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Results for “Temporal Lobe Resection”

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PubMed1981

[Contamination of a glioma by the herpes virus].

The clinical and neuropathologic descriptions of a glioma in a 65 years old patient, who died 9 days after its subtotal resection, are documented. The post-mortem study of the brain revealed an herpetic encephalitis with its classical topographical distribution. There were numerous eosinophilic inclusion bodies which ultrastructurally were characteristic of herpes simplex virus. The author discusses, with reference to the literature, the exo and endogenous sources of infection, the means of dissemination, the problem of latency and reactivation of the virus. He proposes the hypothesis that the infection of the glioma cells is this case was most likely related the immature immunity of the cells, corticoid therapy and surgical resection acting as inducers. The almost complete absence of an inflammatory reaction evokes an opportunistic viral infection in an immunodeficient patient. Inspite of the description by many authors of different particles which have been interpreted as of viral origin in some brain tumours, the hypothesis of an oncogenic action of the herpetic virus is not retained in this particular case, considered as exceptional, of the glioma described herein. The precocious search for HSV antibodies by immunofluorescence and a temporal lobe biopsy in order to establish an early diagnosis are necessities so as to administer as rapidly as possible the specific therapy, adénine-arabinoside.

Aged↗

PubMed1998

Selective amobarbital test for the determination of language function in patients with epilepsy with frontal and posterior temporal brain lesions.

PURPOSE: Selective amobarbital tests with selective temporary inactivation of the left frontal operculum and/or the left parietotemporal cortex were performed in 5 patients with left-hemispheric epileptogenic lesions in or adjacent to classical Broca's and/or Wernicke's area. The aim was to assess language functions in these brain regions before surgery, to tailor the surgery according to the individual functional importance of these brain regions, and to predict postoperative outcome. METHODS: Amobarbital was injected by transfemoral selective catheterization of the arteries supplying the target areas. Along with neuropsychological and neurological testing during the amobarbital procedure, EEG recordings were performed in all patients, and [99mTc]HMPAO-single photon emission computed tomography (SPECT) in 2 patients. RESULTS: After the amobarbital injection into the left frontal opercular region, there was no recognizable language dysfunction in 3 patients. In these 3 patients, the lesions in or adjacent to the frontal operculum were completely resected without postoperative language impairment. In the remaining 2 patients, temporary language impairment after the amobarbital injection into the left frontoopercular and Wernicke's region, respectively, suggested language functions in these areas. Surgery was restricted to the left mesiotemporal lobe in 1 patient. In the other patient, the tumor infiltrating the frontal operculum was restrictively resected. Postoperatively, the first patient had no language impairment, but the latter had transient global aphasia, from which she recovered. CONCLUSIONS: Selective temporary amobarbital inactivation of brain regions that may be associated with language has clearly indicated the presence or absence of language functions in these regions. The test contributed substantially to planning of the surgical approach in each patient. The predictive value of the amobarbital test was demonstrated by the postoperative outcome.

Adolescent↗

PubMed2001

Long-term survival of a patient with giant cell glioblastoma. Case report.

The authors report on a patient who had undergone resection of a left-sided temporal giant cell glioblastoma at the age of 69 years and who survived for more than 17 years. This man had not undergone postoperative radiotherapy or adjuvant chemotherapy. He died at the age of 86 years without clinical evidence of tumor recurrence. Histologically, the lesion was characterized by highly pleomorphic tumor cells (including bizarre multinucleated giant cells) with high mitotic activity, large necroses, and prominent mononuclear infiltration. A point mutation in the TP53 tumor suppressor gene (c.524G>A; R175H) and no epidermal growth factor receptor gene amplification were revealed on molecular genetic analysis. No diagnostic chromosomal imbalances were identified on comparative genomic hybridization, although the average ratio profile for chromosome 10 indicated loss of 10p15 in a subpopulation of tumor cells. This patient is exceptional because tumor resection, probably in conjunction with a marked antitumor immune response, apparently resulted in eradication of the lesion.

Aged↗

PubMed2005

Posterior subtemporal transtentorial approach to intraparenchymal lesions of the anteromedial region of the superior cerebellum.

OBJECT: To overcome the limitations associated with surgical approaches that have been described for accessing intraparenchymal lesions of the anteromedial region of the superior cerebellum, the authors used a posterior subtemporal transtentorial approach to remove tumors in this region. In this paper they describe the surgical technique that they used as well as the operative findings and clinical outcomes observed in patients who underwent resection of tumors in the anteromedial superior cerebellum. METHODS: The consecutive patients with anteromedial superior cerebellar tumors who underwent resection performed using the posterior subtemporal transtentorial approach at the National Institutes of Health were included in this study. Clinical, neuroimaging, and operative results were analyzed. Three patients (two men and one woman) with anteromedial superior cerebellar tumors (two hemangioblastomas and one pilocytic astrocytoma) underwent resection via this approach. All the tumors were larger than 3 cm in diameter (range 3.1-3.5 cm). This approach provided excellent surgical access and permitted complete tumor resection in each case. The patients remained neurologically unchanged compared with preoperative baseline findings at the last follow-up examination (conducted at 4, 18, and 42 months postoperatively). One patient displayed a mild transient confusion immediately after surgery, but it resolved within 6 days. CONCLUSIONS: The posterior subtemporal transtentorial approach provides excellent access to the anteromedial superior cerebellar region. This approach permits resection of large lesions in this location, while avoiding many of the limitations associated with other approaches to this site.

Adult↗

PubMed1996

Epilepsy surgery.

Only 15% of patients with severe epilepsy with frequent partial seizures achieve any improvement in their seizure frequency by further drug treatment. As we know that epileptic seizures result in neuron loss with early development of mental deterioration, that the mortality rate of patients with epilepsy is increased and that an exact localization of the epileptogenic area which can be resected offers the possibility of curative treatment, we have a moral obligation to make this treatment available to people disabled with epilepsy. Surgery for mesial temporal sclerosis and lesional cortical partial epilepsy offers freedom from seizures in 70-80% of the patients, whereas non-lesional, cortical, partial epilepsy is more problematic, as only 30-40% of the patients will be seizure-free. Volumetric MRI, MR spectroscopy, SPECT and PET reduce the need for invasive monitoring in patients with temporal lobe epilepsy. Invasive recordings should be used when scalp-EEG, MRI, SPECT and PET cannot identify the epileptic focus; 50% of the patients who cannot be diagnosed by non-invasive recordings, can be diagnosed by invasive methods. When operated on 70% become seizure free, and a further 10% achieve a significant improvement. As age at surgery influences vocational outcome, surgical therapy should be considered in children. This will prevent their development into chronically ill patients, with all the known accompanying psychic handicaps this involves.

Brain↗

PubMed2003

Delayed radiation necrosis with extensive brain edema after gamma knife radiosurgery for multiple cerebral cavernous malformations--case report.

A 39-year-old man presented with multiple intracranial cavernous malformations manifesting as intractable seizures persisting for more than 20 years. He underwent gamma knife radiosurgery (GKRS) for right frontal and left temporal cavernous malformations. He began to suffer from progressive left hemiparesis and inattention 2 years 5 months after the GKRS. Magnetic resonance imaging showed abnormal ring enhancement and extensive brain edema around the right frontal lesion. Conservative therapies such as external decompression, low-dose barbiturates, and mild hypothermia had no effect on his clinical status. Stereotactic biopsy of the ring-enhanced area demonstrated gliosis. Signs of cerebral herniation appeared, so we performed partial resection of the right frontal lobe. His symptoms recovered immediately. Subsequent hyperbaric oxygen (HBO) therapy significantly improved the extensive brain edema. Delayed radiation necrosis associated with potentially fatal brain edema may occur after GKRS for cavernous malformations. Internal decompression and subsequent HBO therapy were very effective for the treatment of these lesions.

Adult↗

PubMed2004

Anatomical landmarks for hemispherotomy and their clinical application.

OBJECT: The authors introduce the surgical concept of the central core of a hemisphere, from which anatomical structures are disconnected during most current hemispherotomy techniques. They also propose key anatomical landmarks for hemispherotomies that can be used to disconnect the hemisphere from its lateral surface around the insula, through the lateral ventricle toward the midline. METHODS: This anatomical study was performed in five adult cadaveric heads following perfusion of the cerebral arteries and veins with colored latex. Anatomical landmarks were used in five hemispheric deafferentations. The central core of a hemisphere consists of extreme, external, and internal capsules; claustrum; lentiform and caudate nuclei; and thalamus. Externally, this core is covered by the insula and surrounded by the fornix, choroid plexus, and lateral ventricle. During most hemispherotomies, the surgeon reaches the lateral ventricle through the frontoparietal opercula or temporal lobe; removes the mesial temporal structures; and disconnects the frontal lobe ahead, the parietal and occipital lobes behind, and the intraventricular fibers of the corpus callosum above the central core. After a temporal lobectomy, the landmarks include the choroid plexus and posterior/ascending portion of the tentorium to disconnect the parietal and occipital lobes, the callosal sulcus or distal anterior cerebral artery (ACA) to sever the intraventricular fibers of the corpus callosum, and the head of the caudate nucleus and ACA to detach the frontal lobe. CONCLUSIONS: These landmarks can be used in any hemispherotomy during which a cerebral hemisphere is disconnected from its lateral surface. Furthermore, they can be used to perform any resection around the central core of the hemisphere and the tentorial incisura.

Adult↗

PubMed1997

Isolation and characterization of human malignant glioma cells from histologically normal brain.

Brain invasion prevents complete surgical extirpation of malignant gliomas; however, invasive cells from distant, histologically normal brain previously have not been isolated, cultured, and characterized. To evaluate invasive human malignant glioma cells, the authors established cultures from gross tumor and histologically normal brain. Three men and one woman, with a mean age of 67 years, underwent two frontal and two temporal lobectomies for tumors, which yielded specimens of both gross tumor and histologically normal brain. Each specimen was acquired a minimum of 4 cm from the gross tumor. The specimens were split: a portion was sent for neuropathological evaluation (three glioblastomas multiforme and one oligodendroglioma) and a portion was used to establish cell lines. Morphologically, the specimens of gross tumor and histologically normal brain were identical in three of the four cell culture pairs. Histochemical staining characteristics were consistent both within each pair and when compared with the specimens sent for neuropathological evaluation. Cultures demonstrated anchorage-independent growth in soft agarose and neoplastic karyotypes. Growth rates in culture were greater for histologically normal brain than for gross tumor in three of the four culture pairs. Although the observed increases in growth rates of histologically normal brain cultures do not correlate with in vivo behavior, these findings corroborate the previously reported stem cell potential of invasive glioma cells. Using the radial dish assay, no significant differences in motility between cultures of gross tumor and histologically normal brain were found. In summary, tumor cells were cultured from histologically normal brain acquired from a distance greater than 4 cm from the gross tumor, indicating the relative insensitivity of standard histopathological identification of invasive glioma cells (and hence the inadequacy of frozen-section evaluation of resection margins). Cell lines derived from gross tumor and histologically normal brain were usually histologically identical and demonstrated equivalent motility, but had different growth rates.

Aged↗

PubMed2006

High grade glioma in a focal cortical dysplastic lesion.

A 61-year-old woman presented in 1999 with a recent onset of left-sided focal clonic seizures with associated vague speech arrests. A computerised tomography (CT) scan revealed a hypoattenuated non-enhancing lesion within her right temporal lobe which was biopsied and the histopathological features were reported to be consistent with a hamartoma, reminiscent of tuberous sclerosis. Her seizures remained partially controlled with phenytoin and carbamazepine. She presented again 2 years later with an increase in the frequency of her seizures. A magnetic resonance scan of her brain demonstrated a homogenously enhancing mass lesion in her right temporo-parietal lobe. An initial lobectomy showed a hamartomatous lesion on histology but a subsequent sample obtained from a wide resection carried out when there was further worsening of her condition revealed a grade IV astrocytoma within a focal cortical dysplastic lesion. Our case highlights the importance of considering the possibility of a cortical dysplastic lesion harbouring a malignancy and the need for further research to explore the behaviour of these malformative lesions.

Brain Diseases↗

PubMed1995

Positron emission tomography in pediatric epilepsy.

PET is an additional tool in the armamentarium to provide improved care to children and infants with epilepsy. It provides important lateralizing information noninvasively, thus avoiding the need for depth or subdural electrodes in most instances. It can be invaluable when CT and MR imaging do not show a structural lesion. When it corresponds to an EEG focus of epileptogenicity, intraoperative electrocorticography may be used to delineate further the extent of surgical resection, often with impressive reduction in the seizure frequency postoperatively. As PET technology continues to improve, the clinical role of PET in the future will undoubtedly continue to grow.

Adolescent↗

PubMed2005

Fractionated proton beam irradiation of pituitary adenomas.

PURPOSE: Various radiation techniques and modalities have been used to treat pituitary adenomas. This report details our experience with proton treatment of these tumors. METHODS AND MATERIALS: Forty-seven patients with pituitary adenomas treated with protons, who had at least 6 months of follow-up, were included in this analysis. Forty-two patients underwent a prior surgical resection; 5 were treated with primary radiation. Approximately half the tumors were functional. The median dose was 54 cobalt-gray equivalent. RESULTS: Tumor stabilization occurred in all 41 patients available for follow-up imaging; 10 patients had no residual tumor, and 3 had greater than 50% reduction in tumor size. Seventeen patients with functional adenomas had normalized or decreased hormone levels; progression occurred in 3 patients. Six patients have died; 2 deaths were attributed to functional progression. Complications included temporal lobe necrosis in 1 patient, new significant visual deficits in 3 patients, and incident hypopituitarism in 11 patients. CONCLUSION: Fractionated conformal proton-beam irradiation achieved effective radiologic, endocrinological, and symptomatic control of pituitary adenomas. Significant morbidity was uncommon, with the exception of postradiation hypopituitarism, which we attribute in part to concomitant risk factors for hypopituitarism present in our patient population.

Adenoma↗

PubMed1998

Anaplastic ganglioglioma with dissemination to the spinal cord: a case report.

BACKGROUND: Gangliogliomas are rare tumors that generally arise in the temporal lobe. Although most are benign, malignant gangliogliomas have been reported. The clinical course of anaplastic gangliogliomas has not been well understood. CASE REPORT: An anaplastic ganglioglioma of the right parieto-occipital lobe is reported in a 7-year-old girl who presented with left homonymous hemianopsia and papilledema. Neurologic examination revealed a choked disc and a left homonymous hemianopsia. A computed tomographic scan and magnetic resonance imaging showed a large enhancing mass with calcification. Radiation therapy was administered after subtotal resection of the tumor. Histologic and immunohistochemical studies showed a typical appearance of anaplastic ganglioglioma. Spinal dissemination developed 3 months after the operation. In spite of spinal axis radiation and chemotherapy, she expired 15 months after the diagnosis. CONCLUSION: Although the clinical course of anaplastic gangliogliomas is not always aggressive, our case indicates the importance of strict follow-up assessments of the whole craniospinal axis.

Brain Neoplasms↗

PubMed1999

Cerebral metabolism of the remote area after epilepsy surgery.

To clarify whether epilepsy surgery improves cerebral metabolism, pre- and postoperative positron emission tomography (PET) scans were performed, with special reference to hypometabolism outside the resected epileptogenic zones in nine patients (8 males, 1 female) with medically intractable complex partial seizures and multiple hypometabolic zones. Seven patients underwent unilateral anterior temporal lobectomy, one patient underwent selective amygdalohippocampectomy, and one patient underwent parieto-occipital cortical resection and anterior temporal lobectomy. PET scans were obtained at least 6 months after surgery. Eight patients became seizure-free, and one patient had fewer than three seizures per year. Four patients showed improved glucose metabolism in the formerly hypometabolic zones, which were remote to the surgical site and ipsilateral to the epileptogenic foci. Five patients, who showed bilateral temporal hypometabolism preoperatively, had contralateral temporal hypometabolism after surgery. The relative glucose uptake in four of these patients showed increased metabolism of the adjacent lobes ipsilateral to the surgical site. The lobes that showed increased glucose metabolism after surgery were mostly frontal. Hypometabolism is reversible in the ipsilateral remote area, and may be caused by inhibition via the intercortical pathway. Contralateral temporal hypometabolic zones that persist after surgery may be caused by a different mechanism, and neither indicate the presence of seizure foci nor affect the seizure outcome.

Adolescent↗

PubMed1990

[Neurosurgical therapy of epilepsy].

We are witnessing a renaissance of the surgical treatment of epilepsy, with renewed interest in the classic procedures and development of new ones such as selective amygdalohippocampectomy. Surgery is being increasingly used in the treatment of medically intractable seizures. Exact presurgical evaluation, with definition of the focus, is of the utmost importance and good results are largely dependent on case selection for surgical therapy. The various therapeutic options such as temporal lobectomy, selective amygdalohippocampectomy, extratemporal cortical resections, hemispherectomy and corpus callosotomy are described and the risks and benefits of surgery discussed. Selective amygdalohippocampectomy, anterior temporal lobectomy and hemispherectomy yield very rewarding results as regards seizure control, while corpus callosotomies frequently reduce the number and severity of generalized seizures.

Amygdala↗

PubMed1993

[A case of selective short-term memory disturbance due to a glioma in the left temporo-parietal lobe].

We report a patient with selective short-term memory disturbance caused by a glioma in the left temporal-parietal lobe. The patient was a 40-year-old right-handed housewife who complained of difficulty in memorizing series of numbers. She was working as a car dealer. She was well until 6 months prior to the present admission when she noted a difficulty in memorizing series of numbers such when telephone numbers and car registration numbers. She had to write them down as her customers told them to her. On admission, she was alert and oriented to all spheres. She was mentally sound without dementia. She did not show aphasia, apraxia, or agnosia, except for brief periods of seizures in which she became unable to speech. Neuropsychological examination revealed that she had difficulty in repeating and dictating series of numbers and meaningless kana words. However, she could easily pick up the correct series of numbers or kana words among multiple choices presented visually. Thus it was clear that her problem was not the disturbance of auditory input nor expression, but a selective impairment of short-term memory. She could memorize the same stimuli when visually presented. Therefore, her problem was thought to be a disturbance of auditory short-term memory of meaningless words. After resection of her tumor, she developed transient amnesic aphasia, which improved a year later. She was examined again in her memory function. In the task of visual stimuli, we presented her a card in which a series of numbers or a nonsense syllable was written for 5 seconds and asked her to remember them.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed2006

A step-by-step resection guided by electrocorticography for nonmalignant brain tumors associated with long-term intractable epilepsy.

To delineate a surgical strategy for long-term intractable epilepsy associated with nonmalignant brain tumor, we developed a protocol for 25 patients whereby removal of tumor alone and additional irritative peritumoral tissue between sulci (gyrectomy), as well as further resectioning, was performed based on intraoperative electrocorticogram results. In five patients, no irritative zones were observed that required resectioning following complete removal of tumors. Additional gyrectomy was indicated in 18 patients who demonstrated gliosis or cortical dysplasia in the peritumoral residual irritative zone. Remote irritative zone observed in two patients was correlated with long-term and frequent seizures. During a follow-up period of at least 5 years, seizure outcome was Engel category I in 92%, and all patients have remained tumor-free. Peritumoral gyrectomy as a means of removing likely epileptic tissue following tumor resection appears to be a useful method for treating long-term intractable tumoral epilepsy. Further resectioning of remote tissue should be considered in patients with severely intractable seizures.

Adolescent↗

PubMed2002

Development of a functional magnetic resonance imaging protocol for intraoperative localization of critical temporoparietal language areas.

The aim of this study was to evaluate the use of functional magnetic resonance imaging as an alternative to intraoperative electrocortical stimulation mapping for the localization of critical language areas in the temporoparietal region. We investigated several requirements that functional magnetic resonance imaging must fulfill for clinical implementation: high predictive power for the presence as well as the absence of critical language function in regions of the brain, user-independent statistical methodology, and high spatial accuracy. Thirteen patients with temporal lobe epilepsy performed four different functional magnetic resonance imaging language tasks (ie, verb generation, picture naming, verbal fluency, and sentence comprehension) before epilepsy surgery that included intraoperative electrocortical stimulation mapping. To assess the optimal statistical threshold for functional magnetic resonance imaging, images were analyzed with three different statistical thresholds. Functional magnetic resonance imaging information was read into a surgical guidance system for identification of cortical areas of interest. Intraoperative electrocortical stimulation mapping was recorded by video camera, and stimulation sites were digitized. Next, a computer algorithm indicated whether significant functional magnetic resonance imaging activation was present or absent within the immediate vicinity (<6.4mm) of intraoperative electrocortical stimulation mapping sites. In 2 patients, intraoperative electrocortical stimulation mapping failed during surgery. Intraoperative electrocortical stimulation mapping detected critical language areas in 8 of the remaining 11 patients. Correspondence between functional magnetic resonance imaging and intraoperative electrocortical stimulation mapping depended heavily on statistical threshold and varied between patients and tasks. In 7 of 8 patients, sensitivity of functional magnetic resonance imaging was 100% with a combination of 3 functional magnetic resonance imaging tasks (ie, functional magnetic resonance imaging correctly detected all critical language areas with high spatial accuracy). In 1 patient, sensitivity was 38%; in this patient, functional magnetic resonance imaging was included in a larger area found with intraoperative electrocortical stimulation mapping. Overall, specificity was 61%. Functional magnetic resonance imaging reliably predicted the absence of critical language areas within the region exposed during surgery, indicating that such areas can be safely resected without the need for intraoperative electrocortical stimulation mapping. The presence of functional magnetic resonance imaging activity at noncritical language sites limited the predictive value of functional magnetic resonance imaging for the presence of critical language areas to 51%. Although this precludes current replacement of intraoperative electrocortical stimulation mapping, functional magnetic resonance imaging can at present be used to speed up intraoperative electrocortical stimulation mapping procedures and to guide the extent of the craniotomy.

Adult↗

PubMed2003

Why does surgery fail to cure limbic epilepsy? Seizure functional anatomy may hold the answer.

Surgery for the mesial temporal lobe epilepsy syndrome is highly effective in controlling seizures in as many as 80% of the patients who undergo this procedure. However, the majority of the patients with successful operations still require medications to control their seizures. Only a small minority are able to stop medications and remain seizure free, patients who would be considered cured. Why are so few patients cured by this procedure? The answer may lie in the relation of the critical seizure circuits to the tissue that is actually resected. In this paper we will discuss two hypotheses for the functional anatomy of limbic epilepsy in light of what is known about the pathology and physiology of limbic epilepsy. Combining the clinical and scientific observations with these constructs for seizure initiation may lead us to a better understanding of this particular epilepsy syndrome as well as to more effective surgical approaches.

Epilepsy↗