value (SUV). We also assessed the relation between MET uptake and proliferation capacity observed in the surgical specimens. RESULTS: Whereas four patients with DNETs did not show high MET uptake visually, the ganglioglioma and gliomas of the remaining three patients were identified as high-MET-uptake lesions. In the DNETs, the SUV ranged from 1.03 to 1.41, and the L/C ratio ranged from 0.99 to 1.14. MET uptake was significantly lower in the patients with DNETs than in the patients with ganglioglioma and brain gliomas (SUV, p = 0.045; L/C ratio, p = 0.0079). The Ki-67 labeling index was 4% in one patient with DNET and 5% in one patient with pleomorphic xanthoastrocytoma (higher labeling index). The higher labeling index was not related to high MET uptake based on the SUV (p = 0.91) and L/C ratio (p = 0.38). CONCLUSIONS: Negative MET uptake in benign temporal lobe tumors with TLE is consistent with a preoperative diagnosis of DNET.

Adolescent↗

PubMed1999

Visual confrontation naming outcome after standard left anterior temporal lobectomy with sparing versus resection of the superior temporal gyrus: a randomized prospective clinical trial.

PURPOSE: Intraoperative mapping of eloquent cortex during left (speech dominant) anterior temporal lobectomy has shown a significant proportion of patients to have sites on the anterior superior temporal gyrus at which visual confrontation naming can be disrupted by electrical stimulation. The purpose of this investigation was to conduct a randomized clinical trial to determine whether sparing versus resection of the superior temporal gyrus affected visual confrontation naming outcome after standard left anterior temporal lobectomy. Also examined was the degree to which inherent patient characteristics were associated with language outcome regardless of surgical technique. METHODS: Thirty patients with intractable left temporal lobe epilepsy undergoing standard anterior temporal lobectomy were randomized in regard to whether the superior temporal gyrus was resected or spared. Patients were tested preoperatively and 6-8 months postoperatively by using two conventional tests of visual confrontation naming ability. RESULTS: No significant differences were found between the groups in either confrontation naming or surgical outcome. Postoperative decline in nominal speech was most closely associated with later age at onset of epilepsy/absence of hippocampal sclerosis. CONCLUSIONS: It appears that specific types of localization-related temporal lobe epilepsy are more closely associated with the risk of adverse language outcome after anterior temporal lobectomy than with the surgical variations investigated in this study.

Adult↗

PubMed2005

Multifocal pilocytic astrocytomas with ependymal differentiation in the bilateral medial temporal lobes: case report.

A 7-year-old boy presented with headache, visual disturbance, and psychomotor seizures persisting for 7 months. He had mild hemiparesis and homonymous hemianopia on the left. Neuroimaging showed bilateral temporal lobe masses with calcification and cysts. The right temporal mass was subtotally resected. The histological diagnosis was pilocytic astrocytoma with ependymal differentiation and a MIB-1 staining index of up to 8.0%. Postoperatively his hemiparesis and psychomotor seizures disappeared. Adjuvant chemotherapy consisting of carboplatin and vincristine was given followed by radiotherapy. Neuroimaging showed that the bilateral tumors had disappeared and showed no recurrence for 29 months after the diagnosis. Pilocytic astrocytoma usually presents as a solitary mass in the cerebellum or optic pathway with low proliferative activity, but should be included in the differential diagnosis of multifocal tumors arising in the bilateral temporal lobes. Ependymal differentiation with extremely high proliferative activity might be related to this unusual clinical presentation. Intensive treatment is recommended for patients with such specific neuroimaging and histological features.

Antibodies, Antinuclear↗

PubMed2004

Hippocampal microdialysis during spontaneous intraoperative epileptiform activity.

BACKGROUND: The actual mechanisms underlying human hippocampal epileptogenicity, a process ultimately mediated by neurochemical events, remains to be fully elucidated. We submit early insight data regarding microdialysis (MD) recovery of the neuroactive amino acids glutamate, aspartate and gamma-aminobutyric acid (GABA) from the intraoperative and intact, spontaneously epileptiform human hippocampus. METHOD: Generally anaesthetised temporal lobe epilepsy (TLE) patients (N=7) undergoing therapeutic and anatomically standardised resective surgery were also subjected to ipsilateral anterior hippocampal MD with concomitant hippocampal electrocorticography (ECoG). Recovered 10-min dialysate samples were quantified for glutamate, aspartate and GABA using high-performance liquid chromatography; corresponding ECoG data was assessed for epileptiform activity (EA); mesial resection tissue was postoperatively examined and graded for hippocampal sclerosis. FINDINGS: Mean 'Sample 3' dialysate absolute recovery of glutamate, aspartate and GABA from hippocampi with minimal EA (N=5) was ( micro M+/-SEM): 6.406+/-2.143, 0.600+/-0.215, and 0.357+/-0.093, respectively. In contrast, 'Sample 3' dialysate absolute glutamate, aspartate and GABA levels ( micro M) from the hippocampi of two patients with vigorous EA were: 101.099 and 211.861, 21.860 and 14.482, and 4.241 and 4.817, respectively. Mesial resection tissue in all cases demonstrated hippocampal sclerosis, though the histopathological degree of sclerosis varied between patients. INTERPRETATION: These preliminary intraoperative findings suggest that dialysate glutamate, aspartate, and GABA levels from the sclerotic anterior hippocampus likely reflects the functional status of the sampled tissue - i.e., lower levels of these neuroactive amino acids are to be expected during quiescent or minimal EA versus considerably higher levels corresponding to vigorous EA.

Adult↗

PubMed1998

Reduction in temporal N-acetylaspartate and creatine (or choline) ratio in temporal lobe epilepsy: does this 1H-magnetic resonance spectroscopy finding mean poor seizure control?

BACKGROUND: Proton magnetic resonance spectroscopy (1H-MRS) is a potentially useful tool in the in vivo investigation of brain metabolites in intractable temporal lobe epilepsy (TLE). Focal N-acetylaspartate (NAA) reductions have been correlated with mesial temporal sclerosis (MTS) in surgically resected epileptogenic foci. OBJECTIVE: To evaluate the abnormalities in the metabolites NAA, creatine+ phosphocreatine (Cr), and choline containing compounds (Cho) in the temporal lobe of medically refractory patients with temporal lobe epilepsy, seizure free patients with temporal lobe epilepsy, and normal controls. PATIENTS AND METHODS: Ten refractory patients, 12 seizure free patients with temporal lobe epilepsy, and 10 age matched normal controls were studied by 1H-magnetic resonance spectroscopy. All patients had consistently unilateral temporal EEG abnormalities and a normal brain MRI. Proton MR spectra were obtained from an 8 ml volume in the medial temporal lobes in patients with temporal lobe epilepsy (ipsilateral to EEG foci) and the normal controls. The signals measured were expressed in terms of NAA/Cr, NAA/Cho, and Cho/Cr. RESULTS: When compared with seizure free patients with temporal lobe epilepsy and normal controls, the 10 refractory patients with temporal lobe epilepsy had a lower mean (SEM) NAA/Cr ratio (1.65 (0.53) v 2.62 (0.60), and 2.66 (0.73); p<0.002 and p<0.006) and a lower mean NAA/Cho ratio (1.59 (0.79) v 2.83 (1.33) and 2.58 (0.67); p<0.02 and p<0.007). Furthermore, the two patients showing the lowest NAA/Cr ratios (1.47 and 1.73) in the seizure free group had had a past period of poor seizure control. CONCLUSIONS: There were reduced temporal NAA/Cr and NAA/Cho ratios, suggesting neuronal loss or damage, associated with past or present poor seizure control in the patients with temporal lobe epilepsy, but it does not exclude the possibility of a future complete seizure control (seizure free patients with temporal lobe epilepsy at the time of 1H-MRS). This study warrants further 1H-MRS investigation with a larger series of patients with temporal lobe epilepsy.

Adolescent↗

PubMed2006

Efficacy of intraoperative electrocorticography for assessing seizure outcomes in intractable epilepsy patients with temporal-lobe-mass lesions.

PURPOSE: The findings of previous studies have been controversial regarding the optimal surgical procedures required for effective seizure control. In particular, there are varying views as to whether or not lesionectomy of a temporal-lobe-mass lesion is a satisfactory process or whether removal of additional seizure foci is necessary. In this study, we evaluated the efficacy of additional removal of electrically positive foci using intraoperative electrocorticography on mass lesions related to temporal lobe epilepsy. METHODS: Thirty-five medically intractable epilepsy patients with temporal-lobe benign mass lesions, who had been surgically treated, were assessed. The relationship between resection of the epilepsy focus using intraoperative electrocorticography and seizure outcome was analyzed. In addition, the sites of residual spikes after lesion removal were evaluated. RESULTS: In this study, the benign mass lesions consisted of 21 gangliogliomas, 8 cavernous angiomas and 6 dysembryoplastic neuroepithelial tumors. The number of 3-year postoperative seizure-free incidences for the group that underwent lesionectomy plus additional spike-positive site resection equated to 90.9%. In contrast, in the group that underwent a lesionectomy only, 76.9% were seizure-free for 3-years postoperatively. After complete removal of mass lesions, 86.4% of the residual spikes were detected over the hippocampus. CONCLUSION: Even after the complete removal of temporal-lobe-mass lesions, a high frequency of residual spikes was obtained from the hippocampus. Effective surgical seizure control was achieved by carrying out additional procedures on the affected hippocampus. To detect seizure foci surrounding the lesion, especially over the hippocampus, intraoperative electrocorticogram monitoring was shown to be an effective technique.

Adult↗

PubMed1977

Temporal lobe oligodendroglioma developing from infancy into adulthood.

Clinical, radiological, surgical, and histological features are reported for a patient with a temporal lobe oligodendroglioma that had developed in infancy and was diagnosed and partially resected at age 10. The patient is presently 24 years old and still well. To the best of our knowledge this is the first report of an oligodendroglioma with probable onset at 5 months of life and satisfactory course over 24 years.

Adolescent↗

PubMed1993

Intraoperative electrocorticography during tumor resection: impact on seizure outcome in patients with gangliogliomas.

Gangliogliomas are indolent neoplasms that are often associated with long-standing intractable seizures. The seizure-free outcome following ganglioglioma resection alone (or "lesionectomy") has been generally favorable, ranging in most series from 50% to 65%. Thus, the value of resection of epileptogenic cortex in addition to tumor with regard to seizure outcome has been the subject of controversy. The authors describe a series of 12 patients with frontal or temporal lobe gangliogliomas associated with long-standing intractable seizures. In these patients, intraoperative electrocorticography was used to guide the resection of epileptogenic cortex along with tumor. Functional brain mapping, interictal and ictal monitoring of seizures, as well as thorough neuropsychological assessments were performed prior to resection in all cases. Outcome with regard to seizures, tumor recurrence, and neurological deficits was assessed with a mean follow-up period of 3.1 years. There was universal freedom from seizures postoperatively in 11 patients in whom complete or near-complete resection of epileptogenic cortex was achieved. In one patient in whom complete tumor resection and subtotal removal of epileptogenic cortex was achieved, a 95% reduction in seizure frequency was identified. No tumor recurrence or neurological deficits were observed. In a subset of four patients, neuropsychological and cognitive function were evaluated pre- and postoperatively. In these four, a clear trend toward improvement was noted in most functions. Thus, resection of epileptogenic cortex along with tumor may improve seizure outcome in selected patients with tumor-associated epilepsy without engendering identifiable neurological or cognitive deficits attributable to the incremental resection.

Adolescent↗

PubMed2006

Recessive symptomatic focal epilepsy and mutant contactin-associated protein-like 2.

Contactin-associated protein-like 2 (CASPR2) is encoded by CNTNAP2 and clusters voltage-gated potassium channels (K(v)1.1) at the nodes of Ranvier. We report a homozygous mutation of CNTNAP2 in Old Order Amish children with cortical dysplasia, focal epilepsy, relative macrocephaly, and diminished deep-tendon reflexes. Intractable focal seizures began in early childhood, after which language regression, hyperactivity, impulsive and aggressive behavior, and mental retardation developed in all children. Resective surgery did not prevent the recurrence of seizures. Temporal-lobe specimens showed evidence of abnormalities of neuronal migration and structure, widespread astrogliosis, and reduced expression of CASPR2.

Child↗

PubMed2004

Intracranial metastasis via transplacental (vertical) transmission of maternal small cell lung cancer to fetus: CT and MRI findings.

We present the computed tomography (CT) and magnetic resonance imaging (MRI) findings of brain metastases in an unusual case of a premature, 33-week gestational age neonate who was emergently delivered from a mother suspected of having lung cancer according to imaging performed during the third trimester of pregnancy. Owing to the presence of placental metastases noted after delivery, the fetus had initial screening with brain MRI and chest/abdomen CT as well as serial screening imaging studies during the first 5 months of life, all of which were apparently normal. However, serial examinations eventually revealed a cerebellar lesion that significantly improved after chemotherapy but recurred and enlarged within a few months. This lesion was later confirmed to be metastasis by subsequent biopsy and resection. More metastatic lesions were identified in the frontal and temporal lobes on follow-up MRI. In the setting of aggressive maternal malignancy (without known fetal primary malignancy) an intracranial mass can, on the exceedingly rare occasion, result from maternal high-grade malignancy and the neuroradiologist should be alerted to this phenomenon.

Adult↗

PubMed1999

Solitary eosinophilic granuloma of the temporal lobe: case report and review of the literature.

A solitary eosinophilic granuloma of the central nervous system is an unusual manifestation of histiocytosis X. A unique case of a solitary eosinophilic granuloma of the right temporal lobe without osseous involvement is described. A 20-year-old man presented with a grand mal seizure. Magnetic resonance imaging demonstrated an intraaxial enhancing mass in the right temporal lobe with marked vasogenic edema. A right temporal craniotomy was performed for resection of the lesion and the diagnosis of an eosinophilic granuloma was confirmed by histopathology. Follow-up MR imaging obtained 5 years following resection demonstrated no recurrence. Solitary eosinophilic granuloma should be considered in the differential diagnosis of enhancing mass lesions affecting the central nervous system. Although the natural history of solitary eosinophilic granulomas remains poorly defined, surgical treatment still remains the mainstay of therapy for these unifocal cerebral lesions.

Adult↗

PubMed1999

Visual confrontation naming following left anterior temporal lobectomy: a comparison of surgical approaches.

Change in visual confrontation naming was examined following left (speech dominant) anterior temporal lobectomy (ATL) as a function of surgical technique and patient characteristics. Two hundred seventeen patients with intractable left temporal lobe epilepsy were selected according to standard criteria across 8 centers, and combined into 4 surgical approaches to ATL: (a) tailored resections with intraoperative mapping of eloquent cortex, (b) tailored resections with extraoperative mapping, (c) standard resections with sparing of superior temporal gyrus, and (d) standard resections including excision of superior temporal gyrus. Changes in visual confrontation naming were examined with an index of reliable change derived from an independent sample of 90 nonsurgical patients with complex partial seizures. Results showed significant decline in visual confrontation naming following left ATL, regardless of surgical technique. Across surgical approaches, the risk for decline in visual confrontation naming was associated with a later age of seizure onset and more extensive resection of lateral temporal neocortex.

Adult↗

PubMed2005

Abnormal GABAA receptors from the human epileptic hippocampal subiculum microtransplanted to Xenopus oocytes.

We studied the properties of GABAA receptors microtransplanted from the human temporal lobe epilepsy (TLE)-associated brain regions to Xenopus oocytes. Cell membranes, isolated from surgically resected brain specimens of drug-resistant TLE patients, were injected into frog oocytes, which rapidly incorporated human GABAA receptors, and any associated proteins, into their surface membrane. The receptors originating from different epileptic brain regions had a similar run-down but an affinity for GABA that was approximately 60% lower for the subiculum receptors than for receptors issuing from the hippocampus proper or the temporal lobe neocortex. Moreover, GABA currents recorded in oocytes injected with membranes from the subiculum had a more depolarized reversal potential compared with the hippocampus proper or neocortex of the same patients. Quantitative RT-PCR analysis was performed of the GABAA receptor alpha1- to alpha5-, beta1- to beta3-, gamma2- to gamma3-, and delta-subunit mRNAs. The levels of expression of the alpha3-, alpha5-, and beta1- to beta3- subunit mRNAs are significantly higher, with the exception of gamma2-subunit whose expression is lower, in subiculum compared with neocortex specimens. Our results suggest that an abnormal GABA-receptor subunit transcription in the TLE subiculum leads to the expression of GABAA receptors with a relatively low affinity. This abnormal behavior of the subiculum GABAA receptors may contribute to epileptogenesis.

Animals↗

PubMed1995

Selective amygdalohippocampectomy for hippocampal sclerosis: postoperative MR appearance.

PURPOSE: To analyze the anatomic consequences of selective amygdalohippocampectomy (AH) in patients with hippocampal sclerosis and to correlate the clinical outcome with the MR appearance. METHODS: Seventeen patients were examined with clinical and neuropsychologic examination and cranial MR after AH (7 transcortical AH, 10 trans-Sylvian AH). The clinical and neuropsychologic outcomes after AH were compared with those of anterior lobectomy (ATL). RESULTS: There was no significant difference in seizure cure between transcortical or trans-Sylvian AH and ATL. However, patients with left AH fared significantly better in terms of verbal IQ and nonverbal memory when compared with those with left ATL. Verbal memory and cognition were not significantly different in the two AH groups. Variable amounts of hippocampal and amygdala remnants were found in both AH groups and did not correlate with seizure cure. White matter change consistent with gliosis probably secondary to wallerian degeneration was demonstrated in the anterior temporal lobe to a mean distance of 4.5 cm after transcortical AH and to a lesser degree as a consequence of trans-Sylvian AH. Nine patients (53%) (4 transcortical All, 5 trans-Sylvian AH) demonstrated wallerian degeneration in the optic radiations after surgery. All had incomplete contralateral quadrantanopia. CONCLUSIONS: There is more secondary damage to the temporal lobe after AH than was previously recognized. The extent of hippocampal and amygdala resection in AH do not seem to be directly related to seizure cure. Visual field defects are common in AH because of the anterior but variable course of the optic radiations

Adolescent↗

PubMed1995

Bilateral hippocampal atrophy in medial temporal lobe epilepsy.

Quantitative evidence of hippocampal atrophy has been correlated with site of seizure onset, hippocampal neuronal loss, and seizure relief after resection. Most studies have quantified hippocampal atrophy using ratios or differences between right and left hippocampal values. However, bilateral hippocampal atrophy may remain undetected by these techniques. To assess the frequency and implications of bilateral hippocampal atrophy, we studied absolute hippocampal volumes in 53 temporal lobectomy patients who had undergone intracranial electroencephalogram recordings preoperatively. Coronal images were constructed perpendicular to the longitudinal axis of the hippocampus. Atrophy was defined as > 2 SD below control values in the volume of the posterior 1.5 cm of the hippocampus. Five of 53 patients (9%) had bilateral hippocampal atrophy; four of these cases were undetected by ratios. Surgery was performed on the side of ictal onset in all five patients; four have been seizure-free for > 2 years. These results suggest that (a) mesial temporal sclerosis can be present bilaterally and may go undetected by hippocampal ratio or difference measures; (b) absolute hippocampal volume values as well as ratios are needed to detect all patients with bilateral hippocampal atrophy; and (c) temporal lobectomy is not contraindicated in patients with bilateral hippocampal atrophy, but success depends on electroencephalographic documentation of the side of predominant ictal onset.

Atrophy↗