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Results for “Temporal Lobe Resection”

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PubMed2005

Heart rate increase in otherwise subclinical seizures is different in temporal versus extratemporal seizure onset: support for temporal lobe autonomic influence.

Ictal heart rate was investigated in otherwise subclinical epileptic seizures to test the hypothesis as to whether ictal tachycardia is physiological and not a physical or psychological stress response. In addition, we aimed to evaluate the localizing significance of pure ictal tachycardia. We included 21 epilepsy patients, who showed an ictal EEG seizure pattern during 22, otherwise subclinical seizures. All patients underwent ictal video-EEG recordings to evaluate the possibility of resective epilepsy surgery. The changes in heart rate in these patients were investigated in order to determine their relationship to localization and duration of EEG seizure patterns. Ictal tachycardia was observed in 41% of the otherwise subclinical seizures (nine out of 22), and significantly more often in seizures arising from the temporal lobe than from extratemporal regions (62% versus 11%, p < 0.0018). The seizure duration as defined by EEG was significantly positively correlated with an increase of heart rate (p = 0.043). Ictal heart rate can increase as a result of epileptic activation of autonomic cortex, reflecting a temporal lobe autonomic influence. Thus, measurement of heart rate should be included in the evaluation of otherwise subclinical epileptic seizures, because of its localizing value.

Adolescent↗

PubMed2001

Surgical treatment of intractable epilepsy combined with bipolar electrocoagulation on functional cortex.

OBJECTIVE: Resecting epileptogenic foci combined with bipolar electrocoagulation of functional cortex has been successfully used to treat intractable epilepsy. METHOD: 124 cases with intractable epilepsy have been treated from 1996 to 1999, 75 cases with temporal lobe epilepsy and 48 cases with extra-temporal lobe epilepsy, and one case with infantile hemiplegia. Electrocorticography (ECoG) was used pre- and postoperatively. 108 cases were followed-up from one to three years. RESULTS: The general efficiency of bipolar electrocoagulation on functional cortex (BCFC) for epilepsy is 91.7%. The pathological features indicate that the damage by coagulation of the cortex is only in the supra- and infra-granular layers, similar to multiple subpial transection (MST). CONCLUSION: When the epileptogenic foci are located in functional cortex, the method of resecting the foci combined with BCFC has been effective and improves the results greatly. BCFC is safe and easy to use.

Adolescent↗

PubMed1993

Operant conditioning after temporal lobe lesions in man: conditional and simple discrimination learning.

Temporal lobe lesions have been found to impair the acquisition of classical conditional discrimination learning in an eyelid conditioning paradigm, with sparing of simple eyelid conditioning. In the present study, subjects with left or right temporal resections were compared with normal controls on two operant conditioning tasks using a conditional and a simple discrimination paradigm analogous to the previously reported classical conditioning tasks. Subjects with right temporal lesions, and to a lesser extent those with left temporal lesions, were impaired relative to frontal lobe and control subjects in the acquisition of a conditional discrimination within an operant conditioning setting. A subsequent experiment showed that both left and right temporal lobe subjects were unimpaired on a simple operant discrimination task. These findings are compatible with theory relating hippocampal function to the learning of if-then rules.

Adult↗

PubMed1998

Intracranial EEG seizure-offset termination patterns: relation to outcome of epilepsy surgery in temporal lobe epilepsy.

PURPOSE: Studies using stereo-EEG (SEEG) and electrocorticography (ECoG) should not only identify a patient's epileptogenic zone, but also should provide prognostic information for surgical outcome. In this respect, seizure-offset patterns have so far been the subject of only one study, in which they were shown to be associated with poor outcome when recorded over cortical areas outside the temporal lobe of seizure onset. To clarify whether seizure-offset patterns are reliable in predicting seizure outcome, we studied SEEG/ECoG in a similar group of patients with temporal lobe epilepsy (TLE). METHODS: SEEG/ECoG records of 44 patients with refractory TLE were analyzed. The areas of seizure termination were classified as ipsilateral or contralateral (mesial and/or lateral) temporal, (temporal and) frontal, and diffuse/bilateral. Patients were classified with respect to seizure outcome as either seizure-free (UCLA class 1a) or not seizure free (UCLA class 2-4); both groups were correlated with specific seizure-offset categories using Fisher's exact probability test and analysis of variance (ANOVA). RESULTS: Of the 44 patients, the majority (n = 36) had at least part of their seizure offsets in the ipsilateral temporal lobe, whereas 8 patients manifested no seizure offsets in this lobe. Only 9 patients (20%) showed exclusive offsets in the ipsilateral temporal lobe. No statistically significant difference was evident between patients with all seizure offsets in the ipsilateral temporal lobe and those with offsets elsewhere. Similarly, no statistically significant difference was evident between patients with a diffuse seizure offset and those with seizure offsets of a different category. CONCLUSIONS: Seizure-offset patterns in SEEG/ECoG are unreliable in predicting seizure outcome after resective activity surgery for TLE.

Adolescent↗

PubMed1999

Basal lateral subtemporal approach for trigeminal neurinomas: report of an experience with 18 cases.

Subtemporal craniotomy centred on the external ear canal was used to surgically treat 18 trigeminal neurinomas. The approach was found to be suitable to deal with either or both the middle fossa and the posterior cranial fossa components of the tumour. The basal extension of the exposure was achieved by resection of the roots of the zygomatic arch, roof of the external ear canal and superior third of the mastoid bone. The temporalis muscle was rotated anteriorly. The direction of the approach to the tumour was the shortest and perpendicular from the surface and avoided any neural or vascular exposure or manipulation. The basal exposure was horizontally wide and significantly low which reduced the operating distance, limited the extent of temporal lobe retraction and provided additional space for manipulation of instruments. The exposure was manoeuvreable with anterior, posterior and medial expansion being possible during or prior to tumour resection. The approach had the advantage of being simple and relatively quick and of its familiarity to general neurosurgeons. The experience with the approach with trigeminal neurinomas and its possible advantages over other available approaches to these lesions are analysed in this report.

Adult↗

PubMed1998

[Temporal lobe epilepsy and ganglioglioma in children. Clinical aspects, imagery and neuropathology; nosological discussion of six cases].

BACKGROUND: Gangliogliomas belong to debated nosological entity. They are classified as neuronal or neuroglial tumors. PATIENTS AND METHODS: Six children aged from 4 months to 15 years (mean age: 4 years and 6 months) were initially seen for partial seizures resistant to treatment. Tumoral resection was performed in all six. Diagnosis was made from immunohistological study of the tumor. DISCUSSION: Gangliogliomas are non-malignant, with a good prognosis, even if inaugural clinical manifestations are severe. Neuroradiological diagnosis with astrocytomas and cortical dysplasia is not easy, and pathological distinction from cortical dysplasia is difficult. CONCLUSION: The immunohistochemical confirmation of diagnosis permits a logical therapeutic attitude: complete resection of tumor is followed by an excellent outcome.

Adolescent↗

PubMed1996

P300 abnormalities in patients with selective impairment of recent memory.

We recorded auditory event-related potential (ERP) by using the standard oddball paradigm in seven amnestic patients. Patients were divided into three groups according to brain CT or MRI findings. (1) Three patients with no detectable lesion, including two patients studied during the episode of transient global amnesia, showed a well-defined P300. (2) Three patients with detectable lesions in the mesial temporal lobes did not show any wave form corresponding to P300. In two of these three patients, the ERP wave form showed a significant change in accordance with the improvement of MRI findings. (3) One patient who had a hypothalamic lesion due to total resection of craniopharyngioma showed a low-amplitude P300. Although neuropsychological examinations showed selective and severe impairment of recent memory function in all of these patients, no significant relationship was found between the degree of memory disturbance and P300 abnormality. These results suggest that P300 is more affected by existence and extension of brain lesions, especially in the mesial temporal lobes, rather than degree of memory disturbance. However, these results do not necessarily suggest that the potential generated in the mesial temporal lobes is directly recorded as a component of the scalp-recorded P300.

Adult↗

PubMed2004

Intra-operative mapping of the subcortical visual pathways using direct electrical stimulations.

Despite the risk of postoperative visual field defect following surgery within the temporo-parieto-occipital region, visual mapping has rarely been described, in particular at the subcortical level. In this report, we successfully performed a subcortical mapping of the visual pathways using intra-operative electrical stimulations (IES), during surgery under local anesthesia for a low-grade glioma invading the whole temporal lobe and the temporo-occipital junction. The optic radiations then constituted the posterior and deep functional boundary of the resection, avoiding the occurrence of a post-operative hemianopsia, in spite of an asymptomatic quadrantanopsia. This preliminary experience illustrates the possibility to use intra-operative direct electrical stimulation during surgery of lesions involving the posterior afferent visual system, in order to identify and then preserve the visual pathways, as previously reported for sensorimotor and language subcortical fibers.

Adult↗

PubMed1998

Surgical management of intractable epilepsy.

Cortical resective surgery (including amygdalohippocampectomy) and corpus callosotomy are the most widely accepted modes of surgical treatment for intractable epilepsy. Between July 1989 and May 1996, 146 surgeries for epilepsy were done at Severance Hospital, Yonsei University. Resective surgery was performed in 126 patients and corpus callosotomy in 20 patients. Of the 126 patients who underwent resective surgery, surgery for the removal of the epileptic lesion (lesionectomy) was performed in 21 patients (16.7%) while 105 patients (83.3%) underwent surgery without a structural lesion. Current surgical therapy for intractable epilepsy requires the precise localization of a resectable zone of epileptogenesis. Unfortunately, finding a localized focus in an extratemporal region is far more difficult than in the temporal lobe. Surgeries for extratemporal lobe epilepsy without lesions have been less successful than surgeries for temporal lobe epilepsy. Although surgery for intractable epilepsy has been increasingly successful, we still need to refine our techniques to further improve the success rate and to reduce complications of surgery such as language and memory impairment.

Adolescent↗

PubMed2001

December 2000: 6 month old boy with 2 week history of progressive lethargy.

This 6-month-old Caucasian boy presented with a 10-day history of lethargy, obtundation, inability to hold his head up and mild torticollis. MRI and CT scans showed a large solid and cystic mass involving the right temporal, parietal and occipital lobes, pineal, superior pons, mesencephalon and posterior right thalamus. He underwent craniotomy initially for a partial tumor resection with an intraoperative diagnosis of desmoplastic astrocytoma. With immunohistochemistry and special stains the diagnosis of desmoplastic infantile ganglioglioma (DIG) was made. A near total resection was performed a week after initial resection.The patient then was treated with chemotherapy. Two months later an MRI showed tumor growth. Following additional aggressive chemotherapy, an MRI at 5 months post-resection indicated further tumor progression. This case illustrates that some DIGs may behave more aggressively than typical WHO grade I lesions.

Brain↗

PubMed1991

[A case of disproportionately large communicating fourth ventricle after resection of temporal astrocytoma that evolved an isolated fourth ventricle].

The isolation and enlargement of the fourth ventricle after a ventriculoperitoneal (V-P) shunt was classified as "isolated fourth ventricle (IFV)". The term, "disproportionately large communicating fourth ventricle (DFV)" was first introduced by Scotti et al as being an enlarged fourth ventricle communicating with the third ventricle. The authors present a case of DFV after the resection of an astrocytoma. Upon recurrence of the tumor a second resection was carried out 5 years later. It was found that IFV had evolved because a cyst in the right temporal lobe was obstructing the aqueduct. After shunting of the tumor cyst, the aqueduct was again found to be patent and the fourth ventricle gradually decreased in size. A 34-year-old female presented headache, nausea, and a mild left hemiparesis. An initial CT scan demonstrated a fourth ventricle of approximately normal size and a right temporal mass. The first craniotomy revealed an astrocytoma. A CT scan after the surgical procedure showed enlargement of all ventricles, especially the fourth, resulting from the blockage of the foramina of Luschka and Magendie. The insertion of a V-P shunt was followed by a reduction in size of all ventricles. The diagnosis of DFV was thus confirmed because the fourth ventricle had a demonstrated communication with the third ventricle. After a second craniotomy for tumor recurrence five years later, a CT scan revealed the enlargement of the fourth ventricle and a cyst in the right temporal lobe. A metrizamide CT scan revealed that the cyst was isolated and an RI ventriculogram confirmed obstruction of the aqueduct.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1998

[Intracranial epidermoid and dermoid cysts].

INTRODUCTION: Dermoid and epidermoid cysts are dysembryogenic tumors representing 1% of all intracranial tumors. They are characterized by slow growth, localization to the middle in relation to the basal cisterns and their benign course. OBJECTIVES: To analyze the clinical and radiological characteristics, and the results of surgical treatment of intracranial dermoid and epidermoid cysts. PATIENTS AND METHODS: We reviewed 18 cases of epidermoid and 3 dermoid intracranial cysts which had been diagnosed and treated during a period of 18 years. All patients were diagnosed by computerized tomography (CT) and the last 15 cases by magnetic resonance (MR). RESULTS: The commonest site was the temporal lobe with 7 cases, followed by the suprasellar region with 4 cases. All patients had peculiar imaging characteristics both on CT (hypodense and with no contrast silhouetted) and on MR (hypointensity in T1 and in T2). They were completely resected in 16 cases. There were 3 episodes of aseptic meningitis and 2 deaths. CONCLUSIONS: Dermoid and epidermoid cysts are characterized by long term clinical symptoms. The commonest site is supratentorial in the midline or in the temporosylvian region. The diagnostic investigation of choice is MR. Treatment is surgical, preferably complete resection. However, after sub-total resection there is a prolonged period of remission.

Adolescent↗

PubMedDate not supplied

Correlation of unit recordings with regional cell counts in epileptogenic human temporal lobe.

The previously reported diminished incidence of neuronal activity recorded from areas ipsilateral to a seizure focus may result from either cell loss or pathophysiologic changes in hippocampus and related structures. We examined records of single-cell discharge from 471 electrode bundles in 62 patients who later had cell counts taken from samples of resected tissue. Analysis of variance showed that amygdala and parahippocampal gyrus had more activity than hippocampus and the subicular complex and that the resected side had less activity overall. Only the posterior subicular complex showed more high-amplitude (> 50 microV) activity on the epileptogenic side; all other areas showed more activity contralaterally. Activity between 25 and 50 microV did not differ across sides or structures. Percentage of maximal cell count was correlated with the number of electrodes with high-amplitude activity only in the subicular complex. Low-amplitude activity in nonresected hippocampus, however, was strongly negatively correlated with cell counts on the resected side, perhaps owing to compensatory mechanisms. Cell counts in hippocampus correlated negatively with high-amplitude unit activity in resected amygdala, suggesting reciprocity between these areas. These results suggest that the amount of cell activity recorded from mesiotemporal structures involves bilateral factors more complex than simple cell loss.

Amygdala↗

PubMed2001

GABA(B(1)) mRNA expression in hippocampal sclerosis associated with human temporal lobe epilepsy.

GABA(B) receptors act to inhibit neurotransmitter release from presynaptic terminals, and mediate the late inhibitory postsynaptic potential. Studies of GABA(B) receptor function in rodent models of temporal lobe epilepsy (TLE) suggest that GABA(B) receptor expression and/or function may be perturbed. GABA(B(1)) mRNA levels were investigated in 10 hippocampal resection samples obtained at surgery from intractable hippocampal sclerosis (HS) associated TLE patients and five neurologically normal post-mortem (PM) control samples. In situ hybridisation with a 35S-dATP-labelled oligonucleotide was carried out to measure mRNA levels, along with three-dimensional cell counting, for assessment of neuronal density in hippocampal subregions. GABA(B(1)) mRNA was significantly up-regulated in the subiculum of HS samples as compared with PM controls. When adjusted for the characteristic neuronal density changes observed in HS, GABA(B(1)) mRNA was significantly up-regulated in CA1, hilus and dentate gyrus granule cell layer of HS samples as compared with PM controls. The possibility of increased GABA(B(1)) expression suggests that changes in GABA(B) receptor mechanisms may be involved in the pathogenesis of human HS-associated TLE.

Adult↗

PubMed2000

Alterations of neuronal connectivity in area CA1 of hippocampal slices from temporal lobe epilepsy patients and from pilocarpine-treated epileptic rats.

PURPOSE: Neuronal network reorganization might be involved in epileptogenesis in human and rat limbic epilepsy. Apart from aberrant mossy fiber sprouting, a more widespread fiber rearrangement in the hippocampal formation might occur. Therefore, we studied sprouting in area CA1 because this region is most affected in human temporal lobe epilepsy. METHODS: In slices from hippocampi of patients operated on for temporal lobe epilepsy (n = 134), from pilocarpine-treated rats (n = 74), and from control rats (n = 15), viable neurons were labeled with fluorescent dextran amines. RESULTS: In human hippocampi as well as in pilocarpine-treated rats, the degree of nerve cell loss varied. In 67 of 134 slices from human specimens with distinct Ammon's horn sclerosis and in 23 of 74 slices from pilocarpine-treated rats, a severe shrunken area CA1 presented with a similar picture: few damaged neurons were labeled, and aberrant fiber connections were not visible. This was in contrast to human resected hippocampi and hippocampi from pilocarpine-treated rats with no or moderate loss of neurons. In these cases, pyramidal cells remote from the injection site were labeled (human tissue, n = 59 of 134; pilocarpine-treated rats, n = 39 of 74). In human resected hippocampi without obvious pathology and in control animals, no pyramidal neurons were labeled apart from the injection site. CONCLUSIONS: Axon collaterals of CA1 pyramidal cells are increased in human temporal lobe epilepsy and in pilocarpine-treated rats. Adjacent CA1 pyramidal cells project via aberrant collaterals to the stratum pyramidale and the stratum radiatum of area CA1. This network reorganization can contribute to hyperexcitability via increased backward excitation.

Animals↗

PubMed2004

Linguistic deficits following left selective amygdalohippocampectomy: a prospective study.

Language deficits in 10 patients with medically intractable left-sided temporal lobe epilepsy prior to and following selective amygdalohippocampectomy are described. Preoperatively, a pattern of minor linguistic deficits was observed in three patients; isolated minor naming deficits were detectable in one additional patient. Three months after surgery, six patients' linguistic functions were unchanged, whereas in four patients, a significant decline in linguistic functions could be observed. All four patients revealed a very similar language syndrome characterized by reduced language comprehension and fluency, well-articulated speech, frequent word-finding difficulties, circumlocutions, and semantic paraphasias in the absence of any phonological disorder. These deficits remained stable during the 12-month follow-up period. However, magnetic resonance imaging did not show any neocortical lesions outside the resection area. Possible explanations for these findings include neuronal cell loss and deafferentiation in cortical areas, disruption of the basal temporal language area pathways, reorganization of the language network in chronic temporal lobe epilepsy, and neocortical lesions due to the surgical intervention. Furthermore, correlations between linguistic and demographic data for our patients suggest that patients older at epilepsy onset are at greater risk for developing postoperative language deficits.

Adult↗

PubMed1994

[Long survival after removal of a huge brain tumor which had metastasized from a lung cancer: case report].

Patients with large metastatic brain tumors are considered to have poor prognosis. We report a case of a patient with more than 33 months survival after complete resection of a huge temporal tumor which had metastasized from a lung cancer. A 57-year-old woman presented left hemiparesis and disturbance of consciousness. Magnetic resonance images revealed a huge cystic mass lesion in the right temporal lobe. After a macroscopically complete excision of the tumor, she received radiation therapy (whole brain 50 Gray). She had received lung surgery for the primary lung cancer, 2 years prior to brain metastasis. Histological examination showed papillary tubular adenocarcinoma which was similar to the previously resected lung cancer. Thirty three months after the resection of the intracranial tumor, she has no neurological deficits and no signs of recurrence of either brain tumor or lung tumor. We discuss the size of metastatic brain tumor and the postoperative prognosis of patients with metastatic brain tumor.

Adenocarcinoma, Papillary↗

PubMed1995

Chronic invasive monitoring for identifying seizure foci in children.

In both children and adults, it has been well established that the precise localization of a seizure focus allows for the best possible resection and outcome. Long-term invasive monitoring with DE has been the most widely used modality to evaluate patients with intractable seizures of temporal lobe origin. The study of epilepsy in children, however, requires assessment of the cause of the seizures with a resultant decision regarding the optimal modality of study for the particular problem. Complex partial seizures of medial temporal lobe origin without clear concordance or lateralizing information are best studied using DE. With MR imaging anatomic localization, stereotactic insertion of DE can be performed accurately and relatively safely. The information obtained permits lateralization and focus localization if the lesion is within the medial structures. The ability of DE to study epilepsy outside of the medial temporal lobe, however, is suboptimal. Many centers have used surface electrodes to map temporal lobe foci successfully. SE and SGE have not been widely used in children. Subdural electrode arrays, however, are superior to DE in extratemporal epilepsy because the cortical surface contacts provide the best recordings of epileptiform activity from a wide range of extratemporal regions. The limitations of intraoperative ECoG in the awake child are well understood. It is rare that a child can undergo surgery under local anesthesia and cooperate to the extent necessary for definitive mapping of the seizure focus and eloquent areas. Thus, invasive long-term monitoring would seem ideal in the epileptic pediatric patient because it allows for a more relaxed pace in which to record events, and because of the indwelling nature of these electrodes, it is possible for the investigator to map eloquent areas of the brain before resection. This type of evaluation completely and accurately maps interictal and ictal activity, and through cortical stimulation or mapping of somatosensory areas by evoked potentials, eloquent areas of the brain, such as motor and speech regions, can be identified. This method is limited to older children because the young child often has inadequate cortical development to localize these areas definitively. One should note that in young children (under the age of 4 years), the absence of a response to standard cortical stimulation does not indicate nonfunctional cortex. Long-term intractable seizures and significant antiepileptic drug requirements may contribute to developmental and psychosocial deficiencies in the epileptic patient.(ABSTRACT TRUNCATED AT 400 WORDS)

Child↗