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PubMedDate not supplied

[Experience in surgical treatment of patients with focal forms of temporal epilepsy].

Fifteen patients with focal lesions of temporal epilepsy were examined before and 6 months to 4 years after surgery. There were low-grade gliomas in 13 cases, muscle tissue heterotopy in 1 case, and medial temporal sclerosis in 1. Epileptogenic lesions were localized in the medial structures of the temporal lobe in 10 cases and in the lateral temporal regions in 5 cases. Comprehensive neurophysiological study, including intraoperative electrocorticography, was used to identify an epileptogenic zone (EZ). EZs were found in the medial structures on the affected side in all patients. Lesionectomies were performed in all cases. It was combined with medial resection in 12 cases (it was done in 10 patients until epileptic activity disappeared). Nine patients stopped having seizures after surgery. One patient had only auras. Improvements were slight in 5 patients. A relationship was found between the surgical outcomes and the site of a lesion and EZ. They authors conclude that complete recovery may occur in cases with medial locations of a lesion and EZ. The outcomes of surgery are much poorer in cases with the lateral sites of an lesion and in those with the medial site of EZ.

Brain↗
PubMed2006

Reduced neocortical thickness and complexity mapped in mesial temporal lobe epilepsy with hippocampal sclerosis.

We mapped the profile of neocortical thickness and complexity in patients with mesial temporal lobe epilepsy (MTLE) and hippocampal sclerosis. Thirty preoperative high-resolution magnetic resonance imaging scans were acquired from 15 right (mean age: 31.9 +/- 9.7 standard deviation [SD] years) and 15 left (mean age: 30.8 +/- 8.4 SD years) MTLE patients who were seizure-free for 2 years after anteriomesial temporal resection. Nineteen healthy controls were also scanned (mean age: 24.8 +/- 3.9 SD years). A cortical pattern matching technique mapped thickness across the entire neocortex. Mesial temporal structures were not included in this analysis. Cortical models were remeshed in frequency space to compute their fractal dimension (surface complexity). Both MTLE groups showed up to 30% bilateral decrease in cortical thickness, in the frontal poles, frontal operculum, orbitofrontal, lateral temporal, and occipital regions. In both groups, cortical complexity was decreased in multiple lobar regions. Significant linkages were found relating longer duration of epilepsy to greater cortical thickness reduction in the superior frontal and parahippocampal gyrus ipsilateral to the side of seizure onset. The pervasive extrahippocampal structural deficits may result from chronic seizure propagation or may reflect other causes such as initial precipitating factors leading to MTLE.

Adult↗
PubMed1990

Focal functional anatomy of dorsolateral frontocentral seizures.

We compared 6 patients with dorsolateral frontocentral seizures to 7 patients with temporal lobe seizures. We determined general seizure location by structural lesions in 7 patients, bilateral depth electrodes in 4, and EEG and semiology in 2. We then mapped seizure cortex and essential cortex using chronic ECoG arrays. Two ECoG patterns were similar in frontal and temporal seizures. Focal patterns were near lesions and resections. Regional patterns were distant from lesions but not associated with worse surgical outcome. "Dipolar" seizure patterns occurred in one-half of frontal patients with maps like somatosensory evoked responses, consistent with focal seizure anatomy and involvement of sensorimotor cortex. Dipole location estimates were near centers of seizure cortex determined by lesions, semiology, and outcome. Six temporal patients had focal excisions that gave significant seizure reduction in all. All frontocentral patients had focal excisions that significantly reduced seizures except in 1 patient with progressive disease. We conclude that dorsolateral frontocentral seizures have focal functional anatomy that can be predicted by ictal ECoG.

Adult↗
PubMed2005

Spatio-temporal analysis by voltage topography of ictal electroencephalogram on MR surface anatomy scan for the localization of epileptogenic areas.

A 15-year-old girl developed intractable epilepsy following a right transcallosal resection of the intraventricular teratoma. Magnetic resonance (MR) imaging showed a T (2)-prolonged subcortical lesion in the right frontal lobe as well as a residual intraventricular tumor. The integration of the voltage topography of ictal onset activities of the scalp-recorded electroencephalogram (EEG) and a surface anatomy scan of MR images clearly revealed the epileptogenic area on the cortex above the subcortical lesion, with the propagation pattern towards the frontopolar area. Excision of the epileptogenic cortex and underlying gliosis resulted in a successful cessation of the epilepsy. This non-invasive EEG technique provided useful information that accurately localized the epileptogenic area on a large structural abnormality without invasive intracranial electrocorticographic monitoring.

Adolescent↗
PubMedDate not supplied

[Giant cutaneous squamous cell carcinoma of the nose with subsequent brain extension].

INTRODUCTION: Cutaneous squamous cell carcinoma is an invasive and destructive tumor, and may cause death by local extension or because of metastasis. We report the case of a patient with a giant squamous cell carcinoma of the nose and extension to the brain and discuss the main risk factors from this extension. OBSERVATION: Resection of a giant squamous cell carcinoma was performed of the nose in a 45 year-old man after debulking radiotherapy. Histological examination disclosed a well-differentiated tumor and perineural involvement, with at least a 6 mm margin. A first relapse occurred on the orbital edge of the initial resection, the lesion was removed revealing an involvement of the infra-orbital nerve. Whilst the patient was receiving chemotherapy, a second relapse occurred responsible for ophthalmoplegia and loss of vision, with involvement of the left orbital apex, cavernous sinus and temporal lobe. The patient died from grand mal seizures. DISCUSSION: Brain extension of cutaneous squamous cell carcinoma of the head is rare. It develops along the anatomic pathways, especially perineural spread. Main risk factors for such a poor course are discussed, including the size of tumor, the anatomic site, the depth and perineural invasion.

Brain Neoplasms↗
PubMedDate not supplied

Gliosarcoma with areas of primitive neuroepithelial differentiation and extracranial metastasis.

We report a case of gliosarcoma with areas of primitive neuroepithelial differentiation arising in the temporal lobe of a 53-year-old man. The sarcomatous component of this tumor was perivascular in its distribution and showed expression of factor VIII-related antigen, smooth muscle actin and CD34. The primitive neuroepithelial component possessed a small cell morphology and showed expression of neuronal antigens. Strong expression of p53 was demonstrated throughout the tumor with only focal weak expression of epidermal growth factor receptor. The tumor developed widespread extraneural metastases 5 months after surgical resection of the primary tumor. Histological examination of the liver metastases showed them to consist predominantly of the primitive neuroepithelial component. We believe this to be a novel pattern of differentiation in a gliosarcoma which in this case was associated with an aggressive metastatic potential.

Biomarkers, Tumor↗
PubMed2002

Fusiform gyrus epilepsy: the use of ictal magnetoencephalography. Case report.

The authors report successful presurgical identification of an epileptic focus in the fusiform gyrus by using ictal magnetoencephalography (MEG), which was performed with the aid of an advanced whole-brain neuromagnetometer. A 22-year-old man had suffered from medically refractory complex partial seizures since he was 10 years of age. Seizure symptoms, magnetic resonance imaging, and ictal single-photon emission computerized tomography examinations indicated right temporal lobe epilepsy; however, ictal electroencephalography, including sphenoidal recordings, failed even to lateralize the seizure focus. The MEG studies revealed that equivalent current dipoles of interictal activities were scattered bilaterally around the medial temporal structures, but those of ictal onset and postictal activities formed a cluster in the left fusiform gyrus. After confirmation of each ictal and interictal MEG finding by using long-term electrocorticography recordings, focal cortical resection of the left inferior temporal and fusiform gyri was performed. The histopathological diagnosis was cortical dysplasia, and the patient has achieved a good seizure outcome, now 15 months after the operation. Ictal and also postictal MEG may be more specific than interictal MEG for identifying the ictal onset zone.

Adult↗
PubMed2003

Desmoplastic fibroma of the cranium: case report and review of the literature.

OBJECTIVE AND IMPORTANCE: Desmoplastic fibroma is a benign bone tumor that can be locally aggressive. It usually occurs in the long bones and mandible. We report on a patient with a desmoplastic fibroma arising in the temporal bone and review previously published cases of desmoplastic fibroma originating within the cranium. CLINICAL PRESENTATION: A 43-year-old woman presented with a 12-year history of progressively worsening head asymmetry. Magnetic resonance imaging and computed tomography demonstrated a mass originating from the bone and involving the adjacent soft tissues. INTERVENTION: A temporal parietal craniectomy was performed with excision of a large tumor involving the bone. An acrylic cranioplasty was used to replace the bone. Pathological examination of the lesion identified desmoplastic fibroma of the cranium. After surgery, the patient's cranial asymmetry was corrected. CONCLUSION: Desmoplastic fibroma of the cranium is rare. Surgical resection is the treatment of choice.

Adult↗
PubMedDate not supplied

Response of multiple seizure types to corpus callosum section.

Twenty-four patients (16 men, 8 women) underwent corpus callosum section specifically for improvement of control of atonic or tonic seizures that resulted in falls and injuries. All patients suffered from multiple seizure types, including complex partial (CP) and tonic-clonic (TC) seizures, in addition to the tonic or atonic episodes. Preoperative seizure frequency was quantified for all types for 1 year immediately before surgery and for the most recent year since the procedure; average monthly counts were obtained for each seizure type. The period of follow-up since surgery averaged 43 months (range, 23-79 months). Statistically significant improvements were documented, not only for the atonic/tonic seizures (p less than 0.0001) for all patients, but also for TC seizures (17 patients; p less than 0.001) and CP seizures (20 patients; p less than 0.02). Six patients experienced an exacerbation of CP seizures postoperatively, and three developed new simple partial (SP) seizures. In all of the CP group and all three of the SP group, ictal video and EEG features suggested that the new seizures were an aborted expression of the previously generalized seizures. From these data, we conclude that callosotomy is an effective treatment for tonic, atonic, and TC seizures intractable to anticonvulsant medications. Three patients became seizure free. The procedure may also be useful for certain specific subgroups of CP epilepsy, but further studies are required before expanding callosotomy to intractable CP seizures not amenable to focal resection.

Accidental Falls↗
PubMed1992

Behavioural memory after temporal lobectomy or amygdalo-hippocampectomy.

A total of 46 patients who had undergone surgery for the relief of temporal lobe epilepsy were tested on the Rivermead Behavioural Memory Test (RBMT) and two traditional tests of memory. The patient and a relative or close friend were also asked to complete a questionnaire about the everyday memory problems experienced by the patients. Scores on the RBMT failed to distinguish between patients who had undergone either a traditional en bloc temporal lobectomy or a more restricted resection, the amygdalo-hippocampectomy, although scores on one of the traditional memory tests did. Epilepsy-related variables did not alter the outcome of data analyses. Only relatives' questionnaire ratings of patients' memory correlated with patients' scores on the RBMT.

Adult↗
PubMed2006

Carbamazepine-resistance in the epileptic dentate gyrus of human hippocampal slices.

Overexpression of drug efflux pumps at the blood brain barrier (BBB) has been suggested to be one important factor contributing to drug resistance in epilepsy. This would imply that resected brain tissue of drug-resistant patients is drug-sensitive in absence of the BBB. Here we studied the effects of carbamazepine (CBZ) at therapeutically relevant concentration on epileptiform activity electrophysiologically recorded in acute hippocampal slices of patients with mesial temporal lobe epilepsy (MTLE; 28 patients, 49 slices) or extra-hippocampal tumours (tumour; 6 patients, 11 slices). Epileptiform activity was induced by hilar stimulation (0.067 Hz) during elevation of extracellular potassium concentration ([K(+)](o)) and remained self-sustained in presence of 10-12 mM [K(+)](o). Quantitative analysis of data revealed that epileptiform activity in tissue of tumour-patients was predominantly suppressed by CBZ, indicating that the 'epilepsy model' used is CBZ-sensitive. In contrast, epileptiform activity in tissue of drug-resistant MTLE patients was resistant to CBZ in 82% of patients, partially suppressed in 11% and completely suppressed in 7%. The effects of CBZ in tissue of MTLE patients did not depend on the type of activity, hippocampal pathology, excitability of the tissue, or equilibration time of the drug. Considering that CBZ has direct access to all compartments of the slice, our results suggest that CBZ-resistance mechanisms are located within the parenchyma of the dentate gyrus and contribute to drug resistance in the majority of MTLE patients. BBB-located drug-resistance mechanisms per se may play a minor role in this region, because CBZ-sensitivity was only observed in 7% of CBZ-resistant patients.

Action Potentials↗
PubMed1994

The superior orbital fissure: a microanatomical study.

The superior orbital fissure (SOF) is a small (3 x 22 mm), but functionally very important, region. The microsurgical anatomy of the SOF was studied on five adult, formalin-fixed cadavers. The vascular structures of three of them were injected with latex. The SOF contains the third, fourth, and sixth nerves, the ophthalmic branch of the fifth nerve, and the superior orbital vein. It is divided by the two tendons of the lateral rectus muscle: the superior part contains the fourth nerve, the frontal and the lacrimal branches of the ophthalmic division of the fifth nerve, and the superior orbital vein; the inferior part contains the superior and inferior branches of the third, the nasociliary, and the sixth nerves. In regard to surgical access to lesions involving the SOF, the question is often raised as to whether the dissection should be started from the cranial or the orbital side. The following procedure is recommended: 1) frontotemporo-orbital craniotomy; 2) resection of the lesser wing of the sphenoid bone, of the anterior clinoid, and of the superolateral part of the orbital roof and opening of the dura along the Sylvian fissure, with an extension to the frontal lobe and another extension to the temporal lobe; 3) incision of the periorbita in its superolateral part and identification of the frontal nerve; and 4) dissection of the frontal nerve in an anteroposterior direction. The fourth nerve will be found medially and inferiorly to the frontal nerve. The third nerve will be found inferomedially to the frontal nerve in the SOF, and the sixth nerve will be found inferiorly to the inferior branch of the third nerve.

Adult↗
PubMed2002

Stereotactic radiosurgery for pilocytic astrocytomas when multimodal therapy is necessary.

OBJECT: The goal of this study was to examine the role of stereotactic radiosurgery in the treatment of patients with recurrent or unresectable pilocytic astrocytomas. METHODS: During a 13-year interval, 37 patients (median age 14 years) required multimodal treatment of recurrent or unresectable pilocytic astrocytomas. Tumors involved the brainstem in 18 patients, cerebellum in three, thalamus in five, temporal lobe in four, and parietal lobe in two, as well as the hypothalamus, optic tract, corpus callosum, insular cortex, and third ventricle in one patient each. Diagnosis was confirmed with the aid of stereotactic biopsy in 12 patients, open biopsy in five, partial resection in eight, and near-total resection in 12. Multimodal treatment included fractionated radiation therapy in 10 patients, stereotactic intracavitary irradiation of tumor in four, chemotherapy in two, cyst drainage in six, ventriculoperitoneal shunt placement in three, and additional cytoreductive surgery in four. Tumor volumes varied from 0.42 to 25 cm3. The median radiosurgical dose to the tumor margin was 15 Gy (range 9.6-22.5 Gy). After radiosurgery, serial imaging demonstrated complete tumor resolution in 10 patients, reduced tumor volume in eight, stable tumor volume in seven, and delayed tumor progression in 12. No procedure-related death was encountered. Thirty-three (89%) of 37 patients are alive at a median follow-up period of 28 months after radiosurgery and 59 months after diagnosis. Eight patients participated in follow-up review for more than 60 months. Three patients died of local tumor progression. CONCLUSIONS: Stereotactic radiosurgery is a valuable adjunctive strategy in the management of recurrent or unresectable pilocytic astrocytomas. Despite the favorable histological characteristics and prognosis usually associated with this neoplasm, an adverse location, recurrence, or progression of this disease requires alternative therapeutic approaches such as radiosurgery.

Adolescent↗
PubMedDate not supplied

Mirror focus: function of seizure frequency and influence on outcome after surgery.

The concept of the mirror focus (MF) implies that an actively discharging epileptiform region may induce similar paroxysmal behavior in a homologous site. In a group of patients with complex partial seizures (CPS) we investigated whether occurrence of a MF was influenced by certain clinical factors and whether surgical outcome was influenced by the presence of an MF. Factors studied included age at onset, duration, and total number of seizures. Patients had had CPS for > 3 years and had pathologically proven temporal lobe neoplasms. Seizure frequency was estimated by the history-taking physician. We estimated total seizure number by multiplying frequency by duration. Seven patients had MF, and 15 did not. Mean age at onset of seizures, duration of seizure disorder, and total seizure number did not vary statistically between the two groups of patients. All patients with an MF except 1 were seizure-free at follow-up. Ten of the 15 patients without MF were seizure-free. Three patients who were not seizure-free had had subtotal resection owing to tumor overlap with eloquent cortex. We conclude that an MF is not a contraindication to operation even when the preponderance of interictal spike activity is contralateral to the tumor or when seizures appear to arise from the MF on scalp EEG.

Adolescent↗
PubMed1994

[Surgery for temporal lobe epilepsy].

Interest in surgery for intractable temporal lobe epilepsy has increased during the last ten years, mainly due to a better identification of the epileptogenic focus by modern imaging techniques (MRI) or functional tools (TEP and SPECT scanning). Depth electrodes recording is not mandatory and can be restricted to patients who do not meet congruent non invasive criteria. Simultaneously, modification of surgical techniques has been proposed: in addition to classical temporal lobectomy, other methods are used in order to minimize the resection of temporal lateral neocortex, and increase that of mesial temporal structures; the latter can be selectively performed through amygdalo-hippocampectomy. Outcome of surgery is generally excellent or good. More than three-fourths of patients are seizure free or show major reduction in seizure frequency. Outcome at the end of the second year is a good indication of long-term prognosis.

Cerebral Cortex↗
PubMed2006

Pre-surgical evaluation and surgical treatment in children with extratemporal epilepsy.

INTRODUCTION: This review summarizes some patterns of pre-surgical evaluation and surgical treatment of extratemporal epilepsy in pediatric patients with medically refractory seizures, whose ictal behavior is variable. The most effective treatment for intractable partial epilepsy is a focal cortical resection with excision of the epileptogenic zone (the area of ictal onset and initial seizure propagation). This might be risky, though, in the case of a widespread lesion, sometimes encroaching one or more lobes, given the risk to the functional cerebral cortex. An anterior temporal lobectomy might prove more effective then in preventing seizures with fewer potential complications. If partial extratemporal epilepsy is associated with pharmaco-resistant seizures, the preoperative evaluation and operative strategy are determined according to the epileptogenic zone and to the relationship between a substrate-directed disorder and eloquent areas. The pediatric treatment of extratemporal epilepsy is aimed at controlling the seizures, avoiding morbidity, and improving the patient's quality of life through psychosocial integration. Since the immature brain is more plastic than when mature, the recovery of functions after surgery is greater in children than in adults. RECOMMENDATION: Early surgery is recommended for children with intractable epilepsy, and is now accepted as an important therapeutic modality also for children with chronic epilepsy. CONCLUSION: Technological advances in the last two decades, mainly in neuroimaging, have led many medical centers to consider surgical treatment of epilepsy, accuracy being granted by MRI-based neuronavigation systems-an interface between the lesion seen in the preoperative magnetic resonance imaging (MRI) and the operative field, often invisible to the surgeon.

Electroencephalography↗
PubMed2004

Surgical treatment of intracavernous trigeminal schwannomas via a fronto-temporal epidural approach.

The purpose of this study is to evaluate the efficacy of the fronto-temporal epidural approach in managing intracavernous trigeminal schwannomas. Five unselected patients harboring an intracavernous trigeminal schwannoma were operated on. Each of them was cured by a single craniotomy. In all cases the skull base approach described by Dolenc [Acta Neurochir. (Wien) 130 (1994) 55] was performed. The complete resection of the tumor and its capsule was gained in all five cases. There was no surgical mortality. No patient developed postoperative major complications. The fronto-temporal epidural approach can be applied for parasellar type trigeminal schwannomas, thus avoiding the exposure of the temporal lobe, and resulting in good chance for total excision of the tumor together with minimal surgical complications.

Cavernous Sinus↗