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Results for “Temporal Lobe Resection”

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PubMed2002

Postictal psychosis after temporal lobectomy.

Three of 282 consecutive patients who had temporal resections for intractable epilepsy developed postoperative postictal psychosis. These three patients had seizure recurrence contralateral to the resection, whereas none of the patients with ipsilateral seizure recurrence developed any psychiatric symptoms after surgery. Two had left amygdalo-hippocampectomy and one right temporal lobectomy. The de novo occurrence of postoperative postictal psychosis is a well-defined complication of surgery for temporal lobe epilepsy, and may relate to contralateral epileptogenesis.

Adult↗

PubMed1996

Microsurgical anatomy of the infratemporal fossa as viewed laterally and superiorly.

OBJECTIVE: Benign tumors involving cavernous sinus, trigeminal nerve, and middle cranial fossa occasionally extend to the infratemporal fossa (ITF). In this study, we describe the microsurgical anatomy and dissection of the ITF, as viewed laterally and superiorly. We also describe a new bypass graft to the supraclinoid internal carotid artery using the internal maxillary artery (IMA), which is found in the ITF. METHODS: Twelve cadaver specimens were used. Dissection required zygomatic arch osteotomy, downward displacement of the temporalis muscle, extensive subtemporal craniectomy, and mild elevation of the temporal lobe together with the dura. RESULTS: The anatomic relationships between the lateral and medial pterygoid muscles and the neurovascular bundle of the ITF are demonstrated. The neurovascular bundle contains the IMA, which runs horizontally, and the main branches of the mandibular nerve, which run vertically. The course and anatomic variations of the IMA and inferior alveolar, lingual, auriculotemporal, and buccal nerves are shown. The distal IMA was quite tortuous and, when the artery straightened, we were able to perform a tension-free in situ IMA graft to the supraclinoid carotid artery in 9 of 12 specimens. CONCLUSIONS: Knowledge of the anatomy of the ITF is a prerequisite for tumor resection in this area. The IMA may serve as a bypass graft to the supraclinoid internal carotid artery if the cavernous or petrous carotid artery is involved by tumor and needs to be sacrificed.

Adult↗

PubMed1990

Temporal response of leukocyte accumulation in the thoracic cavity after two types of surgical injury.

To characterize pleural healing, we quantitated leukocyte accumulation in the pleural cavity and histological changes after two types of thoracic surgery. Rabbits underwent intercostal thoracotomy followed by abrasion of the parietal pleura and ligation and resection of the right middle lobe of the lung (group A), or only abrasion of the parietal pleura (group B). After surgery, the influx of leukocytes into the pleural exudate was characterized by an increase in the number of polymorphonuclear neutrophils (PMNs) followed by monocytes/macrophages. In group A, the total number of leukocytes reached maximum levels on days 5-7 after surgery, 80% of which were monocytes/macrophages. In group B, the total number of leukocytes reached peak levels on postsurgical day 3, 85% of which were monocytes/macrophages. Histologically, we observed a relative delay in pleural healing in group A compared with group B. An inflammatory response including appearance of fibrinous exudates and infiltration of acute inflammatory cells occurred in group A on days 1-3 after surgery. On days 5-7, an increase in submesothelial connective tissue was seen. An increase in cellularity was observed in this layer (fibroplasia) and the wound surface was covered by macrophagelike cells. In group B, disappearance of fibrinous exudates and fibroplasia occurred by day 3. In both groups, these histological changes from inflammatory phase to proliferative phase occurred on the day when the number of monocytes/macrophages in the pleural cavity reached peak levels. These data demonstrate that different types of thoracic injury alter the kinetics of leukocyte accumulation in the pleural cavity and the healing process of parietal pleura, suggesting that macrophages that accumulate in the pleural cavity may be implicated in postsurgical repair.

Animals↗

PubMed2003

Image-guided resection of cerebral cavernous malformations.

OBJECTIVE: To evaluate retrospectively the effectiveness of image-guided navigation techniques in the management of cerebral CMs. METHODS: Between July 1997 and January 2001, 44 patients underwent image-guided resection of cerebral CMs. To counteract brain shift, a small silicon catheter was implanted as a guide in the case of deep-seated lesions (except in the case of brain stem CMs) and before excision of multiple lesions. RESULTS: A total of 27 men and 17 women with a mean age of 35 years underwent surgical procedures (5 patients had multiple lesions). The lesions were located in the frontal (n = 14), lobe temporal lobe (n = 12), parietal lobe (n = 6), cerebellum (n = 6), thalamus (n = 5), pons (n = 5), and orbital region (n = 1). Under the guidance of a StealthStation navigator, total removal of the lesions was achieved in all patients. Follow-up revealed marked improvement of preoperative symptoms in 26 patients and no additional deficits in 13 patients. Five patients suffered from additional neurological deficits, but two of them gradually improved during the follow-up period. CONCLUSIONS: With the assistance of an image-guided surgical system, functional areas can be effectively avoided and surgical injury can be decreased. This system is well suited for accurate localization and safe resection of small, deep-seated CMs.

Adult↗

PubMed1985

An ear asymmetry for gap detection following anterior temporal lobectomy.

A threshold elevation in the performance of auditory temporal order judgment in man has been reported in the ear contralateral to the side of an anterior temporal lobectomy. On the basis of temporal order judgments alone it is not possible to determine whether the deficit is attributable to an impairment of recognition, identification, or temporal resolution. The present monaural experiments compared the performance of the two ears in the detection of a gap in a broad-band noise burst in normal and temporal lobectomized subjects. The results revealed a right-left symmetry in gap detection performance by normal subjects but a significant deficit in gap detection in the ear contralateral to the side of an anterior temporal lobectomy--a finding interpreted as revealing the existence of a bonafide deficit in auditory temporal resolution induced by such resection.

Adult↗

PubMed1999

Nonepileptic seizures after resective epilepsy surgery.

PURPOSE: To identify factors that are associated with the emergence of nonepileptic seizures (NES) after resective epilepsy surgery. METHODS: Twenty-two patients with medically refractory epilepsy in whom NESs were documented by EEG after resective surgery were compared with a larger series of epilepsy surgery patients on demographic, neurologic, and psychiatric variables. RESULTS: NES tended to become apparent in the first few months after surgery. Patients who developed NESs did not differ from other epilepsy surgery patients in terms of age, IQ, or preoperative psychiatric diagnoses. However, surgical NES patients' neurologic problems and seizures began later in life, the NES group included a larger proportion of female subjects and patients with right hemisphere surgery, and NES patients were more likely to develop non-NES psychiatric problems after surgery. CONCLUSIONS: The heterogeneous collection of behaviors subsumed under the label NESs are determined by multiple factors. Several variables were found to be specifically associated with the development of NES after resective epilepsy surgery: A disproportionate number of postsurgical NES patients are female, they have primary neurologic dysfunction in the right hemisphere, and their epileptic seizures often began after adolescence. We propose that at least one group of patients with somatoform tendencies develop NESs as part of the psychiatric instability that occurs often in the few months after resective surgery.

Adult↗

PubMed1993

Neuron loss localizes human temporal lobe epilepsy by in vivo proton magnetic resonance spectroscopic imaging.

Temporal lobe epileptogenic foci were blindly localized in 8 patients with medically refractory unilateral complex partial seizures using noninvasive in vivo proton magnetic resonance spectroscopic imaging (1H-MRSI) with 4-ml effective voxel size. The brain proton metabolite signals in 8 matched normal controls were bilaterally symmetrical within +/- 10%. The hippocampal seizure foci had 21 +/- 5% less N-acetyl aspartate signal than the contralateral hippocampal formations (p < 0.01). The focal N-acetyl aspartate reductions were consistent with pathology findings of mesial temporal sclerosis with selective neuron loss and gliosis in the surgically resected epileptogenic foci. Proton MRSI correctly localized the seizure focus in all 8 cases. By comparison, MR imaging correctly localized 7 of 8 cases and single photon emission computed tomography correctly localized 2 of 5 cases. No lactate was detected in these interictal studies. No significant changes in choline or creatine were observed. In conclusion, 1H-MRSI is a useful tool for the noninvasive clinical assessment of intractable focal epilepsy. These preliminary results suggest that 1H-MRSI can accurately localize temporal lobe epileptogenic foci.

Adult↗

PubMedDate not supplied

Mechanism and localization of speech in the parietotemporal cortex.

Cortical stimulation of the supramarginal and angular gyri elicited dysphasia. Delays in verbal response, misnaming, and difficulties in speech production were also elicited from this region. In two patients speech arrest occurred when stimulation was extended into the occipital cortex and the cortex medial to the supramarginal gyrus, respectively. In a left-handed patient, with speech representation presumed to be in the right hemisphere, neither stimulation nor ablation of the angular gyrus resulted in dysphasia. After anterior temporal resections two patients exhibited dysphasia in association with cortical edema. In one of these an additional resection in the inferior temporo-occipital region produced a marked but transient dyslexia. Observations of the disintegration of speech function during stimulation suggest that such stimulation interferes with a search mechanism by which the nonverbal concept of a visual stimulus is linked to a specific word in memory that is then withdrawn for use. A review of autopsy specimens demonstrates how close the cortex bearing indispensable speech representation lies to the occipital pole and the parietal midline. Because the gyral pattern is obscured by the meninges and is subject to anomalies, elective resection in these areas should be preceded by cortical stimulation and functional mapping.

Adult↗

PubMed1997

[Renal cancer presenting as parietal-temporal cerebral metastasis and a persistent fever].

SUMMARY: The authors report the clinical case of a 48-year-old man presenting with persistent fever, in whom a brain tumour was detected. Histological examination of the resection specimen revealed metastasis from a renal cell carcinoma. The primary tumour was discovered on the right kidney which was then resected. The early postoperative course was favourable, but no long-term follow-up is available.

Biopsy↗

PubMed1987

Cortical mapping for defining the limits of tumor resection.

We have used cortical mapping during local anesthesia to help us define the limits of safe resection in neurosurgical patients undergoing tumor resection for lesions near language, somatosensory, or motor areas in the brain. Tumors located near the language areas in the frontal or temporal cortex were safely resected by first establishing the spatial limits for speech in these areas. In one patient with a tumor underneath the hand representation area of the right motor and sensory cortices, we also were able to define which cortical zones had to be avoided if a postoperative deficit secondary to tumor resection were to be averted. Brain swelling was not a problem; patients willingly cooperated during the cortical mapping procedure and were able to define accurately the kinds of sensory or motor changes that occurred when neurostimulation was used. It is possible safely to biopsy or resect tumors that previously might have been considered inoperable; intraoperative mapping is a useful surgical adjunct.

Adult↗

PubMed1995

Intractable seizures associated with brain tumor in childhood: lesionectomy and seizure outcome.

The authors retrospectively reviewed ten pediatric brain tumor patients with intractable seizures who underwent lesionectomy without intentional identification and resection of the epileptogenic region to assess the clinical features and seizure outcome after lesionectomy in such patients. Seizures were complex partial in seven cases and simple partial, absence, and generalized tonic-clonic in one case each. Tumors were located at the medial temporal lobe in four cases, at the frontal lobe in four cases, at the parietooccipital and the suprasellar areas in one case each. The most common pathology was benign oligodendroglioma (five cases) followed by ganglioglioma (two cases). Others were pleomorphic xanthoastrocytoma, hamartoma, and primitive neuroectodermal tumor (one case each). In four cases, complete removal of the tumor was feasible. Postoperatively nine of the ten patients showed favorable seizure control (Engel's classification 1 and 2) and of these, six were seizure-free during the follow-up period (mean duration: 40 months). Therefore, lesionectomy can be an appropriate initial treatment for patients with brain tumor and medically intractable seizures.

Adolescent↗

PubMed1988

Recognition memory of item, associative and serial-order information after temporal lobectomy for seizure disorder.

Children, adolescents, and young adults with temporal lobectomy judged the context of their encounters with a word (by deciding about its prior occurrence or familiarity) and also identified word attributes involving associative content and serial order (by indicating word meanings and reconstructing word sequences). Laterality of temporal lobectomy was important for identifying familiarity: individuals with right-sided temporal lobectomies made better judgements than those with left resections about the prior occurrence of target words, with the more successful performance depending on enhanced sensitivity to the familiarity or non-familiarity of what was heard. Identifying the attributes of an item, as contrasted with its prior occurrence, depended on aspects of temporal lobe disorder in conjunction with laterality: deficits of brain structure involving histopathology and significant tissue loss disrupted content memory; compromised brain function resulting from certain post-infantile seizures impaired memory for serial order. In the young brain after temporal lobectomy, there exists a functional dissociation between judging the familiarity of an event and identifying its attributes, a dissociation that depends, not only on laterality of surgery, but also on the structural and functional intactness of the residual brain.

Adolescent↗

PubMed2005

Three-dimensional relationships of the optic radiation.

OBJECTIVE: This study examined the relationship of the optic radiation to the landmarks important in temporal lobe surgery. METHODS: The optic radiation was dissected by applying Klingler's fiber dissection technique to 20 formalin-fixed human hemispheres. The dissections were performed with the operating microscope and imaged in three-dimensional photographs. Several measures quantified the relationship of the radiation to reliable surgical landmarks. RESULTS: In all specimens, the anterior loop of the radiation extended to the anterior tip of the roof of the temporal horn. The anterior edge of the optic radiation was located an average of 25 mm (range, 22-30 mm) behind the temporal pole. The optic radiation extended an average of 5 mm (range, 3-6 mm) anterior to the hippocampus head and 22 mm (range, 20-25 mm) anterior to the anterior edge of the lateral geniculate body. The optic radiation also extended an average of 2 mm (range, 1-3 mm) anterior to the tip of the temporal horn. The relationships of the optic radiation to important surgical landmarks are discussed. CONCLUSION: The optic radiation reached the anterior tip of the temporal horn. Resections that extend through the roof of the temporal horn more than 3 cm behind the temporal pole cross the anterior loop of the optic radiation.

Dissection↗

PubMed1995

Unilateral hippocampal mossy fiber sprouting and bilateral asymmetric neuron loss with episodic postictal psychosis.

Rarely are both sides of the hippocampus available for pathological study in a patient with intractable temporal lobe epilepsy (TLE). The authors report a patient with TLE investigated with bilateral depth electrodes who had an episode of postictal psychosis. The patient died 4 weeks after temporal lobectomy of unknown reasons, despite complete postmortem examination and clinical evidence of postsurgery seizure control. Pathological examination of surgical and autopsy hippocampal specimens found bilateral asymmetric neuron losses. However, only the resected epileptogenic hippocampus showed the profile of neuron loss typical of mesial temporal sclerosis (MTS) and abnormal mossy fiber synaptic reorganization. Quantitative depth electroencephalographic (EEG) analysis of the postictal psychotic event showed that it was not associated with a cluster of seizures, increased postictal depth EEG spike activity, or insufficient antiepileptic medication. These results support the hypothesis that ipsilateral hippocampal epileptogenesis is associated with MTS and mossy fiber sprouting. The results also suggest that the etiology of postictal psychosis in this patient was initiated by an ictal event and the behavior apparently depended on seizure propagation outside the hippocampus. The relevance of these two findings to the literature is discussed.

Adult↗

PubMed2003

Entorhinal cortex MRI assessment in temporal, extratemporal, and idiopathic generalized epilepsy.

PURPOSE: We previously showed a reduction in the volume of the entorhinal cortex (EC) ipsilateral to the seizure focus in patients with intractable temporal lobe epilepsy (TLE). The purpose of this study was to examine the specificity of EC atrophy in epilepsy. METHODS: We performed volumetric measurement of the EC on high-resolution magnetic resonance imaging (MRI) in patients with TLE (n = 70), extratemporal lobe epilepsy (ETE; n = 18), and idiopathic generalized epilepsy (IGE; n = 20). EC volumes of epilepsy patients were compared with those of 48 age- and sex-matched normal controls. Within the TLE group, 63 patients were selected prospectively with hippocampal atrophy ipsilateral to the seizure focus. The remaining seven patients were chosen retrospectively based on normal volumetric MRI of the hippocampus and amygdale, as well as normal histopathologic examination of the resected tissue. RESULTS: Compared with normal controls, EC volume was smaller ipsilateral but not contralateral to the seizure focus in patients with TLE (p < 0.001). No difference in the EC volumes ipsilateral and contralateral to the seizure focus was seen in patients with ETE and IGE compared with normal controls. The individual analysis showed that the EC was atrophic in 73% of TLE patients with hippocampal atrophy. Three of the seven TLE patients with normal volumetric MRI of the hippocampus and amygdala and normal histopathologic examination had EC atrophy ipsilateral to the seizure focus. In no patient with ETE or IGE was the EC found to be atrophic. CONCLUSIONS: EC atrophy ipsilateral to the seizure focus appears to be specific to mesial temporal lobe structural damage associated with TLE.

Adolescent↗

PubMed2002

The combined subtemporal-suboccipital approach: a modified surgical access to the clivus and petrous apex.

OBJECTIVE: The surgical access to the clivus and the petrous apex is still a challenge. A combined approach is best fitted to lesions located in the middle and posterior cranial fossa. The approach described is centered on the petrous bone and requires an extensive bone resection; nevertheless, no osteoplastic bone flap is necessary. METHODS: In contrast to approaches described before, the petrous bone is drilled away anterior to the sigmoid sinus more extensively, the sinus is unroofed. For exposure of the middle cranial fossa the petrous bone should be resected down to the roof of the external meatus, the total extent of the craniotomy is significantly smaller. RESULTS AND CONCLUSION: The surgical access as described above provides a wide operative field under preservation of important intracranial structures. This modified approach minimizes the cerebellar and temporal lobe retraction. The neural and vascular structures can be preserved under direct vision to the tumor. The blood supply is interrupted at the beginning of the operation.

Cranial Fossa, Posterior↗

PubMed1988

Risk and benefit in the surgery of epilepsy: complications and positive results on seizures tendency and intellectual function.

A review of complications in a series of 560 consecutive craniotomies for surgery of epilepsy shows the mortality to be nil and the morbidity very low. Results on the seizure tendency for temporal resections are presented with emphasis on extent and modalities of removal. In this series the success/failure ratio was in the order of 80/20%. Patients with-right sided removal tend to do better than those with left-sided operations. Removal of the hippocampal formation appears to significantly improve the results. Patients studied with intracerebral electrodes tend as a group to do better than those operated without depth electrodes. Anterior temporal resection is usually followed by a significant increase in intellectual function when measured one year after surgery.

Electrodes↗

PubMed2006

Microsurgical approaches to the medial temporal region: an anatomical study.

OBJECTIVE: To describe the surgical anatomy of the anterior, middle, and posterior portions of the medial temporal region and to present an anatomic-based classification of the approaches to this area. METHODS: Twenty formalin-fixed, adult cadaveric specimens were studied. Ten brains provided measurements to compare different surgical strategies. Approaches were demonstrated using 10 silicon-injected cadaveric heads. Surgical cases were used to illustrate the results by the different approaches. Transverse lines at the level of the inferior choroidal point and quadrigeminal plate were used to divide the medial temporal region into anterior, middle, and posterior portions. Surgical approaches to the medial temporal region were classified into four groups: superior, lateral, basal, and medial, based on the surface of the lobe through which the approach was directed. The approaches through the medial group were subdivided further into an anterior approach, the transsylvian transcisternal approach, and two posterior approaches, the occipital interhemispheric and supracerebellar transtentorial approaches. RESULTS: The anterior portion of the medial temporal region can be reached through the superior, lateral, and basal surfaces of the lobe and the anterior variant of the approach through the medial surface. The posterior group of approaches directed through the medial surface are useful for lesions located in the posterior portion. The middle part of the medial temporal region is the most challenging area to expose, where the approach must be tailored according to the nature of the lesion and its extension to other medial temporal areas. CONCLUSION: Each approach to medial temporal lesions has technical or functional drawbacks that should be considered when selecting a surgical treatment for a given patient. Dividing the medial temporal region into smaller areas allows for a more precise analysis, not only of the expected anatomic relationships, but also of the possible choices for the safe resection of the lesion. The systematization used here also provides the basis for selection of a combination of approaches.

Cadaver↗