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Results for “Temporal Lobe Resection”

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PubMed1995

Unusual seizure types.

There is no consensus as to what constitutes a diagnostic complex partial seizure type for any given focus. Nevertheless, some forms are seen infrequently, such as in the patient just described who had parietal seizures, whereas others, such as the bland onset followed by oral-alimentary automatisms of temporal lobe epilepsy, are more common. It helps to be aware of the possible origins of these unusual forms when differentiating electrical seizures from pseudoseizures, planning for use of specific pharmacologic treatments, or planning a surgical resection. Although one cannot recommend a surgical resection based on semiology alone, one can place intracranial electrodes more strategically when the hypothesis regarding the seizure focus includes the clinical characteristics of the patient's seizures.

Epilepsy, Frontal Lobe↗

PubMed1995

Extent of medial temporal resection on outcome from anterior temporal lobectomy: a randomized prospective study.

WE REPORT A prospective, randomized, blinded clinical trial comparing seizure and neuropsychological outcomes from anterior temporal lobectomies between two groups of patients. One group (n = 34) underwent hippocampal resection posteriorly to the anterior edge of the cerebral peduncle (partial hippocampectomy). In the other group (n = 36), the hippocampus was removed further to the level of the superior colliculus (total hippocampectomy). The amount of lateral cortical resection was the same between groups. Patients were and neuropsychological morbidity. At 1 year postoperatively, the total hippocampectomy group had a statistically superior seizure outcome compared with the partial hippocampectomy group (69 versus 38% seizure-free), and examination of time to first seizure (survival analysis) revealed significantly superior outcomes associated with total hippocampectomy. There was no increased neuropsychological morbidity associated with the more extensive hippocampal resection.

Adolescent↗

PubMed2002

Surgical treatment of temporal lobe epilepsy. Personal experience.

The authors present their results with epilepsy surgery of the temporal lobe performed during a 5 years period at the Hospital of the University of Jordan, in 12 patients. All patients underwent comprehensive presurgical evaluation, including neurological history, examination, video-Electroencefalogram, Electroencephalogram for intercritical and habitual seizures and optimum magnetic resonance. After appropriate selection, we performed epilepsy surgery in 12 patients (9 males and 3 females). The mean age at operation was 21.4 years (range 4-44 years). All patients were receiving high therapeutic doses of antiepileptic therapy. Abnormal findings in Magnetic Resonance were observed in all cases. Pre and post resection electrocorticogram were recorded and graded according to Jay Scale. Pathological findings showed, neoplasic lesion in 2 cases (16%); one ganglioglioma and a low grade astrocytoma) and 10 patients (84%) showed non-neoplasic lesions. Three patients (25%) had cortical dysplasia, another 3 (25%) had mesotemporal sclerosis, three more (25%) gliosis and one (8%) an arachnoid cyst. Post resection ECoG showed (84%) type A, (8%) type B, and (8%) type C. The present study has shown that intraoperative ECoG has an important role in the prediction of medically intractable epilepsy. Outcome of temporal lobe epilepsy surgery in our series was comparable to results reported by other authors despite of the absence of sophisticated functional tests.

Adult↗

PubMed1991

Comparison of bitemporal and unitemporal epilepsy defined by depth electroencephalography.

Of 166 consecutive patients studied with depth electroencephalography (EEG), 87 had seizures arising from one temporal lobe and 23 had seizures arising independently from each temporal lobe. We retrospectively reviewed and compared those patients with unitemporal and those with bitemporal seizures. There was no statistically significant differences between the two groups in terms of age at onset of seizures, duration of epilepsy, localization of scalp EEG abnormalities, surgical results, or pathological findings. The bitemporal group, however, had significantly fewer patients with a history of febrile seizures (p less than 0.025). Two patients with bitemporal seizures were later found to have extratemporal lesions, and one an extrahippocampal temporal lesion, on magnetic resonance scans; one patient's extratemporal lesion was resected and all habitual seizures stopped. These findings suggest that a single pathophysiological process accounts for unitemporal and some bitemporal epilepsy, but that independent onset of seizures from each temporal lobe detected by depth EEG may also indicate extratemporal foci.

Adolescent↗

PubMed1994

What is needed for resective epilepsy surgery from a neurosurgical point of view?

Invasive versus non-invasive epileptogenic zone definition was analyzed in a series of 89 patients operated on for drug-resistant epilepsy. In the group of 69 cortical resections, 26% needed invasive recordings, 13.5% when foreign-tissue lesions had been detected by MRI and 32% when were absent. In this last group temporal resections had invasive EEG recordings in 23.5% versus 54.5% when the epileptogenic zone was extratemporal. In a group of 43 temporal resections with more than one year follow-up MRI has detected some abnormality in 84%. Excluding focal lesions, MRI detected hippocampal/temporal lobe atrophy in 66% of the cases in agreement with other noninvasive tests and in 4% contralateral to the epileptogenic zone located by subdural strips. The outcome analysis showed that 85% of the patients with MRI-EEG agreement were seizure free in contrast to only 43% when MRI was non-lateralizing. Future studies has to be oriented to better understand the epileptic process of patients without MRI abnormalities.

Brain↗

PubMedDate not supplied

[Dysembryoplastic neuroepithelial tumors. A benign tumor cause of partial epilepsy in young adults].

Dysembryoplastic neuroepithelial tumor (DNT) is a newly recognized brain lesion first reported in 1988 by Daumas-Duport et al. The authors described five cases of DNT, that occurred in young people and were characterized by partial seizures. Seizures could become intractable and secondary generalised. Usually, the interictal neurological examination was normal. In most cases, computed tomography showed a supratentorial, "pseudocystic" low density appearance associated in some cases with calcific hyperdensity or focal contrast enhancement. Magnetic resonance imaging demonstrated a predominantly intracortical lesion. Common features included low signal intensity on T1-weighted images and high signal on T2-weighted images. Temporal and frontal lobes were mainly involved. Dysembryoplastic origin explained the clinical and radiological stability and the benign evolution of this tumor. Tumor resection was required only when epilepsy was intractable or when there was intracranial hypertension. Earlier intervention can prevent the physical and psychosocial damage resulting from chronic seizures and can improve the prognosis for these young patient. Histologically, DNT have been incorporated amond the category of neuronal and mixed neuronoglial tumors. Three patterns are described: a simple form with a unique glioneuronal element, a complex form with specific glioneuronal element, nodules being made of multiple variants looking like astrocytomas, oligodendrogliomas or oligo-astrocytomas, foci of dysplastic cortical disorganisation, and a non specific form. When specific glioneuronal composant is absent (50% of cases), the identification of DNT has therapeutic and prognostic implications because aggressive therapy may be avoided, sparing these young patients the long term effects of radio-or chemotherapy.

Adult↗

PubMed2004

Depression and anxiety before and after temporal lobe epilepsy surgery.

PURPOSE: To examine the course of depression and anxiety in patients with temporal lobe epilepsy (TLE) treated with epilepsy surgery (and anticonvulsant drugs) or medical means alone. METHODS: Of 94 TLE patients evaluated for epilepsy surgery, 76 underwent a resective procedure, 18 continued on medical treatment alone. Depression (Beck Depression Inventory (BDI)) and anxiety scores (Self-Rating Anxiety Scale (SRAS)) were examined during presurgical evaluation (T1) and after a mean of 16 months (T2), or 12 months after surgery. Depression and anxiety scores were related to type of intervention, underlying epileptogenic lesion, change of seizure control and anticonvulsant therapy. RESULTS: At T1, depression and anxiety scores were higher in patients with TLE than scores in published normal populations. At T2, depression but not anxiety scores were significantly lower than at T1. Change of depression scores interacted with improvements of seizure control. CONCLUSIONS: Evidence of depression and anxiety is commonly found in patients with TLE. Depression improves not because of epilepsy surgery per se, but because of improved seizure control. This is more commonly achieved by surgery than medical treatment. The results are consistent with the hypothesis that depression in TLE is caused by pathological epileptic activity rather than a fixed structural defect.

Adult↗

PubMed1999

Extended lateral subtemporal approach for petroclival meningiomas: report of experience with 24 cases.

Subtemporal craniotomy centred on the external ear canal and its basal extension, involving resection of the roots of the zygomatic arch, roof of the external ear canal and superior third to half of the mastoid bone was used to treat surgically 24 meningiomas located in the petroclival region, having their maximum bulk at the level of tentorium. The approach was found to be suitable for dealing with middle fossa extensions of the tumour in addition to the part extending up to the mid-clivus or vertebrobasilar junctional region. The direction of the approach to the petroclival region was the shortest and most perpendicular from 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 manoeuverable 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 petroclival meningiomas and its possible advantages over other available approaches to these lesions are analysed in this report.

Adolescent↗

PubMed2004

Surgical Treatment for Extratemporal Epilepsy.

Partial seizures of extratemporal origin may present unique challenges in the patient with medically refractory seizures. The efficacy of an extratemporal focal cortical resection may be less effective than an anterior temporal lobectomy for intractable epilepsy. The potential operative complications may be increased in individuals with extratemporal epilepsy because of functional cerebral cortex involvement and the need for a large cortical resection to significantly reduce seizure tendency. Partial seizures of extratemporal origin are predominantly associated with frontal lobe epilepsy. The most effective treatment for intractable partial epilepsy is a focal cortical resection with excision of the epileptogenic zone, that is, an area of ictal onset and initial seizure propagation. The preoperative evaluation and operative strategy in patients with partial epilepsy of extratemporal origin associated with pharmacoresistant seizures is determined by the anatomic localization of the epileptogenic zone and the presence of a substrate-directed disorder. The goals of surgical treatment in extratemporal epilepsy include rendering the patient seizure-free, avoiding operative morbidity, and allowing the individual to become a participating and productive member of society. Before surgical treatment, the individual with extratemporal epilepsy will require a comprehensive preoperative evaluation, including routine electroencephalogram (EEG), long-term EEG monitoring, neuropsychologic studies, and magnetic resonance imaging (MRI). Patients with a normal MRI study, conflicting preoperative evaluation, or involvement of suspected functional cerebral cortex would require chronic intracranial EEG monitoring. The rationale for intracranial EEG includes localization of the ictal onset zone or intraoperative functional mapping, or both. Two-fluorodeoxyglucose positron emission tomography studies are usually unremarkable in patients with extratemporal epilepsy and normal MRI scans. Subtraction ictal single photon emission computed tomography coregistered to MRI (SISCOM) study may be useful to demonstrate a localized cerebral perfusion alteration in patients with intractable partial epilepsy. The diagnostic yield of SISCOM has been confirmed in patients with extratemporal epilepsy undergoing surgical treatment. The results of the SISCOM study may tailor the placement of intracranial EEG electrodes and affect the operative strategy. Patients with extratemporal epilepsy overall are less favorable operative candidates than individuals with medial temporal lobe epilepsy. However, individuals with MRI-identified lesional pathology of SISCOM-identified perfusion alterations concordant with the epileptogenic zone may be considered for surgical treatment. Chronic intracranial EEG monitoring may be necessary to confirm the localization of the ictal onset zone before epilepsy surgery. Patients with normal neuroimaging studies and extratemporal epilepsy are unlikely to be rendered seizure-free with focal cortical resection and should be considered candidates for other alternative forms of treatment for intractable partial epilepsy. Patients with non-substrate-directed extratemporal epilepsy should undergo a preoperative evaluation and surgical treatment at a comprehensive epilepsy center with extensive experience in chronic intracranial EEG monitoring and contemporary neuroimaging procedures because of the inherently high acuity associated with the operative management clinical disorder.

Journal Article↗

PubMed2001

[A pediatric case of intractable complex partial seizures associated with mesial temporal lobe astrocytoma: usefulness of interictal epileptiform discharges in the present case].

The patient was a 10-year-old male with normal developmental milestones. He had medically intractable complex partial seizures since the age of 7 years. At the age of 10 years, he had focal motor seizures of the right face, and a head CT scan showed a calcified lesion in the left mesial temporal region. The tumor exhibited low intensity on T 1-weighted and high intensity on T 2-weighted MR images, and was not enhanced by gadolinium-diethylenetriamine pentaacetic acid. Interictal SPECT showed hypoperfusion in the left temporal region. One-day video/EEG monitoring revealed very frequent epileptiform discharges which occurred only during sleep period exclusively in the left anterior-to-middle temporal region. The patient underwent lesionectomy with the guidance of electrocorticography. The histological study of the resected tissue showed astrocytoma. After surgery he has had no seizures for 10 months. It was concluded that very frequent interictal epileptiform discharges strictly localized to the temporal lobe at which MRI-identified tumor was present could be predictive of epileptogenic zone in the present patient in whom clinical symptoms and the results of other studies were also concordant.

Astrocytoma↗

PubMed2000

Temporal and spatial determination of EEG-seizure onset in the frequency domain.

OBJECTIVE: A quantitative analysis of scalp electric fields in patients suffering from pharmacoresistant temporal lobe epilepsy was performed in order to study the development of rhythmic ictal activities over time. METHODS: A method that calculates phase-corrected voltage maps in the frequency domain (FFT-approximation) was applied to ictal multichannel recordings in 10 epileptic patients. The onset of the ictally dominant frequency was determined and its temporal evolution over a time period of 46 s around the ictal EEG onset was studied. The analysis was completed by a linear inverse solution that estimated the sources of the dominant frequency. RESULTS: This method permitted the identification of an ictally dominant frequency which started on the average prior to the onset of initial EEG signs as determined by visual inspection. The frequency incremented during the evolution of the seizure in all patients. The linear inverse solution algorithm localized the source of this frequency to the brain region which was clinically determined as the site of seizure onset and whose resection rendered all patients seizure-free. CONCLUSIONS: Our data suggest that the constant increase of the ictally dominant frequency is related to the amount of temporal lobe tissue generating the ictal discharges. Frequential analysis of ictal electric fields can be reliably used to detect focal pathological activity early during seizure onset arising in deep structures such as the mesial temporal lobe.

Adult↗

PubMedDate not supplied

Granule cell mRNA levels for BDNF, NGF, and NT-3 correlate with neuron losses or supragranular mossy fiber sprouting in the chronically damaged and epileptic human hippocampus.

This study determined in temporal lobe epilepsy patients if there were correlations among hippocampal granule cell expression of neurotrophin mRNAs, aberrant supragranular mossy fiber sprouting, and neuron losses. Consecutive surgically resected hippocampi (n = 9) and comparison tissue from autopsies (n = 3) were studied for: 1. Granule cell mRNA levels using in situ hybridization for brain-derived neurotrophic factor (BDNF), nerve growth factor (NGF), and neurotrophin-3 (NT-3); 2. neo-Timm supragranular mossy fiber sprouting; and 3. Ammon's horn neuron densities. Clinically, patients were classified into those with hippocampal sclerosis (HS; n = 7) and non-HS cases (i.e., mass lesions and autopsies; n = 5). Results showed that compared to non-HS cases, HS patients showed increased granule cell mRNA levels for BDNF, NGF, and NT-3 (p = 0.035, p = 0.04, p = 0.045 respectively; one-tail directional test). Moreover, granule cell BDNF mRNA levels correlated inversely with Ammon's horn neuron densities (p = 0.02) and correlated positively with greater supragranular mossy fiber sprouting (p = 0.02). NGF mRNA levels correlated inversely with Ammon's horn neuron densities (p = 0.02), and NT-3 mRNA levels correlated inversely with age at surgery (p = 0.04) and correlated positively with greater mossy fiber sprouting (p = 0.026). These results indicate in the chronically damaged human hippocampus that granule cells express neurotrophin mRNAs, and mRNA levels correlate with either hippocampal neuron losses or aberrant supragranular mossy fiber sprouting. These data support the hypothesis that in the epileptic human hippocampus, there may be pathophysiologic associations among mossy fiber synaptic plasticity, hippocampal neuron damage, and granule cell mRNA neurotrophin levels.

Analysis of Variance↗

PubMed1990

The Zürich amygdalo-hippocampectomy series: a short up-date.

Selective amygdalohippocampectomy was developed as a surgical treatment for temporal lobe epilesy with a well-defined unilateral mesiobasal limbic seizure onset. Since 1975, 236 patients have been operated on in Zürich. We briefly summarize recent studies on the seizure outcome with analysis of the postoperative long-term fluctuations in relation to postoperative anticonvulsant drug treatment, on the underlying neuropathology, and on the relationships between magnetic resonance scanning estimates of total volume of the removed tissue and the resection scores of amygdala, hippocampus and parahippocampus gyrus.

Adult↗

PubMed2002

Lateralizing semiology predicts the seizure outcome after epilepsy surgery in the posterior cortex.

Compared with temporal or frontal resections, epilepsy surgery in the posterior cortex is rarely performed, and the literature concerning clinical predictors for the postoperative seizure outcome in this particular subgroup is sparse. The data of 42 patients with lesional focal epilepsies of the parieto-occipital lobe and the occipital border of the temporal lobe were evaluated retrospectively and related to the seizure outcome 2 years after epilepsy surgery. The investigated parameters included ictal semiology, pre- and postoperative EEG and neuroimaging, histological findings and demographic data. Postoperatively, seizure-free outcome was seen in: (i) 69% of patients with lateralizing auras, but only in 28% of patients without lateralizing auras (P = 0.01); and (ii) 57% of the patients with lateralizing seizures, but only in 17% of patients without lateralizing ictal semiology (P = 0.02). None of the patients with neither lateralizing auras nor lateralizing seizures achieved freedom from seizures (P < 0.01). The proportion of lateralizing seizures (P < 0.01) and auras (P = 0.02) in the total number of recorded seizures and auras was significantly related to the probability of a favourable surgical outcome. No patient with clinical lateralizing signs to the non-lesional hemisphere but 58% without such "false" lateralization achieved freedom from seizures (P = 0.02). The following parameters also proved to be predictive for a favourable seizure outcome: (i) tumoural aetiology; and (ii) absence of epileptiform discharges in the postoperative EEG. The presence and frequency of ictal semiology lateralizing to the lesional hemisphere and the absence of lateralizing signs to the non-lesional hemisphere are highly predictive of a favourable outcome after surgical treatment of epilepsy in the posterior cortex.

Adolescent↗

PubMed1988

Surgical treatment of intractable neonatal-onset seizures: the role of positron emission tomography.

We have performed positron emission tomography (PET) with 2-deoxy-2[18F]fluoro-D-glucose (FDG) in eight infants and children (aged 18 days to 5 years) with medically refractory epilepsy of neonatal onset. It was hypothesized that in at least some of these infants a surgical approach (focal resection, cerebral hemispherectomy) might be of benefit in achieving seizure control, and that PET might assist in surgical selection. In three of the eight subjects, interictal PET revealed unilateral diffuse hypometabolism; following cerebral hemispherectomy in these three patients, all seizures ceased and there were no adverse effects. In one child, ictal PET showed hypermetabolism in the left frontal cortex, left striatum, and right cerebellum; a partial left cerebral hemispherectomy guided by intraoperative electrocorticography was performed, following which all seizures ceased. One infant had relative hypermetabolism in the right temporal and occipital lobes, right thalamus, and left frontal lobe on ictal PET, and EEG telemetry revealed a right occipitotemporal epileptic focus; this infant died from anesthetic complications following right occipitotemporal cortical resection. Of the three unoperated patients, one is a potential candidate for right frontal lobectomy, but the other two were not considered to be surgical candidates due to bilateral epileptogenicity. Neuropathologic correlation in our series revealed that PET is a sensitive test capable of detecting cytoarchitectural disturbances whereas CT and MRI failed in this regard. In addition, PET provides a very unique and important assessment of the functional integrity of brain regions outside the area of potential resection.

Brain↗

PubMed1996

Mesial temporal lobe epilepsy: clinical features and seizure mechanism.

To study the clinical features of mesial temporal lobe epilepsy, 24 cases were selected based on two criteria: (a) the origin of seizure was localized to the mesiotemporal region on phase 2 monitoring, and (b) a class 1 or 2 postoperative result was obtained after selective mesiotemporal resection. A history of febrile convulsion, particularly in the form of status epilepticus, seems to be a prognostic factor. As for presurgical evaluation, electroencephalography (EEG), magnetic resonance imaging (MRI), magnetoencephalography (MEG), and ictal single-photon emission-computed tomography (SPECT) are important tests. Recording of spontaneous seizures by means of intracranial electrodes is the most reliable for diagnosis. Ammon's horn sclerosis and mesial temporal sclerosis are the most frequent pathologic findings. The seizure mechanism was studied by means of depth EEG recordings and ictal SPECT. The hippocampal formation is more responsible than the amygdala for the origin of seizures. Preferential pathways for seizure spread may be the fornix and stria terminalis, amygdalofugal fibers, and uncinate fasciculus. The concept of mesial temporal lobe epilepsy is valid for selecting medically refractory but surgically remediable patients for surgical treatment.

Adolescent↗

PubMed2005

Subtemporal approach to basilar bifurcation aneurysms: advanced technique and clinical experience.

OBJECTIVE: The surgical treatment of basilar bifurcation aneurysms is challenging, and many of these aneurysms are currently treated by endovascular means. However, the complete closure of the aneurysm by surgical clipping still remains the best and most permanent cure for the aneurysm. The "gold standard", subtemporal approach was established and introduced by Drake and it has been adapted by the senior author Hernesniemi. We describe our present modified technique of this approach based on clinical experience. METHODS: The subtemporal approach to basilar bifurcation aneurysms has been regularly used by the senior author Hernesniemi in recent 15 years in over 200 operations in Kuopio and Helsinki, Finland. RESULTS: This approach is suitable in most basilar bifurcation aneurysms except for those high above the posterior clinoid process. To avoid temporal lobe damage, cerebrospinal fluid drainage is necessary. Benefits of subtemporal approach are short operative and retraction times, and no need for skull base resection. CONCLUSION: The subtemporal approach is simple and safe in experienced hands, and should be considered the standard method to approach most basilar bifurcation aneurysms.

Basilar Artery↗

PubMed2002

Isolated primary Langerhans' cell histiocytosis of central nervous system.

Solitary eosinophilic granuloma that involves the CNS is an uncommon lesion and most frequently affects the hypothalamus. We report a new and rare case of solitary eosinophilic granuloma of the left temporal lobe in a patient without systemic disease. The diagnosis was confirmed by electron microscopy and immuohistochemical techniques. The treatment of choice is surgical resection. There is a better prognosis in comparison with cases accompanied by systemic disease.

Adult↗