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PubMed1995

The hippocampus: functional and structural correlations.

This paper reviews the current literature relating neuropsychological measures of the functional integrity of the hippocampus with structural indices obtained from magnetic resonance imaging (MRI) volumetric scans and the histological analysis of postoperative specimens. The first part of the discussion presents an overview of the current methods and applications of volumetric MRI of the hippocampus. The processes and contemporary standards applied to the histological analysis of resected hippocampal tissue are also described. Both of these measures of structural integrity have been studied in relation to preoperative performance on neuropsychological tests, including the intracarotid sodium amytal test, and postoperative memory functioning. The findings from these studies are reviewed. The challenges presented by these new technologies to the field of neuropsychology are discussed.

Brain Mapping↗

PubMed2004

Utilization of magnetoencephalography results to obtain favourable outcomes in epilepsy surgery.

Magnetoencephalography (MEG) is a well-known technique in the presurgical evaluation of epilepsy patients. Like EEG, it can detect and localize epileptic activity. Epilepsy surgery can be used to evaluate MEG source localizations. Resection volumes were determined in 33 epilepsy surgery patients. The resection volume, taken together with the post-operative outcome, was used to evaluate MEG results. The scattering MEG localizations of interictal epileptic activity were represented by an ellipsoidal volume. Using this MEG results ellipsoid, it was demonstrated that a high coverage by the resection volume and a small distance to the resection volume are both correlated to a favourable outcome; in addition, a homogeneous distribution of MEG localizations is correlated to a favourable outcome. This study shows that MEG source localization can help to delineate epileptic activity and, along with other techniques, should be taken into account for epilepsy surgery.

Adolescent↗

PubMed2004

SEEG-guided RF thermocoagulation of epileptic foci: feasibility, safety, and preliminary results.

PURPOSE: Depth electrodes recordings may be required in some cases of epilepsy surgery to delineate the best region for cortical resection. We usually implant depth electrodes according to Talairach's stereoelectroencephalography (SEEG) method. By using these permanently implanted depth electrodes, we are able to perform radiofrequency (RF)-thermolesions of the epileptic foci. We report the technical data required to perform such multiple cortical thermolesions, as well as preliminary results in terms of seizure outcome in a group of 20 patients. METHODS: Lesions were performed by using 100- to 110-mA bipolar current (50 V), applied for 10 to 50 s. Each thermocoagulation produced a 5- to 7-mm diameter cortical lesion. In total, two to 16 lesions were performed in each of the 20 patients. Lesions were placed without anesthesia. No general or neurologic complication occurred during the procedures. Two transient postprocedure side effects, consisting of paresthetic sensations in the mouth and mild apraxia of the hand, were observed. RESULTS: At a follow-up time of 8 to 31 months (mean, 19 months), 15% of the patients became seizure free, 40% experienced a > or =80% reduction of their seizure frequency, and 45% were not significantly improved. CONCLUSIONS: SEEG-guided RF thermolesions is a safe technique. Our preliminary results indicate that such lesions can lead to a significant reduction of seizure frequency and could be proposed as a palliative procedure if no resective surgery is possible. A randomized controlled trial is needed to determine which patients are likely to respond to SEEG-guided RF thermolesions.

Adult↗

PubMed1997

Can neuronavigation contribute to standardization of selective amygdalohippocampectomy?

Tailored selective amygdalohippocampal resections seem to be an interesting application for neuronavigation. The accuracy of freehand frameless neuronavigation was assessed in 28 patients for its ability to determine the hippocampal resection length, as compared to postoperative MRI. Brain collapse due to CSF displacement caused an expected error of navigation at the brain surface, but almost no error at the tentorial notch. Yet, the hippocampal resection length was overestimated by navigation to an extent of 3 +/- 2 mm. The discrepancy is explained by an anterior-posterior component of brain collapse in a tilted head. Horizontal positioning of the head or navigational marking prior to the occurrence of brain collapse may overcome the problem.

Adult↗

PubMed1997

Results and complications after reoperation for failed epilepsy surgery in children.

The seizure outcome and neurological outcome in children who undergo reoperation for failed epilepsy surgery have not been well documented. This retrospective study evaluated 20 children who underwent a second resective surgery for recurrent seizures. Four categories of patients were identified: (1) extension of the initial resection was performed in 8 patients; (2) 5 patients underwent lobectomy or corticectomy in a region remote from the original surgical site; (3) multilobar resection which may have included further resection of the initial procedure was accomplished in 4 patients; (4) hemispherectomy was performed in 3 patients. Patients with reoperation in the same lobe as the first procedure (group 1) had a 62% seizure-free rate, while 44% of patients in groups 2 and 3 were free from seizures at follow-up evaluation. Patients undergoing hemispherectomy had a 67% seizure-free rate. Significant unexpected neurological deficits occurred in 3 patients who underwent multilobar resection at reoperation. Complications included motor and language deficits. Reoperation for intractable partial epilepsy is beneficial in selected children. Patients who require multilobar resections may have higher risk of postoperative neurological deficit than those patients with reoperation in one lobe. These factors may be useful in counseling parents of children considering reoperation for recurrent epilepsy.

Adolescent↗

PubMed1995

[Cerebrovascular abnormalities in pregnancy].

A 37-year-old pregnant woman without neurological history was admitted in the 21st week of pregnancy for multiple seizures. Angiography confirmed the diagnosis of cerebral angioma. The patient decided to continue with her pregnancy; caesarean section under regional anesthesia via an epidural catheter was uneventful. Five weeks later the angioma was resected after sudden recurrence of seizures and neurological deterioration. In this report, the therapeutic options for elective neurosurgical intervention after possible termination of pregnancy, during pregnancy, or after delivery are discussed including anesthesiological management during delivery.

Adult↗

PubMedDate not supplied

Intracarotid amobarbital procedure: II. Lateralizing value in evaluation for temporal lobectomy.

The intracarotid amobarbital procedure (IAP) was assessed for lateralizing value in 37 patients who later had temporal lobectomy for intractable epilepsy. Among patients who failed IAP memory testing on one side (defined as a retention score for test items at least 20% lower on one side than the other), significantly more patients failed the injection contralateral (16 of 20, 80%) than ipsilateral (4 of 20, 20%) to the side of later resection (p = 0.008). In addition, preoperative EEG evidence of bilateral temporal epileptogenicity was significantly more frequent among patients who failed the ipsilateral IAP injection (2 of 4, 50%) than among patients who passed the ipsilateral IAP injection (2 of 33, 6%) (p = 0.050). Finally, failure of the contralateral IAP injection involved significantly more severe amnesia for test items (median retention score 25%) than did failure of the ipsilateral injection (median retention score 59%) (p = 0.047). Profoundly low retention scores less than 33% occurred only with contralateral injection. These findings suggest that the IAP has some adjunctive lateralizing value for the epileptogenic hemisphere in patients with temporal lobe epilepsy, especially when the retention score with one injection is profoundly low.

Adolescent↗

PubMed2001

Spatial localization after excision of human auditory cortex.

Neurophysiological and animal ablation studies concur that primary auditory cortex is necessary for computation of the spatial coordinates of a sound source. Human studies have reported conflicting findings but have often suffered from inadequate psychophysical measures and/or poor lesion localization. We tested patients with unilateral temporal lobe excisions either encroaching on or sparing Heschl's gyrus (HG), quantifying lesion extent using anatomical magnetic resonance imaging measures. Subjects performed two tasks. In the localization task, they heard single clicks in a free-field spatial array subtending 180 degrees of azimuth and indicated the perceived location with a laser pointer. In the discrimination task, two clicks were presented, and subjects indicated if they were in the same or different position. As a group, patients with right temporal excision, either encroaching onto HG or not, were significantly impaired in both hemifields in both tasks, although this was not true for all individuals. Patients with left temporal resections generally performed normally, although some of the patients with left HG excision showed impaired performance bilaterally, especially in the discrimination task. This pattern stands in marked contrast to previous studies showing significant preservation of localization in hemispherectomized patients. We conclude that (1) contrary to hypotheses derived from animal studies, human auditory spatial processes are dependent primarily on cortical areas within right superior temporal cortex, which encompass both spatial hemifields; (2) functional reorganization may not take place after restricted focal damage but only after more extensive early damage; and (3) the existence of individual differences likely illustrates differential patterns of functional lateralization and/or recovery.

Acoustic Stimulation↗

PubMed2000

A transient deficit of motion perception in human.

We studied the motion perception abilities in a young adult, SF, who had her right occipito-temporal cortices resected to treat epilepsy. Following resection, SF showed transient deficits of both first- and second-order motion perception that recovered to normal within weeks. Previous human studies have shown either first- or second n order motion deficits that have lasted months or years after cerebral damage. SF also showed a transient defect in processing of shape-from-motion with normal perception of shape from non-motion cues. Furthermore, she showed greatly increased reaction times for a mental rotation task, but not for a lexical decision task. The nature and quick recovery of the deficits in SF resembles the transient motion perception deficit observed in monkey following ibotenic acid lesions, and provides additional evidence that humans possess specialized cortical areas subserving similar motion perception functions.

Adult↗

PubMed2002

Microsurgery for glioblastoma preserves short-term quality of life both in functionally impaired and independent patients.

OBJECTIVE: Considering the short remaining life expectancy with glioblastoma multiforme, numerous patients and their referring physicians are hesitant to use aggressive surgical treatment for fear of greater risk of neurological deterioration. The aim of our study was to determine whether surgical treatment of glioblastoma, utilizing modern microsurgical dissection techniques and tools, interferes with short-term quality of life. METHODS: The functional status before and after 67 microsurgical operations in 65 patients with glioblastomas was studied retrospectively. To evaluate the patients' quality of life, their functional neurological status was correlated with the Karnofsky performance scale (KPS). Post-operative evaluation was done within 7 days of surgery. RESULTS: No significant difference was found between the preoperative and the early postoperative functional status. Neither patient age nor the preoperative functional status determined a significant risk for postoperative functional deterioration. Patients with tumors involving so-called eloquent brain areas statistically worsened (p = 0.018); however, they showed only mild clinical impairment that was represented by a mean KPS status decline of less than -10. After total tumor resection, patients showed functional improvement. CONCLUSION: Microsurgery is safe and effective in order to improve or preserve short-term quality of life in glioblastoma patients. Total tumor resection is not associated with a significantly greater risk for neurological deterioration, either in patients with preoperative functional impairment, or in functionally independent patients.

Adolescent↗

PubMed2006

Dumbbell-shaped middle cranial fossa meningioma with interdural cavernous sinus extension: report of two cases with complete removal.

BACKGROUND: Surgery for meningiomas involving the cavernous sinus remains controversial. Interdural cavernous sinus is called the lateral dural wall in the cavernous sinus, which is composed of two layers, the outer dural layer and the inner membranous layer. We encountered two cases of dumbbell-shaped middle cranial fossa meningioma with interdural cavernous sinus extension, which were successfully removed by surgical means. CASE DESCRIPTION: A 57-year-old woman presented with headache and decreased visual acuity. Neurological assessment was normal. Computed tomography and magnetic resonance imaging showed the presence of a dumbbell-shaped, smooth-contoured, well-enhanced mass in the right mesial temporal area. The lateral wall of the cavernous sinus was exposed via frontotemporal craniotomy and the tumor originating in the lateral wall was totally removed. A 41-year-old man presented with seizure attacks and drowsy mental status. Magnetic resonance imaging showed the presence of a multilobulated, well-enhanced mass in the left parasellar area. The tumor was totally resected via a transsylvian temporopolar approach. The mass originated from tentorial edge and extended into the cavernous sinus by dural penetration. CONCLUSION: Middle cranial fossa meningioma with interdural cavernous sinus extension can be removed more easily than other tumors with intracavernous sinus extension and, consequently, can be safely resected without any resulting cranial nerve deficit.

Adult↗

PubMed1997

Significance of spikes recorded on intraoperative electrocorticography in patients with brain tumor and epilepsy.

PURPOSE: Patients with medically intractable epilepsy due to brain tumors may undergo resective surgery for treatment of both the tumor and the epilepsy. In this instance, the extent of surgical resection is sometimes guided by spikes recorded on intraoperative electrocorticography (ECoG). Whether spikes recorded by electrocorticography imply active epileptogenicity has not been addressed adequately. METHODS: We performed preresection and postresection electrocorticography on 36 patients with brain tumor and seizures. There were 31 low-grade gliomas, 4 high grade gliomas, and 1 dysembryonic neuroepithelial tumor. Patients had resection of the tumor to normal tissue margins only. No additional surgery was performed, based on electrocorticography findings. Patients were divided into 2 groups: Group I (no seizures or rare seizures after resection) and Group II (recurrent seizures). Recorded spikes were analyzed for spike distribution and spike discharge rate. RESULTS: On preresection ECoG, 85% of patients in Group I and 88% of patients in Group II had spikes. In Group I, 70% of patients had spikes over the tumor bed, and 63% of patients had spikes in the surrounding tissue. In Group II, 55% of patients had spikes over the tumor bed and 89% of patients had spikes in the surrounding tissue. Spike distribution and discharge rate did not correlate with outcome. On postresection ECoG, 60% of patients in Group I and 67% of patients in Group II had residual spikes. In Group I, 46% of patients had spikes along the margin of resection and 26% of patients had extramarginal spikes. In Group II, 50% had spikes along the margin of resection and 67% of patients had extramarginal spikes. CONCLUSIONS: The difference in spike distribution in the extramarginal area between the 2 groups was not statistically significant, but showed a trend toward a relationship between postresection spikes and seizure recurrence.

Brain Neoplasms↗

PubMed1993

Temporal lobectomy for intractable epilepsy: experience with 58 cases over 21 years.

Sixty patients with intractable complex partial seizures underwent surgery between 1969 and 1990, and 58 of these underwent a temporal resection. Of 39 patients who had chronic subdural electrocorticography (ECoG) 37 subsequently underwent an anterior temporal lobectomy (ATL) and two had the electrodes removed without resection. Two patients had bilateral depth electrodes placed and then had an ATL. Fourteen patients with evidence of temporal structural lesions had temporal resections with intraoperative ECoG and five had resection without ECoG. Mean length of follow-up for all patients was 6 years. Fifty-five per cent of cases were seizure-free postoperatively, 7% almost seizure-free, 21% had worthwhile improvement and 17% no improvement. The outcome for patients with structural lesions was particularly good. Nine patients complained of mild memory impairment postoperatively and one had a severe amnestic problem. One patient with an unsuspected tumour developed a hemiparesis and dysphasia. One other patient had persistent dysphasia. No mortality was attributable to the surgery. It is concluded that ATL is an excellent operation for the treatment of intractable epilepsy arising from the temporal lobe and chronic subdural ECoG is a safe and reliable method for localizing the seizure origin.

Adolescent↗

PubMed1995

[Recurrence of pleomorphic xanthoastrocytoma six years after total removal of mural nodule: a case report].

A case of recurrent pleomorphic xanthoastrocytoma (PXA) was reported. A 46-year-old male underwent total removal of mural nodule from cystic tumor in the left temporal lobe in 1986. Histological diagnosis was astrocytoma. There were no abnormal neurological signs or symptoms after the operation. However, 6 years after the operation he complained of strong unpleasant smell as of rotten onions and was admitted to our hospital. MRI revealed a cystic tumor with a mural nodule which was enhanced markedly by Gd-DTPA in the same location as previous tumor site. He was operated upon again and tumor was removed with the cyst wall. Histological diagnosis was PXA. Surgical procedures for removal of cystic PXA has been controversial; removal of tumor only, tumor removal with biopsy of cyst wall, or tumor removal with resection of cyst wall. Real reason for recurrence of this tumor in our case is unknown. However, since astrocytoma cells were found in the biopsy specimen of the cyst wall at time of the first operation, the tumor might have recurred from these cells. Therefore, this time we removed not only the mural nodule but also the cyst wall, because the cyst wall peeled off easily. We would like to propose that PXA cyst walls should be resected, whenever possible, in order to accomplish total removal of tumor.

Astrocytoma↗

PubMed1999

Cerebral gangliogliomas: clinical characteristics, CT and MRI.

Eight patients with ganglioglioma who received surgical treatment at our institute between January 1989 and January 1997 were reviewed to determine their clinical, CT and MRI characteristics. Tumours were located in the temporal lobe (four patients), trigone of the lateral ventricle (two patients), basal ganglia (one patient) and fronto-temporal lobe (one patient). On imaging, two types of tumours were seen, a solid mass in 5 patients (62.5%) and a cystic mass in three patients (37.5%). Six complete tumours (75%) and all of the solid components of the cystic tumours were enhanced by contrast medium. Seven tumours (88%) had no peripheral oedema. On CT, the tumours being studied appeared as iso-(62.5%) or low density (37.5%) intra-axial tumours. Four tumours (50%) contained calcification. On MRI, the tumours appeared as well-circumscribed, iso-(62.5%) or low intensity (37.5%) intra-axial tumours on T1 weighted images, and as high (75%) on T2 weighted images. Three underwent total resection, 2 subtotal resection and 3 partial resection. No patients had have any further treatment such as radiation therapy or chemotherapy. Postoperative studies were conducted on all patients with an average follow-up period 56 months (range 4-147 months) after surgery. There was no evidence of recurrence of tumours or of growth of residual tumours. We observed gangliogliomas which were located in unusual regions such as the trigone in two of the patients. To our knowledge, our series is the first report to describe trigonal gangliogliomas. We conclude, therefore, that ganglioglioma should be included as a possibility in the differential diagnosis of intracranial masses, even when they are located in the trigone.

Adolescent↗

PubMed2001

Absence of hippocampal sclerosis in children with multiple daily seizures since infancy.

We report a series of nine children with multiple daily seizures since infancy who underwent functional hemispherectomy that included en bloc resection of the hippocampus and the temporal neocortex. In all cases, the hippocampi were normal by conventional histology despite the fact that these patients had suffered from recurrent seizures over a long period of time. This observation suggests that extremely frequent seizures in childhood are not invariably associated with the development of hippocampal sclerosis.

Child↗

PubMed2005

Effect of chronic deep brain stimulation of the subthalamic nucleus for frontal lobe epilepsy: subtraction SPECT analysis.

OBJECTIVES: Experimental data and case reports of patients with intractable epilepsy treated with deep brain stimulation (DBS) of the subthalamic nucleus (STN) suggest a considerable anticonvulsant effect. However, no satisfactory mechanisms of action have yet been elucidated. We investigated the putative therapeutic mechanisms of DBS from cerebral perfusion changes as measured by subtracting the SPECT image of the pre-DBS period from that of the chronic post-DBS state. METHODS: Two patients who had previous resective surgery on their right frontal cortices with or without anterior callosotomy were selected for DBS of the STN. Both of them showed frequent bilateral asymmetric tonic seizures (left > right) with rare drop attacks, and 1 patient's seizure frequency was more than 15/month during the pre-DBS period. They had both taken more than four antiepileptic agents for more than 10 years. After video-EEG monitoring, the irritative zones of the brain were delineated. The regional cerebral blood flow (rCBF) changes between the two SPECT images (pre-DBS and post-DBS after at least 6 months) were analyzed by SPECT subtraction with the volumetric MRI coregistration method using Analyze 5.0 software. RESULTS: After chronic STN DBS (18 months, case 1; 6 months, case 2), both patients experienced markedly reduced seizure frequencies (86.7% reduction in patient 1, 88.6% in patient 2). In patient 1, the increased rCBF was observed in the right frontal areas (dorsolateral and inferior frontal area), which corresponded to the irritative zones as confirmed by previous EEG recording. Unexpectedly, there was definite hyperperfusion in the right superior and inferior temporal areas as well as rCBF increase in the right superior frontal area (SMA) in patient 2. CONCLUSIONS: We demonstrated that the cerebral perfusion increase in the irritative zones of epilepsy patients is associated with favorable seizure reduction after STN DBS in 2 cases of frontal lobe epilepsy. Although the exact mechanism remains unknown, our findings suggest that the perfusion changes after STN DBS in frontal lobe epilepsy patients are quite different from those in subjects with Parkinson's disease. Our preliminary data suggest the clinical relevance of subtraction SPECT imaging in assessing the postprocedural outcome as well as the characteristics of SPECT perfusion patterns in other epilepsy syndromes.

Adult↗

PubMed1991

P300 brain activity in seizure patients preceding temporal lobectomy.

Event-related potentials were recorded over occipital and parietal scalp from 20 patients suffering from intractable partial complex seizures prior to undergoing a temporal lobectomy. Subjects were presented with language and nonlanguage visual stimuli using a divided-field, "odd-ball" paradigm. Although behavioral performance (button-press accuracy, reaction time, and running counts) was comparable across all groups (although accuracy was worse for those in the left temporal group), patients showed tremendous variability in both the amplitude and latency of the P300 response. Particularly notable was the observation that more slow wave activity was present among the patients than among the control subjects, and those scheduled for a left temporal resection evinced more amplitude reduction than those scheduled for a right temporal resection. In addition, a number of patients appeared not to show a P300 response at all. These results are discussed in the context of the utility of using noninvasive event-related potential measures to examine both memory impairment and the integrity of the neural structures that mediate memory functioning in certain patient populations.

Adult↗