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Results for “Temporal Lobe Resection”

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PubMed2001

Bilateral resective epilepsy surgery in a child with tuberous sclerosis: case report.

OBJECTIVE AND IMPORTANCE: Surgical intervention can reduce the burden of seizures in selected patients with tuberous sclerosis and medically refractory epilepsy. CLINICAL PRESENTATION: A child presented with tuberous sclerosis and severe epilepsy beginning in the first month of life and delayed development before 1 year of age. Video-electroencephalographic monitoring at the age of 1 year revealed a left temporal seizure focus. Repeat videoelectroencephalography at 2 years of age revealed a right posterior quadrant seizure focus. Bilateral subdural electrodes were placed, confirming independent seizure onsets from the right parietal area (overlying a tuber) and prominent interictal activity over the left superior temporal region. INTERVENTION: The right parietal focus was resected, and electrodes were maintained over the left temporal focus. After right parietal resection, ictal discharges were recorded over the left temporal region; a corticectomy was performed 2 days later. No tonicoclonic or complex partial seizures have occurred during a follow-up period of more than 24 months. Simple partial motor seizures involving the right foot have been reduced by more than 80%, and other simple partial seizures have been eliminated. Postoperatively, there has been marked improvement in the patient's cognitive and motor developmental status. CONCLUSION: In selected patients with bilateral seizure foci involving separate lobes, aggressive bilateral surgery can be safe and effective.

Cognition Disorders↗

PubMed1997

Surface and depth EEG findings in patients with hippocampal atrophy.

OBJECTIVE: To establish if MRI evidence of hippocampal atrophy (HcA) is an independent surrogate of EEG criteria for the diagnosis of medial temporal lobe (MTL) epilepsy (MTLE). BACKGROUND: MRI evidence of HcA has been shown to correlate with mesial temporal sclerosis (MTS), intracranial evidence of MTL seizure onset, and outcome after temporal lobectomy. The reported rate of discordance between scalp ictal EEG recordings and MRI evidence of unilateral HcA ranges from rare to moderate. We examined the surface and depth ictal EEG findings of patients with HcA, as detected by volumetric MRI, to clarify their significance in detecting areas of epileptogenicity in this group of patients. METHODS: From a group of patients with refractory epilepsy, we identified 119 patients with HcA (97 with unilateral and 13 with bilateral HcA, 9 with HcA and mass lesion). MRI volumetric studies were used to obtain Hc ratios. Absolute volumes were used to detect bilateral atrophy. Surface and depth EEG recordings were analyzed for localization of ictal abnormalities, and their distribution was compared for concordance with the location of HcA. Surgical outcome was reviewed. RESULTS: Of the 110 patients with isolated HcA, 63 had surgery; 82% of ictal depth EEG onsets were concordant with the atrophic Hc, and 72% ictal surface EEG onsets were concordant. Four patients with concordant EEG and HcA failed to achieve seizure control with resection of the atrophic Hc. Furthermore, 3 patients with discordant EEG and HcA had resection of the non-atrophic Hc with excellent results. Among the 47 non-operated patients, 54% had discordant or unlocalized ictal depth EEG results and 52% had discordant ictal surface EEG. Four of the 9 lesional patients with HcA had excellent outcome after lesionectomy without hippocampectomy. CONCLUSION: The presence of HcA is not an independent predictor of the site of epileptogenesis.

Amygdala↗

PubMed1996

Word-finding deficits persist after left anterotemporal lobectomy.

OBJECTIVE: To determine the incidence and extent of exacerbation of word-finding difficulty following anterotemporal lobectomy and to identify predictors of change. DESIGN: Case-series study of qualitative and quantitative changes in confrontation naming ability before surgery and 1 year after surgery. Stepwise multiple regression analysis of predictors of postoperative naming change. SETTING: A university epilepsy surgery program. PARTICIPANTS: Fifty-nine consecutive patients. INTERVENTION: Standard, en bloc anterotemporal lobectomy. MAIN OUTCOME MEASURE: Raw scores and types of errors on the 85-item Boston Naming Test. RESULTS: A significant exacerbation of word-finding difficulty was noted that persisted at least 1 year after surgery in 25% of patients with left, speech-dominant anterotemporal lobectomy (Laterality x Time interaction [F = 24.5; P < .0005]). "Tip-of-the-tongue"-type errors were most frequent (F = 54.66; P < .001), as opposed to paraphasic-type errors seen more frequently among patients with aphasia or dementia. Word-finding decline was worse among patients who underwent a left anterotemporal lobectomy and who were left-hemisphere speech dominant, older, or evaluated earlier in the postoperative course. CONCLUSIONS: Significant, persisting worsening of word-finding difficulties is not a rare consequence of a left anterotemporal lobectomy, as suggested by previous studies. Differences between these results and those of previous studies may reflect differences in extent of surgical resection and/or differential sensitivity of psychometric measures of naming to word-finding problems. Information regarding extent, frequency, and predictors of word-finding declines may be used in counseling surgical candidates about the potential cognitive side effects of anterotemporal lobectomy.

Adult↗

PubMed2004

Cerebral astroblastoma.

BACKGROUND: Astroblastoma is a rare glial tumour about which little is known. METHOD: We report a case of cerebral high grade astroblastoma and discuss the clinical, histopathological, surgical, radiological and prognostic features of this tumour, in the light of the pertinent literature. RESULT: Present patient had an initial histological diagnosis of glioblastoma multiforme. Three years later an histological reevaluation was performed and revealed a high grade astroblastoma. Our patient underwent surgical removal and radiotherapy; five years after the operation he is alive and without evidence of recurrence. INTERPRETATION: Classification and histogenesis of this tumour is still debated. The lack of a clinicopathological correlation makes the prognosis of this tumour unpredictable. The optimal management is not defined, but total resection and post-operative radiotherapy seem to be the effective means to treat the astroblastoma.

Adult↗

PubMed1995

[Temporal lobectomy: indications and role in the surgery of epilepsy].

When a focal epilepsy proves refractory to medical therapy, surgical treatment is increasingly used. Most interventions consist in cortical resections, and by far the most common operation is a temporal lobectomy. The presurgical evaluation is a multi-disciplinary one, and includes history and examination, neuropsychological testing, neuro-imaging techniques, functional studies (functional imaging and intracarotid amobarbital procedure), and neurophysiologic data (EEG-video monitoring). When non-invasive EEG does not succeed in localizing the epileptogenic zone with sufficient accuracy, several invasive techniques are available. Each has its own advantages and disadvantages. In appropriately selected cases, postoperative outcome is excellent, especially in temporal lobe epilepsy. In general, outcome is slightly less successful in extra-temporal cases.

Electroencephalography↗

PubMed1987

Effect of commissurotomy on complex partial epilepsy in patients without a resectable seizure focus.

Twenty-five patients in a series of 51 undergoing partial or complete section of the corpus callosum for the treatment of intractable epilepsy experienced complex partial seizures among their seizure types preoperatively. Ten of these 25 patients have experienced no further complex partial seizures. Reduction in severity of seizures has been found in 11 of the 15 patients still experiencing this seizure type, and 3 have had greater than 80% frequency reduction. These findings are consistent with the electrophysiologic observations of Lieb on the relative unimportance of the hippocampal commissure in man and the behavioral observations of Quesney on unilateral versus bilateral temporal lobe seizure activity.

Corpus Callosum↗

PubMed1998

Awareness and responsiveness during partial seizures.

We examined the impairment of consciousness during partial seizures (PS) arising from various brain sites according to the operational definition of the international classification, i.e., altered awareness and/or responsiveness. The subjects were 142 patients who underwent intracranial EEG evaluation and subsequent resective surgery. First, the patients were examined to determine whether they usually had been partially or completely aware of their seizures. Second, spontaneous habitual seizures that had been videotaped with simultaneous intracranial EEG recording were reviewed to determine responsiveness and recall during ictal behavioral alterations. In all, 114 patients were partially or completely aware of their seizures. Patients who tended not to be aware of their seizures were those with frontal lobe epilepsy (FLE) with extensive epileptogenic regions on the language nondominant side and those with temporal lobe epilepsy (TLE) with seizure origin in the lateral cortex of the language dominant side. Of the 21 patients with FLE, 88 with TLE, and 4 with occipital lobe epilepsy, 7, 22, and 2 patients responded to stimuli during the seizure, respectively, but only 11 of the patients with FLE and none of the other patients could recall the stimuli applied during the behavioral alterations. Bilateralization of seizure discharges correlated with impaired responsiveness. According to the International Classification, about half of patients with FLE had only simple partial seizures (SPS) and the other patients had complex partial seizures (CPS). Altered awareness and/or responsiveness occurred in most habitual partial seizures in our subjects. The term "complex" appears to be useful in clinical practice, although the contents of ictal behavior and the site or side of seizure origin are not implied.

Adolescent↗

PubMed1995

Language dominance in patients with early childhood tumors near left hemisphere language areas.

RATIONALE: Language function often develops in the right hemisphere following an acute left hemispheric insult in early childhood. Little is known, however, about lateralization of language function in patients with early childhood tumors near potential left hemisphere language areas. Issues of language dominance are important in the strategy for resection of left temporal and frontal tumors. METHODS: We studied 12 patients who had determination of hemispheric language dominance by the intracarotid amobarbital procedure prior to resection of a left inferolateral frontal or left mid or posterior temporal tumor that (1) was near a classic language area and (2) first manifested with partial seizures by age 6 years (mean, 3.7). RESULTS: Hemispheric language dominance was left in 10 patients (83%), right in one patient, and bilateral in one patient. Six patients with left temporal tumors had localization of Wernicke's area with cortical stimulation, and in five the language area was posterior to the tumor. In one patient, the tumor infiltrated Wernicke's area. Eleven of the 12 patients had complete tumor resection (mean age at operation, 11.8 years) and were seizure-free at follow-up (mean, 3.1 years). Neuropsychological testing showed a tendency for improved language function after operation, and no patient had new overt language deficits. CONCLUSIONS: Early low-grade left frontal and temporal tumors usually did not result in transfer of language dominance to the contralateral hemisphere. Tumors may grow slowly along with the developing brain in young children, with continued left hemisphere language development in regions separate from the neoplasm. Successful tumor resection can be accomplished, but it may require cortical stimulation for localization and sparing of nearby language areas.

Adolescent↗

PubMed2005

Temporal lobe epilepsy: analysis of failures and the role of reoperation.

PURPOSE: To analyze failures and reoperations in temporal lobe epilepsy (TLE), and compare these patients with those seizure-free, and to determine any significant differences between the groups. METHODS: A total of 262 patients with TLE, treated surgically between 1984 and 2002, were followed at 3, 6 and 12 months and yearly thereafter. Sixty-five percent became seizure-free (class I), 19% had rare seizures (class II), and 16% continued to have seizures (classes III and IV). Patients in classes III and IV underwent re-evaluation, and were compared with seizure-free patients. RESULTS: Analysis of failures (n = 41): 12% had febrile seizures (FS), 29% head trauma, 7% encephalitis, 52% abnormal imaging, 34% bitemporal spiking, and 20% posterior temporal localization. Post-surgical MRI (available in 30 of 41 patients) showed residual posterior mesial temporal structures (PMTS) in 86.6%, PMTS and posterior temporal lesions (PTLs) in 6.6%, and PTLs in another 6.6%. Twenty-one had reoperation, 14 had resection of the PMTS, five of the PMTS and basal posterior temporal cortex, and two of the PMTS, and PTLs. There was no surgical mortality or morbidity; 57% became seizure-free and 24% had rare seizures. Seizure-free patients (n = 170): 45% had FS, 12% head trauma and 70% abnormal imaging studies. CONCLUSION: When compared with seizure-free patients, patients who failed TLE surgery were less likely to have a history of FS and abnormal imaging, and more likely to have a history of head trauma, encephalitis and posterior temporal localization, suggesting larger epileptogenic zones. Following reoperation, 57% became seizure-free. Predictors of a good outcome after reoperation were anterior temporal localization and abnormal imaging studies.

Adolescent↗

PubMed2001

Fear as the main feature of epileptic seizures.

OBJECTIVES: There are circumstances in which partial seizures may be misdiagnosed as acute psychiatric disturbances. In particular, when fear is the prominent feature the patient may be considered for years as having panic attacks. Eight patients in whom fear was the main symptom of the seizures are reported on. Patients who had a proved lack of consciousness during the fits and patients in whom fear was just fear of having a seizure were excluded. The ictal involvement of temporal limbic and frontal structures in those patients with fear of particular intensity was studied. METHODS: The localisation of the epileptogenic zone was assessed by prolonged interictal EEG recordings as well as ictal video-EEG recording of at least one seizure in every patient; five had ictal SPECT and four had chronic stereotactic implantation of depth electrodes (SEEG). In six patients, a cortical resection was performed with an Engel's class 1 outcome (minimum 28 months follow up, except for two patients). RESULTS: Localisations of primary epileptogenic zones were right temporal in three patients, left temporal in three, bitemporal in one, and frontal in one. In all cases, diagnosis of epileptic seizures could be clinically evoked because of the stereotypy of fits and of associated symptoms. The association of a fear sensation, autonomic symptoms, and coordinated behaviour suggests disturbance of a particular system. The SEEG data argue for temporolimbic and prefrontal lobe involvement in the expression of ictal fear. CONCLUSIONS: In intense ictal fear, with coordinated behaviour and autonomic features, the discharge may involve or interfere with a physiological complex information processing network. This network involves orbitoprefrontal, anterior cingulate, and temporal limbic cortices.

Adolescent↗

PubMed2003

Repeated operations for infiltrative low-grade gliomas without intervening therapy.

OBJECT: Progression of infiltrative low-grade gliomas (LGGs) has been reported previously. The limitations of such studies include diverse histological grading systems, intervening therapy, and the lack of histological confirmation of malignant tumor progression. The aim of this study was to determine tumor progression in adult patients with an initial diagnosis of infiltrative LGG who subsequently underwent a repeated operation, but no other intervening therapy. The authors examined factors that may be associated with tumor progression. METHODS: The authors retrospectively reviewed a database of 300 patients with the initial diagnosis of LGG and who had been treated at their institution between 1990 and 2000. One hundred four of these patients had undergone a second surgery. Patients with infiltrative LOGs who had undergone two surgical procedures at least 3 months apart without intervening therapy were selected; the authors identified 40 patients who fit these criteria. Clinical, neuroimaging, and pathological data were centrally reviewed. There were 29 men and 11 women in the study, whose median age was 35.5 years (range 23-48 years). At the time of the second surgery, 50% of patients had experienced tumor progression. Patients whose tumors had progressed had a longer median time to repeated operation (49 compared with 22.5 months). Patients who had undergone gross-total resection, as demonstrated on postoperative magnetic resonance images, had a median time to repeated operation of 49 compared with 25 and 24 months in patients who underwent subtotal resection and biopsy, respectively (p = 0.02). The extent of resection did not influence the likelihood of tumor progression (p > 0.3). CONCLUSIONS: Fifty percent of patients with initially diagnosed infiltrative LGOs had tumor progression at the time of a repeated operation. A gross-total resection was associated with an increased time to repeated surgery. There was no statistically significant effect of gross-total resection as a predictor of tumor progression.

Adult↗

PubMed1995

Language function after temporal lobectomy without stimulation mapping of cortical function.

We studied 95 patients who underwent standard anterior temporal lobectomy (ATL) without stimulation mapping of language areas, using neuropsychological parameters of language function preoperatively and 1 year postoperatively [Boston Naming Test and Verbal Fluency, and the Information, Comprehension, Arithmetic, Similarities, Digit Span, and Vocabulary subtests of the Wechsler Adult Intelligence Scale (WAIS)]. Verbal IQ (VIQ), Performance IQ (PIQ), Full-Scale IQ (FSIQ), and Verbal Deviation Quotient were also evaluated, as were parameters of memory function. All patients had hemisphere dominance for language assessed by an intracarotid amytal test. Fifty-three patients had a left dominant (LHDL) ATL with a mean extent of lateral resection of 4.8 cm, and 10 had a left ATL with right or mixed hemisphere dominance (RHDL, MDL). Thirty-two patients had a right nondominant ATL. Seizure outcome was 57 and 59% seizure-free for LHDH and right nondominant group, respectively, 1 year after operation. Comparison of preoperative scores showed the LHDL group to have significantly lower scores than the right nondominant group for several parameters of language function and memory. The group undergoing left dominant ATL showed no significant loss of language function postoperatively and actually showed gains in many parameters. Standard ATL without stimulation mapping of language areas and with conservative lateral resection is safe for long-term language function. In addition, evidence shows preexisting language dysfunction in patients undergoing left dominant ATL.

Adolescent↗

PubMed1993

Surgical treatment of partial epilepsy arising from the insular cortex. Report of two cases.

Despite its documented connections with many limbic structures, the role of the insula in the etiology of partial seizures is poorly understood. Two patients are described in whom lesions of the insula were associated with intractable partial seizures. In the first patient, the seizures involved visceral sensory hallucinations followed by motor automatism. Seizures in the second patient began with somatic sensory hallucinations and then produced visceral motor effects. Both patients were found to have low-grade astrocytomas of the insula. In both instances, resection of the lesion and adjacent insular cortex resulted in a cure of the seizures. These cases are placed within the context of the existing literature on the subject.

Adolescent↗

PubMed1978

[Herpetic meningo-encephalitis : emergency E.E.G. diagnosis and neurosurgical treatment (author's transl)].

Reporting two cases of true herpetic encephalitis, the authors insist on the great diagnostic value of some nearly constant, but transitory, aspects of localised periodic waves in the E.E.G. An emergency cerebral (usually temporal) resection is then advised. Thus focal infection is reduced and intra-cranial hypertension is prevented. Virologic and electron microscopic studies of the cortical specimen establish with certainty the diagnosis of herpetic encephalitis.

Adult↗

PubMedDate not supplied

Significance of sharp waves in routine EEGs after epilepsy surgery.

We retrospectively analyzed the presence of sharp waves in 2-h EEGs performed 6 months after epilepsy surgery in 59 patients. To study the significance of the postoperative interictal epileptiform activity in the tissue remaining after resection, we included only patients with a single epileptic focus (as defined preoperatively by prolonged video/EEG recordings and subdural electrode arrays studies) and no progressive structural lesions. Temporal lobectomy was performed in 51 patients (86%); extratemporal resections were performed in the remainder. The epileptogenic focus was completely resected in 26 patients (44%). The immediate postoperative electrocorticograms (EcoG) showed spikes in 13 patients (22%). At 6-month follow-up, 43 patients (73%) were seizure-free or had auras only and 12 patients (20%) had epileptiform activity on EEG. A significant correlation was noted between presence of sharp waves in the 6-month postoperative EEG and recurrence of seizures (Fisher's exact test p = 0.011) and also with the extent of the resection (complete vs. incomplete p = 0.042). We noted no correlation between postoperative epileptiform activity and location of the resection (temporal vs. extratemporal), presence of spikes in immediate postoperative EcoG, or occurrence of auras only at 6-month follow-up.

Adolescent↗

PubMed1995

The clinical-pathogenic mechanisms of hippocampal neuron loss and surgical outcomes in temporal lobe epilepsy.

A retrospective study was carried out to determine whether a prior cerebral injury or medical illness was associated with hippocampal sclerosis in intractable, surgically treated temporal lobe epilepsy (TLE), or whether there was evidence for progressive hippocampal neuron damage from repeated seizures. Temporal lobe epilepsy patients (n = 162) from one epilepsy centre were retrospectively and blindly catalogued into groups based on the presence or absence of an initial precipitating injury (IPI) and whether, when an IPI was present, it had involved seizures (independent variables). Patients were catalogued into four groups: (i) non-seizure IPIs (Group A; n = 54); (ii) IPIs with a prolonged seizure (Group B; n = 66); (iii) IPIs with repetitive non-prolonged seizures (Group C; n = 20); (iv) or no IPIs and idiopathic TLE (Group D; n = 22). The dependent variables were: the differences in the time course of clinical seizures, and quantified hippocampal neuron counts and seizure outcomes. Statistically significant (ANOVA at least P < 0.05) results showed the following. (i) Patients with IPIs (Groups A, B and C) had hippocampal sclerosis, while those with idiopathic TLE (Group D) showed fewer neuron losses and worse post-resection seizure relief. (ii) Patients with non-seizure IPIs (Group A) were on average older at injury; had a longer latent period; showed less neuron losses in Ammon's horn, CA1 and prosubiculum than seizure associated IPIs (Groups B and/or C). (iii) Initial precipitating injury patients with repetitive non-prolonged seizures (Group C) showed the shortest latent period, earliest age of TLE onset, and less CA2 damage than the other IPI groups. Other findings that were statistically significant by analysis of covariance along with the IPI category included the following. (i) CA1 (P = 0.0097) and prosubiculum (P = 0.0089) neuron losses were greater in patients when their TLE was longer than 22 years. (ii) IPIs after age 4 years were associated with latent periods shorter than 10 years compared with variable and longer latent periods of IPIs before age 4 years (P = 0.0015). These results indicate that in surgically treated TLE, hippocampal sclerosis and good seizure outcomes are associated with IPIs. Most of the hippocampal damage found at surgery and the clinical time course of the habitual TLE are influenced by the pathogenic IPI mechanism. However, some secondary neuron losses were associated with longer TLE seizure histories.(ABSTRACT TRUNCATED AT 400 WORDS)

Adolescent↗

PubMed1993

The tailored temporal lobectomy.

The indications, rationale, operative technique, risks, and outcome from the tailored temporal lobectomy are reviewed. The tailored lobectomy allows intraoperative identification of both electrically active cortex and functionally essential cortex, thus permitting maximal resection of epileptic regions without damage to Rolandic cortex or essential language cortex. This allows surgical strategy to be planned on the basis of preoperative interictal scalp electroencephalography recordings, thus lowering hospital costs and avoiding risk of implanting intracranial electrodes.

Brain Mapping↗

PubMed2002

Focal cortical dysplasia of Taylor's balloon cell type: a clinicopathological entity with characteristic neuroimaging and histopathological features, and favorable postsurgical outcome.

BACKGROUND AND PURPOSE: Focal cortical dysplasia of Taylor's balloon-cell type (FCD-BC) are a frequent cause of pharmacoresistant epilepsy in young patients. In order to characterize FCD-BC, we coupled MRI and histopathology, and analyzed the clinical outcome following epilepsy surgery. METHODS: From an epilepsy data bank with 547 histological specimens, 17 FCD-BC were re-evaluated of which high resolution MRI was available. Five additional FCD-BC were prospectively identified by MRI. Histopathological and immunohistochemical features were related to MRI. Outcome following lesionectomy was analyzed as determined on routine examinations 3, 6 and 12 months following surgery. RESULTS: All but one lesion were located outside the temporal lobe. A markedly hyperintense funnel-shaped subcortical zone tapering towards the lateral ventricle was the characteristic finding on FLAIR MRI. Histopathologically, the subcortical zone of the FCD-BC displayed hypomyelinated white matter with radially oriented balloon cells and gliosis. Dysplastic neurons were found in the adjacent, disorganized cortex. All patients with complete lesionectomy were seizure free one year following surgery. CONCLUSION: Focal cortical dysplasias of Taylor's balloon-cell type (FCD-BC) have characteristic MRI and histopathological findings. MRI recognition is important, since outcome following resective surgery is favorable.

Adolescent↗