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Results for “Temporal Lobe Resection”

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PubMed1989

Zygomatic approach for resection of mesial temporal epileptic focus.

By using the zygomatic approach, temporal mesial and polar epileptic foci are easily accessible through an incision in the inferior temporal gyrus. In this approach, a major part of the superior and middle temporal gyrus is preserved, and there is no risk of postoperative dysnomia even on the dominant side for speech. Combined use of depth and subdural electrodes is advisable for precise determination of focus distributions throughout the mesial and lateral structures of the temporal lobe. We have applied this approach in 5 patients with satisfactory results.

Epilepsy, Temporal Lobe↗

PubMed2004

Semiquantitative analysis of interictal glucose metabolism between generalized epilepsy and localization related epilepsy.

Positron emission tomography (PET) with [18F]fluoro-D-deoxyglucose (FDG) has been used to detect seizure foci and evaluate surgical resection with localization related epilepsies. However, few investigations have focused on generalized epilepsy in children. To reveal the pathophysiology of generalized epilepsy, we studied 11 patients with generalized epilepsy except West syndrome, and 11 patients with localization related epilepsy without organic disease. The FDG PET was performed by simultaneous emission and transmission scanning. We placed regions of interest (ROI) on bilateral frontal lobe, parietal lobe, occipital lobe, temporal lobe, basal ganglia, thalamus and cerebellum. Standardized uptake value (SUV) was measured and normalized to SUV of ipsilateral cerebellum. Then, we compared the data of generalized epilepsy to those of localization related epilepsy. FDG PET revealed significant interictal glucose hypometabolism in bilateral basal ganglia in generalized epilepsy compared to that in localization related epilepsy (right side: p = 0.0095, left side: p = 0.0256, Mann-Whitney test). No other region showed any significant difference (p > 0.05) between the two groups. These findings indicate that the basal ganglia is involved in the outbreak of generalized seizures or is affected secondarily by the epileptogenicity itself.

Adolescent↗

PubMed2004

Functional MRI and Wada determination of language lateralization: a case of crossed dominance.

The Wada test has historically been the conventional procedure for determining language lateralization before neurosurgery. However, functional magnetic resonance imaging (fMRI) offers a less invasive alternative to the Wada procedure. Research indicates that the two techniques used together may provide comparable, and sometimes complementary, information that results in improved prediction of postsurgical language ability. We present a case in which use of fMRI in conjunction with Wada testing provided complementary information about language lateralization before neurosurgical resection of a mesial temporal subependymoma for seizure control in a patient with schizencephaly.

Brain Neoplasms↗

PubMed2002

Results of multimodality treatment for 141 patients with brain arteriovenous malformations and seizures: factors associated with seizure incidence and seizure outcomes.

OBJECTIVE: Previous reports of seizure outcomes after arteriovenous malformation (AVM) treatment have involved single-treatment modality (surgery, radiosurgery, or embolization) series. Such series reflect only selected lesions, of certain sizes, locations, and other clinical and anatomic characteristics, that are amenable to the single therapy, limiting the analysis of those factors. We report the results of AVM treatment using a multimodality approach that we think encompasses a broader spectrum of treatable brain AVMs. We tested for factors associated with seizure presentation and seizure outcomes. METHODS: Between 1991 and 1999, the multidisciplinary neurovascular unit at Massachusetts General Hospital treated 424 patients with brain AVMs. Treatment consisted of surgical resection, radiosurgery, or embolization, either alone or in combination. One hundred forty-one patients (33%) experienced seizures before treatment. We studied the following factors: sex, age, AVM size, AVM location, occurrence of intracranial hemorrhage, seizure type, duration of seizure history, treatment modality, and AVM obliteration. We tested for statistical associations between these factors and seizure presentation and outcomes. Clinical follow-up monitoring was via mailed questionnaires. RESULTS: When we compared the 141 patients with seizures with the 283 patients who did not experience seizures (total of 424 patients), male sex, age of less than 65 years, AVM size of more than 3 cm, and temporal lobe AVM location were statistically associated with seizures (P < 0.01, P < 0.05, P < 0.0001, and P < 0.01, respectively). Posterior fossa and deep locations were statistically associated with no seizures (P < 0.0001). One hundred ten (78%) of the 141 patients who experienced seizures before treatment responded to the mailed questionnaires, with a mean follow-up period of 2.9 years. A detailed comparison of responders and nonresponders demonstrated no statistically significant differences in pertinent characteristics. As determined with the Engel Seizure Outcome Scale, there were 73 (66%) Class I (free of disabling seizures), 11 (10%) Class II (rare disabling seizures), 1 (0.9%) Class III (worthwhile improvement), and 22 (20%) Class IV (no worthwhile improvement) outcomes. Three patients died during the follow-up period. We tested for factors associated with Engel Class I outcomes. Sex, age, and AVM size were not associated with Class I outcomes. Short seizure history, association of seizures with intracranial hemorrhage, generalized tonicoclonic seizure type, deep and posterior fossa AVM locations, surgical resection, and complete AVM obliteration were statistically associated with Class I outcomes (P < 0.0001, P < 0.05, P < 0.05, P < 0.05, P < 0.001, and P < 0.001, respectively). When only completely obliterated AVMs were considered, there were no statistically significant differences between surgery, radiosurgery, and embolization. CONCLUSION: Certain factors, as identified in an analysis of a wide spectrum of treatable brain AVMs, can facilitate predictions of the incidence of seizure presentation with AVMs, as well as seizure outcomes after multimodality treatment.

Adolescent↗

PubMed2002

Temporal lobe epilepsy surgery: outcome, complications, and late mortality rate in 215 patients.

PURPOSE: We studied the surgical outcome, complications, and the late mortality rate in a large group of patients with medically refractory temporal lobe epilepsy (TLE). METHODS: Two-hundred fifteen patients with TLE were treated surgically between 1984 and 1999 after a comprehensive presurgical evaluation. Patients were followed up at 6 weeks, 3-6 months, and yearly thereafter. In addition, questionnaires were sent on the anniversary of their surgery. Surgical outcome (Engel's classification), complication rate, and factors contributing to late mortality were analyzed. Standardized mortality ratios (SMRs) were calculated. RESULTS: There was no surgical mortality. Two (0.9%) had mild hemiparesis, one (0.4%) had a hemianopia, seven (3.2%) had transient cranial nerve palsies, and eight (3.7%) had transient postoperative language difficulties. One hundred forty-eight (69%) became seizure free, 43 (20%) had rare seizures, 14 (6.5%) had worthwhile seizure reduction, and 10 (4.6%) had no improvement (follow-up, 1-15 years). Three (2%) of 148 seizure-free patients died during follow-up, compared with eight (11.9%) of 67 not seizure-free patients. The mean duration of epilepsy before surgery for the surviving patients was 17.8 years, and for those patients who died, 25.9 years (p < 0.05). Six (5.7%) of 104 patients with right-sided resections died during follow-up, compared with five (4.5%) of 111 with left-sided resections. CONCLUSIONS: Eighty-nine percent of patients became seizure free or had rare seizures, with low morbidity, and no surgical mortality. The late mortality occurred predominantly in patients with persistent seizures (SMR, 7.4). Those patients who died had a longer duration of epilepsy before surgery. In contrast, among those patients who became seizure free, the mortality rate was much lower, and similar to the general population of Indiana (SMR, 1.7).

Adolescent↗

PubMed2004

The role of mirror focus in the surgical outcome of patients with indolent temporal lobe tumors.

PURPOSE: To review the clinical and neurophysiological data of 21 patients with epilepsy due to temporal lobe tumors and who had undergone evaluation and surgery at the Hospital das Clínicas da Universidade de São Paulo. The aim of this study was to investigate whether the occurrence of a mirror focus was influenced either by certain clinical factors or if the surgical outcome was influenced by the presence of a mirror focus. METHOD: We included these 21 patients who had undergone at least one interictal electroencephalogram in the pre- and post-surgical periods. They had had a minimum follow-up of one year. RESULTS: Eight patients had mirror focus (Group 1) and 13 did not (Group 2). The mean age at seizure onset, duration of epilepsy disorder and total number of seizures did not vary statistically between the two groups of patients. Generalized tonic-clonic seizures occurred more frequently in the mirror focus group. All, but one patient, with a mirror focus were seizure free at follow- up. The mirror focus disappeared in all eight patients in the post-surgical electroencephalogram. In this group, the patient who was not seizure - free had a seizure recorded in his post-surgical electroencephalogram with seizure onset ipsilateral to the resected tumor. The patients who were not seizure-free had either been submitted to an incomplete resection of the tumor or showed evidence of associated cortical dysplasia. CONCLUSION: The occurrence of mirror focus is not a contraindication to surgery even when interictal epileptiform activity predominates contralaterally to the tumor and neither when seizures appear to arise from the mirror focus on scalp EEG. Good surgical outcome is expected despite EEG findings that may conflict with tumor location.

Adolescent↗

PubMed1995

Results of cortical resection for intractable epilepsy using intra-operative corticography without chronic intracranial recording.

Twenty-four patients with intractable partial epilepsy underwent surgery between 1969 and 1988. Localization was by non-invasive means using scalp EEG and CT. In 12 cases the focus was temporal and in eight frontal. Craniotomy was undertaken with intraoperative electrocorticography (ECoG). Ten cases had a standard temporal lobectomy, seven a topectomy, four topectomy with tumour excision and one tumour excision alone. Two cases did not have a resection. Pathology revealed a mass lesion in 12 cases, hippocampal sclerosis in two and gliosis in six. Mean length of follow-up was 7.4 was. Fourteen patients (64%) were seizure free, two (9%) almost seizure free, four (18%) had worthwhile improvement and two (9%) no improvement. Of the temporal resections, 9 out of 12 (75%) were seizure free and of the extratemporal resections 5 out of 10 (50%) were seizure free. Removal of a mass lesion carried the most favourable prognosis for seizure outcome: 10 our of 12 (83%) of the cases with mass lesions, but 3 out of 6 (50%) of the cases with gliosis were seizure free. In two of the frontal resections removal of tumour resulted in disappearance of contralateral frontal independent spikes. It is concluded that where sufficient information exists to localize seizure activity by non-invasive means, invasive recording is unnecessary. The utility of intraoperative ECoG is discussed. It may be of limited use in cases of standard resection of when a mass lesion is present, but ECoG can prove useful to delineate the epileptogenic area in cases where there is o mass lesion and the results can still be rewarding.

Adolescent↗

PubMed1996

Intractable epilepsy due to meningitis: results of surgery and pathological findings.

Between 1986 and 1992, among a total of 668 craniotomies performed for intractable epilepsy, 13 (1.9%) patients had a presumed aetiology of a previous episode of meningitis. Twelve were investigated with chronic electrocorticography with subdural electrodes which showed mesial temporal onset in eight, regional temporal onset in three and bilateral diffuse onset in one. One patient underwent corpus callosotomy and 12 anterior temporal lobectomy (ATL) (6L, 6R). The pathology in the resection cases was hippocampal sclerosis in six and gliosis in six. Mean length of follow up was 3 years (range 1-6 years). Ten of the 12 (83%) ATL patients were seizure free (six off medications). Two ATL patients and the callosotomy patient were significantly improved. It is concluded that in patients where the presumed aetiology of intractable epilepsy is meningitis and widespread damage may therefore be expected, this does not necessarily indicate multifocality, and the prognosis following resective surgery appears to be good.

Adolescent↗

PubMed1990

[Surgical treatment of drug resistant epilepsy].

Even today, epilepsy is resistant to conservative treatment in a certain number of patients. In many of these cases surgical treatment is a meaningful alternative. The most important procedure is the resection of the epileptogenic focus. Thus, surgical treatment is only possible if the preoperative evaluation of the patient reveals a focus in a resectable area of the brain. In this article the modern electrophysiological, nuclear medical and neuroradiological diagnostic procedures, together with the various surgical procedures of surgery for epilepsy are presented.

Brain Mapping↗

PubMedDate not supplied

Fine needle aspiration cytology of a cerebral ganglioglioma. Report of a case.

The fine needle aspiration (FNA) cytology of a rare central nervous system tumor, ganglioglioma, is described. The FNA cytologic diagnosis confirmed a radiologic suspicion of ganglioglioma detected by computerized tomography and intraoperative sonography, thus sparing the patient from a superior temporal gyrus resection, with attendant speech impairment. The cytologic distinction of this lesion from high-grade astrocytoma is important because of the more favorable prognosis in ganglioglioma.

Adult↗

PubMed1995

Applications of magnetic source imaging in evaluation of candidates for epilepsy surgery.

Epilepsy was the first clinical entity to which magnetic source imaging was applied; however, the technology available severely limited early studies. The introduction of large-array magnetic source imaging systems has enabled striking advances in the application of magnetic source imaging in epilepsy surgery programs. The superimposition of functional localization of epileptic sources on anatomic images from MR imaging or computed tomography allows precise definition of the area and extent of epileptogenic tissue for possible resection. Concordance of magnetic source imaging indications with other noninvasive studies may reduce that need for invasive studies in certain patient populations.

Diagnostic Imaging↗

PubMed2003

Recurrent intracranial esthesioneuroblastoma outside the initial field of radiation with progressive dural and intra-orbital invasion.

A 55-year-old man presented with esthesioneuroblastoma in the right paranasal sinuses and orbita, extending into the right anterior and middle cranial fossa. He received a partial resection of tumour and post-operative radiotherapy, which was set with a central focus on the right orbit. Five years later, he came to our hospital with a complaint of left exophthalmos. Neuro-imaging revealed that the tumour recurred on the opposite side of the primary lesion, which was out side the irradiated field, with progressive invasion of the left temporal dura. The residual tumour in the irradiated field had reduced in size. He received gross total resection and post-operative radiotherapy. We would like to emphasize that radiotherapy is an important adjuvant therapy for esthesioneuroblastoma, and that the field setting for radiation therapy is extremely important.

Brain Neoplasms↗

PubMed1985

Surgery for epilepsy.

Despite important advances in the treatment of epilepsy over the past several decades, many patients remain uncontrolled. Partial complex (psychomotor) seizures are the largest problem, with less than two thirds of patients successfully managed despite optimal medication use. In these situations, various surgical procedures may be helpful, depending on the type of epilepsy, its cerebral location of origin, and the neurologic status of the particular patient. Intensive investigation including EEG and audiovisual monitoring are utilized to evaluate the medically refractory epileptic. In some instances, specialized recordings from epidural, subdural or intracerebral locations are needed to try to pinpoint onset of focal seizure. When this is possible, and the epileptogenic area is resectable, cortical excision may provide cure or marked reduction of seizures in 60 to 90 per cent of properly selected patients with minimal morbidity. The most common operation is temporal lobectomy; this procedure itself is undergoing modifications as more is learned about the usual locations of seizure foci and the functions of this tissue. Resections in other cortical areas may be more difficult but are possible. When a single focus is not identified or is not resectable, other procedures may be used. Results in seizure control with chronic cerebellar stimulation have been variable. The results of stereotaxic lesions in various locations are difficult to evaluate with the single exception of field H of Forel, which in many reports has been effective for grand mal seizures. Generalized seizures, particularly in patients with infantile hemiplegia or frontal lobe epilepsy, are well controlled with corpus callosotomy. Surgery for epilepsy is currently practiced at several centers in this country and abroad. There is great need for more such centers and more education about this treatment as estimates indicate 100,000 patients in the United States at this time could benefit from such procedures.

Adolescent↗

PubMed1985

Verbal memory deficits after left temporal lobectomy for epilepsy. Mechanism and intraoperative prediction.

Verbal memory deficits remain a major complication of dominant hemisphere temporal lobectomy for epilepsy. The extent of this deficit was assessed preoperatively and 1 month and 1 year postoperatively with the Wechsler Verbal Memory Scale (WMSV) in 14 adults undergoing left temporal lobectomy. Intraoperative localization of language and verbal memory was also performed by electrical stimulation mapping. The WMSV score decreased an average of 22% at 1 month (13 cases), and 11% at 1 year (10 cases), even though in the majority of cases the medial extent of the resections had been significantly modified as a result of preoperative memory changes in response to intracarotid amobarbital perfusion testing. Memory decline was greater in patients who were not seizure-free, and correlated with the lateral (but not the medial) extent of the resection. The memory deficit could be predicted intraoperatively with 80% accuracy from the relationship of the resection to sites identified by electrical stimulation mapping as essential to naming or input or storage aspects of memory. This technique was applied prospectively in two additional cases with left temporal epileptic foci and complete verbal memory loss with left hemisphere amobarbital inactivation. These resections were tailored to avoid the essential naming and memory sites; the WMSV score increased 1 month postoperatively in both cases. This study identifies a lateral cortical component for verbal memory. Sites essential for that component can be localized intraoperatively with stimulation mapping; when they are spared in a resection, verbal memory deficit following dominant hemisphere temporal lobectomy can be prevented even in high-risk cases.

Adolescent↗

PubMed1997

Experiences of epilepsy surgery in intractable seizures with past history of CNS infection.

We studied the clinical characteristics, location of epileptogenic regions, and the surgical outcomes in 18 patients with intractable epilepsy associated with previous CNS infections. All patients underwent an extensive presurgical evaluation and 11 patients had intracranial EEG monitoring. On the basis of presurgical evaluation, epileptic regions were localized to the mesial temporal (n = 12) and the neocortical (n = 6) regions. The age of the time of CNS infection was significantly younger and the latent period of non-febrile seizures after CNS infection was longer in patients with mesial temporal lobe epilepsy (MTLE). MRI showed hippocampal atrophy and hippocampal signal changes in 11 of 12 patients with MTLE. Among 6 patients with neocortical epilepsy (NE) 5 patients had normal MRI and one showed cerebral hemi-atrophy. Surgery was successful (class I & II) in all patients with MTLE, however, in the patients with neocortical epilepsy, seizure-free results were not achieved in any patients after resective surgery (6 patients) and only 2 patients achieved Class II outcomes after a second epilepsy surgery consisting of neocortical resection. Patients with MTLE after CNS infection were differentiated from the group of neocortical epilepsy by an earlier onset of CNS infection, a prolonged latent period and a higher frequency of meningitis. The characteristic pathology in this group was hippocampal sclerosis and the surgical result was excellent. Neocortical epilepsy following CNS infection usually had no focal lesion on MRI and was associated with a relatively poor surgical result. This study suggested that the surgical outcome was influenced by the type of epileptic syndromes rather than the etiology of seizures. The association of MTLE with the younger age of CNS infections and with meningitis more frequently suggested that the neocortical neurons during infancy or early childhood may be more resistant to the epileptogenesis, or that the CNS infections in patients with MTLE might be milder in severity to cause selective injuries to the hippocampal neurons during their vulnerable stage.

Adolescent↗

PubMed2000

Subtraction peri-ictal SPECT is predictive of extratemporal epilepsy surgery outcome.

OBJECTIVES: To determine whether localization of extratemporal epilepsy with subtraction ictal SPECT coregistered with MRI (SISCOM) is predictive of outcome after resective epilepsy surgery, whether SISCOM images provide prognostically important information compared with standard tests, and whether blood flow change on SISCOM images is useful in determining site and extent of excision required. BACKGROUND: The value of SISCOM in predicting surgical outcome for extratemporal epilepsy is unknown, especially if MRI findings are nonlocalizing. METHODS: SISCOM images in 36 consecutive patients were classified by blinded reviewers as "localizing and concordant with site of surgery," "localizing but nonconcordant with site of surgery," or "nonlocalizing." SISCOM images were coregistered with postoperative MRI, and reviewers visually determined whether cerebral cortex underlying the SISCOM focus had been completely resected, partially resected, or not resected. RESULTS: Twenty-four patients (66.7%) had localizing SISCOM, including 13 (76.5%) of those without a focal MRI lesion. Eleven of 19 patients (57.9%) with localizing SISCOM concordant with the surgical site, compared with 3 of 17 (17.6%) with nonlocalizing or nonconcordant SISCOM, had an excellent outcome (p < 0.05). With logistic regression analysis, SISCOM findings were predictive of postsurgical outcome, independently of MRI or scalp ictal EEG findings (p < 0.05). The extent of resection of the cortical region of the SISCOM focus was significantly associated with the rate of excellent outcome (100% with complete resection, 60% with partial resection, and 20% with nonresection, p < 0.05). CONCLUSION: SISCOM images may be useful in guiding the location and extent of resection in extratemporal epilepsy surgery.

Adolescent↗

PubMed1992

Amnesia following a discrete basal forebrain lesion.

Destructive lesions of the basal forebrain are associated with memory impairment in both humans and experimental animals. The basal forebrain is thought to contribute to memory function by providing cholinergic innervation to critical memory structures such as the hippocampus and amygdala. In previously reported clinical cases of basal forebrain amnesia, multiple neuroanatomical regions have been damaged, preventing identification of the minimal critical lesion necessary to produce an amnestic syndrome. We describe a patient who developed persistent, global anterograde and retrograde amnesia following resection of a low-grade glioma. Post-surgical magnetic resonance imaging studies revealed a small discrete lesion, centred in the right diagonal band of Broca, that included the preoptic area, the anterior hypothalamus, the lamina terminalis and the paraterminal gyrus. The septal nuclei and the cell bodies of the nucleus basalis of Meynert appeared to have been spared, as were other structures in the medial temporal lobe and diencephalon. Our case provides critical support for the independent contribution of the basal forebrain, in particular the diagonal band nuclei, in memory function. We propose that our patient's amnesia resulted from disconnection of pathways between the diagonal band nuclei and the hippocampal region, depriving the hippocampus of cholinergic innervation.

Amnesia↗

PubMed2002

Epilepsy surgery in childhood.

Epilepsy surgery in childhood can now be more readily considered as a result of enhanced presurgical investigative techniques and safer neurosurgical practice. As in adults, surgery available may be resective (focal resection or hemispherectomy) or functional. The most common procedures are temporal lobectomy and hemispherectomy, with malformative lesions and developmental tumours the next common pathology. The timing of surgery requires careful consideration, and the definition of drug resistance given specific thought in the young child. Presurgical evaluation should be noninvasive where possible, and should include optimised MRI, including 3D data set and video EEG telemetry to document seizures. Detection of temporal lobe abnormalities in temporal lobe epilepsy with MR may be enhanced using quantitative and semiquantitative techniques. Ictal and interictal SPECT may be useful in providing information about the seizure onset zone, if reviewed in conjunction with MR data and video-EEG. Interictal PET is more likely to demonstrate abnormalities relating to structural defects, but may be particularly useful in infants where incomplete myelination may restrict structural information provided by MRI. Neuropsychology testing plays a major role by the determination of verbal and nonverbal function in older children, and in the determination of cerebral dominance. Functional MRI for determination of language or motor cortex may enhance such evaluation, although it is limited to older unsedated children at present. Although the aims of the presurgical evaluation remain similar to adult practice, the range of children presenting is wide, and the aims and likely outcome of surgery require careful evaluation with the family. This aside, the benefits of seizure elimination or reduction in drug-resistant focal epilepsy prior to adolescence, as well as in certain early catastrophic epilepsies of childhood, remain self apparent.

Age Factors↗