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Results for “Temporal Lobe Resection”

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PubMedDate not supplied

[Analysis of the results of surgical treatment for symptomatic epilepsy caused by temporal lobar neoplasms].

The present study involves the analysis of the results of surgical treatment in 35 patients with drug-resistant epilepsy caused by local temporal lobar lesions: glioma without growth (n = 31), gliosis (n = 1), and cavernoma (n = 3). The medial location of neoplasms involving the hippocampus was noted in 25 cases, their extrahippocampal location was observed in 10 cases. The history of seizures was 2 to 18 years; the duration of a postoperative follow-up was 1 to 6 years. Electrocorticographic and EEG findings indicated that in all cases the eliptogenic zone was located in the medial portions of the temporal lobes at the site of lesion. The first stage of surgery was to remove a neoplasm; the adjacent portions of an epileptogenic zone were resected only with preserved convulsive activity in the surrounding areas. Good results (Classes I-II) were observed in cases of the medial location of a lesion in both total removal of a neoplasm and additional resections; in the group of patients the results were better than in routine removal (seizures ceasing in 4 of 5 and in 3 of 12 patients, respectively). Bad results (Classes III-V) were noted with partial removal of a neoplasm from the medial portions (n = 4), there were much better results (Classes I-II) with its total removal from the medial portions and with its partial removal from other areas. With total removal of extrahippocampal neoplasms, seizures were retained (Classes III-IV); additional resections of neocortical zones (n = 2) failed to improve the results of treatment. With resections in the entorial cortical area, the results were better (Class II). Our findings confirm that hippocampal removal plays an important role in symptomatic temporal epilepsy for an adequate monitoring of seizures.

Adolescent↗

PubMed2005

Losing neurons: selective vulnerability and mesial temporal sclerosis.

Mesial temporal sclerosis (MTS) is found in about two-thirds of patients with refractory temporal lobe epilepsy (TLE), and surgical removal of the sclerotic structures eliminates seizures in the majority of cases undergoing surgical resection. Although multiple factors have been implicated in the genesis of MTS, it is still unclear why some individuals are more likely to develop hippocampal sclerosis than others. Epileptologists have proposed that there must be at least two factors involved-an initial precipitating injury (IPI), such as a prolonged febrile seizure, CNS infection, or head trauma, and a second factor that increases vulnerability to neuronal injury. This has been termed the "two-hit hypothesis." Three of the many factors that could possibly heighten susceptibility to neuronal injury and MTS are discussed here. These are microdysgenesis, hippocampal dysgenesis, prior seizures, and genetic predisposition. We conclude that there is currently no compelling evidence to support a role for microdysgenesis in MTS. Hippocampal dysgenesis, on the other hand, may account for febrile seizures and possibly MTS in a small subpopulation of patients with TLE. Additional larger studies are needed to confirm these findings. Experimental evidence indicates that an epileptogenic hippocampus can result from prolonged febrile seizures in infant rats, even though these seizures do not cause MTS in the rat. It is not known if this pathophysiological sequence occurs in humans. Lastly, there appears to be a strong genetic component that predisposes some individuals to MTS, regardless of whether they experience an IPI.

Animals↗

PubMed1997

Recent advances in epilepsy surgery: temporal lobectomy and multiple subpial transections.

THIS ARTICLE REVIEWS four major advances in epilepsy surgery, especially the most frequently performed surgery, temporal lobectomy, as follows: 1) the ability to preoperatively identify (using magnetic resonance imaging) the pathological condition of hippocampal sclerosis (a key component to the syndrome of mesial temporal lobe epilepsy, 2) the ability to identify preoperatively which temporal lobe candidates are at risk for postoperative memory problems, 3) the standardization of temporal lobectomy with respect to how much hippocampus should be resected, 4) a validation of the novel surgical technique of multiple subpial transections. This technique allows surgeons to attack foci within nondispensible cortex and therefore enlarges the applicability of surgical treatment to otherwise inoperable patients and potentially improves outcome.

Epilepsy↗

PubMed1999

Significance of interictal temporal lobe delta activity for localization of the primary epileptogenic region.

Because interictal temporal lobe delta activity (TLDA) has been described in 30 to 90% of patients with temporal lobe epilepsy (TLE) but has not been investigated in patients with extratemporal epilepsy, we sought to determine the localizing significance of TLDA. We compared the presurgical interictal scalp EEG results of 47 consecutive patients who received extratemporal resection (40 frontal and 7 parietal-occipital) for intractable epilepsy with 43 consecutive patients who received anterior temporal lobectomy. We defined lateralized TLDA as runs of lower than 4-Hz waveforms that were easily distinguished from the background rhythms and were maximal at electrodes T4, F8, and T6 or T3, F7, and T5. The lateralized TLDA was subcategorized as temporal intermittent rhythmic delta activity (TIRDA) or temporal intermittent polymorphic delta activity (TIPDA). A chi-square test was used to determine the association of the lobe of the epileptogenic zone with TIRDA and TIPDA. We found TIRDA in 12 (28%) and TIPDA in 8 (19%) patients in the temporal lobe group, and TIRDA in 2 (4%) and TIPDA in 9 (19%) patients in the extratemporal group. TIRDA was strongly associated with TLE (p < 0.003), whereas TIPDA occurred at an equal rate in both groups. Similar to anterior temporal epilepsy, lateralized TIPDA is present in up to 20% of patients with extratemporal epilepsy. The presence of TIRDA strongly suggests TLE but may infrequently occur in extratemporal epilepsy. Caution should be used when using lateralized TLDA as a presurgical localizing finding.

Adolescent↗

PubMed1998

Celiac disease, bilateral occipital calcifications and intractable epilepsy: mechanisms of seizure origin.

PURPOSE: To elucidate the mechanisms of seizure origin in patients with celiac disease and bilateral occipital calcifications (CEBOC). Individuals with CEBOC frequently present with occipital lobe seizures, but additional lesions and additional attack patterns may occur. METHODS: We studied two men and one woman who had CEBOC. Villous atrophy was revealed in the two patients who underwent duodenal biopsy. All had a comprehensive presurgical evaluation, including prolonged video-EEG recordings. Two had magnetic resonance imaging (MRI) with volumetric study of mesial temporal structures (MRIV). One patient had undergone stereotactic intracranial depth electrode studies (SEEG). RESULTS: All patients presented with intractable complex partial seizures. Two had partial simple seizures with visual aura. Neurologic examination was normal; one was of normal intelligence, and two were mildly retarded. Neuroimaging studies showed that each had bilateral occipital calcifications as well as epileptiform abnormalities over temporal lobes. In one, MRI showed an additional right frontal lesion, but SEEG demonstrated right occipital lobe seizure origin with anterior spread; this male patient later underwent a right occipital lobe resection. Another with a history of prolonged febrile convulsions had bilateral hippocampal and amygdalar atrophy demonstrated by MRIV. CONCLUSIONS: In one patient, SEEG confirmed that seizures originated in the occipital lobe. The presence of dual pathology was demonstrated in another, raising the possibility of both occipital and temporal seizure onset. The presence of extraoccipital lesions or of mesial temporal atrophy requires SEEG for clarification of seizure onset. In the absence of confounding factors and when laterality can be demonstrated, surgical treatment may be considered.

Adult↗

PubMed2001

Symptomatic subdural hygroma and temporal lobe edema after translabyrinthine removal of acoustic neuroma.

The translabyrinthine approach is familiar to most neurosurgeons and neuro-otologists and is frequently used to remove acoustic neuromas. Some of the complications associated with this surgery include cerebrospinal fluid (CSF) leaks, meningitis, and rarely fat graft prolapse. The authors report a 60-year-old woman who underwent a translabyrinthine approach and microsurgical resection of a right-sided 1-cm acoustic neuroma. Initially, she was discharged home after an uneventful postoperative course. Four days later, she sought treatment in the emergency room complaining of headaches, dizziness, and lethargy. A computed tomographic (CT) scan showed a large right-sided subdural hygroma and right temporal lobe edema. The patient underwent burr hole evacuation of the collection and placement of a subdural drain, after which the edema in the temporal lobe and hygroma resolved. We speculate that the underlying mechanism was the result of inadvertant damage to the venous drainage and an arachnoid tear that was not appreciated during surgery. Neurosurgeons and neuro-otogists should be aware of this unusual complication of translabyrinthine surgery and its possible underlying mechanisms.

Case Reports↗

PubMed1993

Brain-stem lesions in the course of a presurgical re-evaluation by foramen-ovale electrodes in temporal lobe epilepsy.

Two of 4 patients who were re-evaluated by means of foramen-ovale electrodes in the course of presurgical monitoring suffered a brain-stem lesion. Only 1 of these 2 patients already had a temporal resection. None of 55 patients who underwent this procedure for the first time had such a complication. We conclude that this electrode technique is not indicated to evaluate patients a second time, even if no surgical resection has been performed between the 2 recording sessions.

Brain Diseases↗

PubMed1996

Preserved function in brain invaded by tumor.

OBJECTIVE: Intrinsic brain tumors can arise within regions of the cortex that are essential to language, motor, and somatosensory functions. Although it is commonly thought that such tumors can be safely resected, as long as the resection is limited to grossly abnormal cortex, functional mapping of the cerebral cortex during tumor resection does not support this contention. METHODS: We report our experience with 14 patients (9 men, 5 women; median age, 43 yr) with intrinsic brain tumors of varying degrees of malignancy (four glioblastomas multiforme, four anaplastic astrocytomas, two anaplastic oligodendrogliomas, one anaplastic mixed glioma, three gangliogliomas). Cortical mapping was performed either intraoperatively (n = 11) or extraoperatively via intracranial electrodes (n = 3). RESULTS: Tumors were found to grossly invade functioning cortices (frontal lobe language cortex, four tumors; temporal lobe language cortex, five tumors; motor cortex, four tumors; somatosensory cortex, one tumor). The gross invasion of functional cortex by tumor limited safe resection in all patients. Three patients experienced transient postoperative deficits caused by the proximity of the resection to functional cortex. One patient suffered a delayed postoperative hemorrhage, with resultant persistent motor aphasia. CONCLUSION: Intrinsic brain tumors grow by infiltration of normal brain. Consequently, brain that appears to be abnormal may remain functional, thus precluding safe tumor resection.

Adult↗

PubMed2003

De novo cerebellar medulloblastoma in a 26-year recurrence-free case of temporal glioblastoma multiforme. Case report.

The authors describe a patient who survived 26 years after resection of a right temporal glioblastoma multiforme (GBM) without signs of tumor recurrence. Preoperative emergency angiography demonstrated a hypovascular mass localized in the right temporal lobe with right-to-left shift of the vascular structures. At surgery, the tumor had cystic and solid components localized in the lateral occipitotemporal gyrus, reaching the posterolateral wall of the inferior horn of the right lateral ventricle and extending to the trigone and posterior horn. The initial pathological diagnosis of a GBM was reviewed and confirmed throughout the follow-up period. Twenty-six years after surgery and subsequent radiosurgery, the patient underwent resection of a medulloblastoma localized in the right cerebellum as well as stereotactic biopsy sampling of tissue at the original GBM site. Neither radiological nor histological evidence of recurrence of the GBM could be documented. The intraoperative, histological, and radiological findings are described.

Adult↗

PubMed1988

[Microtumor presenting with temporal lobe epilepsy--a case report].

A 15-year-old girl was admitted to our clinic on July 16, 1985 with the epilepsy which had been resistant to various anticonvulsant therapies. At the age of 10 years automatism seizure, characterized by purposeless movement of arms and head of which the patient was unaware, began to occur and became as frequent as two to three times each day. From the age of 13 years, there were also grand mal seizures several times a year in spite of medical treatment. She had normal delivery and no history of febrile convulsion. There was no family history of epilepsy or mental disease. When examined on admission, she had normal personality and intelligence. There was no neurological abnormality. She complained of sleepiness and hirsutiness. Fit of automatism occurred two to three times a day during admission, though the blood levels of anticonvulsant drugs such as phenobarbital, phenytoin and carbamazepine reached to therapeutic concentration. EEG examination including infratemporal lead recording showed right temporal spike focus. But all the neuroradiological studies such as skull X-rays, CT, cerebral angiography and magnetic resonance imaging failed to show abnormal finding. Right temporal lobectomy was carried out under general anesthesia on Aug 22, 1985, and anterior two-thirds of the middle and the inferior temporal gyri were resected deeply to anterior hippocampus. To the naked eye, no abnormal finding was noted during the operation. In the surgical specimen, macroscopically nothing abnormal was found. Microscopically, serial sections of the lobe revealed clusters of oligodendroglial cells in cortical to subcortical region of the medial basal part of the temporal lobe.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

PubMed2000

Detection of epileptogenic focal cortical dysplasia by depth, not subdural electrodes.

Centers that perform presurgical epilepsy evaluations disagree on whether depth or subdural electrodes represent the optimal technique for invasive recording, especially in seizures originating outside the temporal lobe. A 13-year-old girl with a normal magnetic resonance imaging scan had unlocalized partial onset seizures, despite scalp and subdural grid ictal video/EEG recordings. Repeat video/EEG with depth electrodes showed a discrete site of continuous interictal spiking and seizure onset that was located 2-2.5 cm beneath the surface of the sensory cortex. The resected region showed focal cortical dysplasia and the patient had greater than 95% seizure frequency reduction at 3-year follow-up. We conclude that although subdural electrodes have many advantages when recording seizures outside the temporal lobes, depth electrodes may provide superior recordings when the epileptogenic region is beneath the cortical surface.

Cerebral Cortex↗

PubMed1992

Induced and spontaneous seizures in man produce increases in regional brain lipid detected by in vivo proton magnetic resonance spectroscopy.

Elevations of brain concentrations of arachidonic acid and other free fatty acids (FFAs) by seizures induced in animals were demonstrated some years ago. Similarly, large shifts of potassium (K+) from intra- to extracellular space during seizure activity have been documented in numerous studies. More recent studies of cell membrane function demonstrated a direct effect of FFAs on membrane K+ conductance, suggesting that FFAs may play a primary role in seizure evolution in brain tissue. Using electroconvulsive therapy (ECT), in which generalized seizures are induced in patients by passage of electrical current, as a controlled human model of seizures, we studied the in vivo biochemical effects of single generalized seizures with localized proton magnetic resonance spectroscopy (1H MRS). We found that ECT reliably induces an elevation in the lipid signal that resonates at approximately 1.2 ppm. We observed a similar increase in brain lipids in a patient with temporal lobe epilepsy temporarily off medication; the signal disappeared after re-medication. Similar observations were noted for a subject with focal gliosis bordering a resected brain tumor. Finally, acute alcohol effects seem also to induce observable lipid changes. The 1H MRS technique does not yet permit direct identification of the specific lipids involved but analysis of cerebrospinal fluid obtained by lumbar puncture before and immediately after ECT may permit more precise characterization of the observed lipid increases. Theoretical and clinical implications of these results for the study of brain FFAs and epilepsy will be discussed.

Brain↗

PubMed1997

Extended temporal bone resection for squamous cell carcinoma.

OBJECTIVE: The aim of this study was to assess the surgical results of a series of patients from this unit who underwent extended temporal bone resection for recurrent squamous cell carcinoma as a salvage procedure. DESIGN: The surgical records of 15 patients were analyzed in detail. Each patient had salvage surgery in the form of an extended temporal bone resection with supraomohyoid block dissection, dural grafting, and free microvascular forearm or scalp rotation flap repair for recurrent squamous cell carcinoma in a radical mastoid cavity. RESULTS: Radical surgery yielded a 47% 5-year survival. Twenty-nine percent of the survivors had temporal lobe involvement that necessitated a partial excision of the temporal lobe of the brain. Histologic evidence of local lymph node involvement in the supraomohyoid neck dissection was present in 13% of cases. Those who died did so in the first postoperative year. All those with poorly differentiated tumors died. The survivors had well or moderately differentiated tumors. CONCLUSIONS: Radiotherapy alone or partial temporal bone resection, most commonly a radical mastoidectomy with or without preoperative or postoperative radiotherapy is used by the majority of otolaryngologists in treating squamous cell carcinoma of the temporal bone. The 5-year survival rate after this treatment remains depressingly low and the prognosis gloomy, particularly for advanced tumors. The findings in this series of extended temporal bone resections as salvage surgery in recurrent disease is encouraging, and radical surgery combined with radiotherapy from the outset may give much better 5-year survival figures in the future than the conventional partial temporal bone resection and radiotherapy.

Adult↗

PubMedDate not supplied

[Refractory epilepsy as the presenting symptom of a brucellar brain abscess].

INTRODUCTION: Brucellosis is a zoonotic disease that is occasionally transmitted to human beings from infected animal reservoirs. It is an important condition in endemic areas. One infrequent complication of systemic brucellosis is the infection of the central or the peripheral nervous systems. CASE REPORT: A 54-year-old male who was being studied prior to surgery for refractory epilepsy, with clinical expression in the form of complex partial seizures. Neuroimaging findings revealed an expansive lesion in the right temporal lobe, which direct serological, histopathological and microbiological evidence showed to be a chronic brucellar abscess. After combined treatment involving complete surgical resection followed by a cycle of standard antimicrobial therapy, the patient was seizure-free at one year of follow-up. CONCLUSIONS: Despite its low frequency, infection by Brucella must be considered in the differential diagnosis of intracranial expansive lesions, as well as in the case of patients whose presenting symptoms are epileptic seizures. To perform the diagnosis it is especially important to be aware of the wide range of clinical and radiological manifestations that can be produced, and which do not always correlate. Identification of risk factors on the patient record is also a crucial step.

Agricultural Workers' Diseases↗

PubMed1995

[Ipsilateral coexistence of AVM and meningioma: a case report].

The authors encountered a rare case of sphenoidal ridge meningioma associated with an arteriovenous malformation in the same cerebral hemisphere. A 65-year-old female was admitted to our service because of headache. X-ray computed tomography (X-CT) and magnetic resonance image (MRI) disclosed a huge mass with peripheral edema, diagnosed as a sphenoidal ridge meningioma. An associated small mass was also noted in the right parahippocampal gyrus. This was confirmed by angiography as an arteriovenous malformation (AVM). During the waiting period for surgical treatment she had fallen into coma abruptly. Emergency X-CT revealed intracerebral and intraventricular hematomas. Both lesions were resected successfully in a one stage operation. Postoperative course was uneventful. In general, AVM located in the medial temporal lobe is difficult to approach. However, in this case, the resultant large cavity obtained after removal of meningioma afforded us easy access to the AVM.

Aged↗

PubMedDate not supplied

Surgical treatment of paragangliomas of the neck.

Of a total of 5,700 surgical procedures on the neck performed at our Institution between 1984 and 1995, 13 operations (0.22%) have been done on 11 patients with 16 cervical paragangliomas. A woman underwent resection of synchronous bilateral carotid body tumours and of an intravagal paraganglioma. Ten years later, after preoperative angiographic embolization, she underwent resection of a paraganglioma of the left hypoglossal nerve. Her sister, at age 21, underwent resection of a carotid body tumour and, respectively 19 and 20 years later, of a right and left intravagal paraganglioma. An interposition graft for replacement of the carotid bifurcation was necessary in one patient only. During resection of a left carotid body tumour, acute hypotension occurred resulting in an ischemic lesion of the right temporal lobe. Postoperatively, she also complained of respiratory distress that responded to medical therapy with difficulty. The related neurologic symptoms completely resolved three months after surgery. The operation for a paraganglioma of the left hypoglossal nerve resulted in a temporary motor deficit of the tongue and in permanent considerable difficulty in swallowing. Unilateral recurrent nerve palsy occurred in two patients. No patients during the postoperative follow-up showed signs of local recurrence or metastatic disease. In conclusion, surgery is an effective treatment for cervical paraganglioma, but because of the high surgical complication rate, an experienced and skilled surgeon is called on to optimize outcome. An adequate perioperative care is advisable.

Adult↗

PubMed2006

Fast improvement of verbal memory function after left temporal tumour resection.

CASE REPORT: A 7-y-old, right-handed girl presented at our clinic with complex partial seizures, behavioural problems and word-finding difficulties. Clinical examination was normal, but electroencephalogram revealed bilateral epileptic discharges in the temporal and paracentral leads. Magnetic resonance imaging showed an intracerebral mass in the left mesial temporal lobe in the areas of the gyrus temporooccipitalis medialis and gyrus parahippocampalis. Neuropsychological testing brought to light an above-average general intelligence, but the girl performed below average in verbal memory tests and average in figural memory tests. RESULTS: The tumour was completely removed by surgery. Neuropsychological testing 3 and 11 wk after tumour resection demonstrated above-average verbal learning and memory abilities and improved visual memory. The emotional disturbances, seizures and electroencephalogram abnormalities disappeared completely during the postoperative follow-up. CONCLUSION: After resection of a left temporal brain tumour, the patient was free of seizures, and neuropsychological functions recovered completely within weeks.

Brain Neoplasms↗

PubMed1995

Fast spin-echo, magnetic resonance imaging-measured hippocampal volume: correlation with neuronal density in anterior temporal lobectomy patients.

To assess the value of magnetic resonance imaging (MRI)-measured hippocampal volume in the detection of hippocampal sclerosis, we studied 28 patients undergoing anterior temporal lobectomy for medically intractable mesial temporal lobe epilepsy. Hippocampal volumetry and visual analysis of T2 signal change were performed using fast spin-echo T2-weighed MRI. Quantitative neuronal density measurements were performed in the resected hippocampal specimens. There was a significant correlation between MRI-measured absolute hippocampal volume (AHV) and neuronal density in CA1, CA2, and CA3 subfields (p < 0.0001, p < 0.01, and p < 0.05, respectively). Differential hippocampal volume (side-to-side volume difference) failed to detect bilateral atrophy in three patients, but the bilateral hippocampal atrophy was recognized by considering AHV in these patients. This study suggests that MRI-measured AHV can be of value in elevating patients with mesial temporal lobe epilepsy, especially when there is no side-to-side difference in hippocampal volumetry.

Adolescent↗