[Vestibular disorders in temporal tumors before and after surgical ablation; resection of temporal lobe].
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Brain Neoplasms↗
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Results for “Temporal Lobe Resection”
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Visual field defects after temporal lobectomy -- comparing methods and analysing resection size.
OBJECTIVES: The frequency of visual field defects (VFD) after temporal lobe resections (TLR) was compared for two types of TLR and VFD frequency was correlated to resection size. METHODS: Pre- and post-operative perimetry results were analysed for 50 patients with TLR for medically intractable epilepsy. Thirty-three patients had a classical TLR and 17 had a TLR with less lateral extension. Post-operative MRIs were studied in 34 patients by scoring resection size in 12 compartments in the temporal lobe. RESULTS: Twenty-five patients developed a VFD. In the classical TLR group, 16 of 33 developed a VFD, compared with nine of 17 in the other group. The resection points were higher for the VFD group in the most anterior compartment studied, in the superior temporal gyrus. CONCLUSIONS: There was no clearcut difference in VFD frequency between the surgical methods studied. However, the compartmentalized analysis disclosed a relation between the extent of resection in the anterior part of the superior temporal gyrus and VFD frequency.
Adolescent↗
Development of malignant glioma 15 months after anterior temporal lobectomy in a patient with temporal lobe epilepsy.
We report a 36-year-old woman, who had previously undergone anterior temporal lobectomy for intractable temporal lobe seizures; fifteen months later, magnetic resonance (MR) images showed a space-occupying lesion in the temporal lobectomy cavity. After a second operation, a histopathological examination showed a grade III astrocytoma. The fortuitous co-occurrence of temporal lobe epilepsy and a tumour was suspected, but histopathological and immunohistochemical examination of original resected temporal lobe parenchyma did not show evidence of neoplasm. The patient had not undergone postoperative radiotherapy and had not experienced viral infections. We propose that two factors possibly associated with the development of glioma were chemical exposure from anticonvulsant agents and trauma from resection of the anterior temporal lobe during initial surgery.
Adult↗
Outcome following resective surgery for temporal lobe epilepsy: a prospective follow up study of 102 consecutive cases.
The long term outcome has been assessed in a consecutive series of 102 cases undergoing resective temporal lobe surgery because of medically intractable epilepsy. Patients were followed prospectively for a median of 61 months. Actuarial statistics were used to measure the temporal patterns of remission and stability of outcome over prolonged periods of observation. The probability of achieving one year remission was 57% by one year, 70% by two years, and 77% by seven years. Once a patient was in one year remission the probability of remaining seizure free was 90%. This rose to 94% after two consecutive years of being seizure free. The majority of patients who remit following surgery have done so by two years of follow up. Outcome at the end of the second post operative year is a good predictor of long term prognosis.
Adolescent↗
[Recent advance in epileptology].
Nowadays epilepsy is classified according to the international classification of epilepsies, epileptic syndromes and related disorders proposed by International League Against Epilepsy (ILAE, 1989). Among these epilepsies and epileptic syndromes, I detailed the clinical symptomatology and the clinical significance of benign familial neonatal convulsions, juvenile myoclonic epilepsy, epilepsy with myoclonic absence, mesial temporal lobe epilepsy and chronic progressive epilepsia partialis continua of childhood. Of 218 patients with temporal lobe resection who were followed for over 2 years, 172 patients or 79% were seizure free according to Engel's criteria of seizure outcome after surgical treatment. Of 66 patients with extra-temporal lobe epilepsy, 43 patients or 65% were seizure free. From the postsurgical outcome I talked about the need of strict presurgical evaluation to have the good postsurgical outcome. The neuropathology of surgically resected 278 specimens of temporal lobe epilepsy was mesial temporal sclerosis in 184, neuroepithelial tumors in 66, cortical malformation in 11, vascular anomaly in 13, and others in 4. Thirty-nine of resected 66 specimens of extra-temporal lobe epilepsies were cortical malformation. I presented the recent progress of genetic study in epilepsies and stressed the importance of correct diagnosis of epilepsy for genetic study.
Brain↗
Intraoperative electrocorticography in temporal lobe epilepsy surgery.
Although in clinical use for many years, the validity of intraoperative electrocorticography (ECoG) in guiding resective temporal lobe epilepsy (TLE) surgery is uncertain. Advances in neuroimaging and extraoperative intracranial recordings have contributed greatly to the identification of epileptogenic lesions and cortex, clarifying the limitations of a brief intraoperative interictal recording. Studies of undifferentiated ECoG findings (which classify all interictal cortical spike discharges as equal) tend to not support this method. This article reviews ECoG and presents data from 86 TLE surgeries at the University of British Columbia suggesting that differentiation of ECoG features may enhance the contribution of this time honored method. Specifically, independent foci may be more important for epileptogenesis than synchronous foci, and postexcision activation appears to be a benign phenomenon, while residual spikes unaltered by the resection correlate with a greater proportion of seizure recurrence.
Anesthesia↗
Clinical use of a frameless stereotactic arm: results of 325 cases.
The viewing wand is a frameless stereotactic arm that can be used in conjunction with computerized tomography (CT) or magnetic resonance (MR) imaging to provide image-based intraoperative navigation. The authors report a series of 325 cases in which the viewing wand was used and evaluated for its utility, ease of integration into the standard surgical setup, reliability, and real-world accuracy. The use of the system was associated with minimal additional effort or time spent in setting up the procedure as long as a trained technician performed the data transfer and reconstruction. The viewing wand was used in 165 cases in conjunction with CT and 145 cases with MR imaging. The system was reliable, achieving a useful registration in 310 of 325 cases (95.4%). Fiducial-based registration was more accurate than an anatomical landmark-surface fit algorithm method of registration (mean 2.8 vs. 5.6 mm error, respectively, for CT; and mean 3.0 vs. 6.2 mm for MR imaging). The actual error of the system in estimating the position of the probe tip just after registration was judged by the operating surgeon to be less than 2 mm in 92% of MR imaging cases and in 82% of CT cases, between 2 and 5 mm in 7% of MR imaging and 17% of CT cases, and greater than 5 mm in less than 1% of MR imaging and 1.2% of CT cases. The accuracy of the system degraded during the operation, so that by the third evaluation the error was estimated to be less than 2 mm in 77% of MR imaging and 62% of CT cases. Overall, the viewing wand was found to be reliable and accurate. This real-world accuracy was sufficient for a broad range of applications including glioma resection, cerebrospinal fluid shunting procedures, resection of small subcortical masses, and temporal lobe resection. The system is a useful navigational aid that allows a direct approach to intracranial pathology without the drawbacks of application and the limitations of a stereotactic frame.
Adolescent↗
Recency and frequency discrimination in the amnesic patient H.M.
Temporal contextual memory and event memory were compared across retention intervals in the patient H.M. who is amnesic following bilateral medial temporal lobectomy. Memory for temporal context was assessed using verbal and nonverbal recency discrimination tasks and a frequency task in which subjects made discriminations between words repeated 1, 3 or 5 times. The tests evaluated event memory under parallel conditions by two-choice content recognition tasks. In both recency and frequency tests, H.M. showed above-chance and often normal temporal contextual memory under conditions of impaired and even chance-level content recognition. These results show that temporal contextual memory does not require intact content recognition and is independent of medial temporal lobe structures. Furthermore, the amnesia of bilateral medial temporal lobe resection does not manifest primary loss of temporal contextual memory.
Amnesia↗
Time-related changes in task performance after lesions restricted to the frontal cortex.
Behavioural studies in patients and functional neuroimaging studies in normal subjects suggest that the right frontal cortex plays an important role in sustaining attention to a task. However, the contribution of different regions of the frontal lobe to performance changes has not been clearly established. First, the assessment of sustained attention has not been carried out in patients with lesions that are restricted to cortical regions of the frontal lobe. Second, although sustained attention is often measured by performance on a task requiring effortful attention, it may be more meaningful to measure changes in performance as a function of time-on-task. Two studies were carried out in five groups of subjects: patients with left or right frontal cortical resections, patients with left or right anterior temporal lobe resections, and normal controls. In the first experiment, a brief (4-min) selective attention task was performed. The right frontal group, unlike the other groups, did not show improved reaction times after the first minute on the task. The second experiment involved a long (30-min) shifting attention task. Both the left and right frontal groups were slower than control groups; however, reaction times in the right frontal group increased with time spent on the task. We conclude that the right frontal cortex plays an essential role in modulating arousal during performance of a task and may also underlie aspects of learning during the early stages of task performance.
Arousal↗
Occipitotemporal epilepsy studied with stereotaxically implanted depth electrodes and successfully treated by temporal resection.
A young woman had seizures suggestive of temporal lobe origin with some clinical features indicative of occipital onset. Electroencephalograms recorded through scalp and sphenoidal electrodes showed predominantly right posterior temporooccipital epileptogenic discharges. Stereotaxic depth electrode recordings from the right temporal and occipital lobes demonstrated that some seizures arose independently from either the temporal or occipital lobes. Most arose within the occipital lobe, but, to become clinically evident, the seizure discharge had to spread to the temporal lobe. Following temporal lobe resection, including excision of limbic structures, the patient has remained seizure free for four years except for a few generalized seizures before and after delivery of her child.
Adult↗
Selective posterior cerebral artery amobarbital test: its role in presurgical memory assessment in temporal lobe epilepsy.
PURPOSE: To evaluate the efficacy and risk of complications of selective posterior cerebral artery (PCA) amobarbital anesthesia in memory assessment of patients with epilepsy under consideration for temporal lobe resection. METHODS: Thirty-two candidates for temporal lobectomy in whom conclusive memory assessment could not be obtained by the standard intracarotid amobarbital procedure were submitted to a selective PCA amobarbital test. A mean dose of 75 mg amobarbital was injected via microcatheter into the P2 segment of the PCA. Ten common objects were presented for naming and remembering while the anesthesia was judged efficient. After return to neurologic baseline, recall and recognition memory were assessed. RESULTS: In all of the 32 patients, angiography and PCA anesthesia were successfully accomplished without serious adverse events. All but one of the patients remained alert and cooperative for memory testing under the anesthesia, and 28 of these patients showed adequate memory capacity of the hemisphere contralateral to the side targeted for surgery. So far, 19 patients have proceeded to surgery, and no case of global amnesia or serious, material-specific memory impairment has resulted. Three patients failed the PCA test (fewer than 67% items correctly recognized) and were excluded from surgery, partly on the basis of the PCA test results, but also supported by an overall evaluation of all the diagnostic procedures used. CONCLUSIONS: The selective PCA amobarbital test appears justifiable when performed by interventional neuroradiologists and may significantly reduce the risk of erroneously excluding patients with epilepsy from temporal resection. Further corroboration of the safety of the procedure seems warranted.
Adolescent↗
Alterations of hippocampal acetylcholinesterase in human temporal lobe epilepsy.
Hippocampal sclerosis is the most common pathological finding associated with human temporal lobe epilepsy. Histochemical study with acetylcholinesterase (AChE) staining was used to investigate 7 surgically resected temporal lobes with hippocampal sclerosis from patients with temporal lobe epilepsy. In all 7 specimens, an abnormal but consistent pattern of staining was noted. In the hilum of the dentate gyrus, AChE-rich polymorphic cells were relatively preserved in comparison to the pyramidal neurons. In Ammon's horn, AChE fibers were lost in regions corresponding to the pyramidal cell dropout. AChE fibers were also lost along the inner portion of the molecular layer of the dentate gyrus, yet they were preserved within the outer portions of the molecular layer. These findings provide additional evidence for the relative selectivity of hippocampal pathology in human temporal lobe epilepsy.
Acetylcholinesterase↗
The genetics of localization-related symptomatic epilepsy: risk of a family history with seizures in patients who have undergone surgery.
A family history of epileptic seizures including febrile convulsions was found in 15 of 103 patients (15%) with localization related epilepsy with partial seizures with and without secondary generalization, who were operated on because of drug resistance. This rate was significantly higher than that of the cumulative incidence in the general population (4%). The localization of the brain damage did not play a role (temporal lobe resection left: 15%, right: 17%, extra-temporal lesion excision: 20%, hemispherectomy: 11%). Various family members were involved. Some patients had more than one relative with seizures. Thus, 21 relatives suffered from seizures. Eleven of them had generalized tonic-clonic seizures (one grand mal on awakening), 7 had febrile convulsions (4 complicated), and in 1 patient the grand mal seizures on awakening were preceded by absences; 1 had generalized tonic-clonic and complex partial seizures; 1 after complicated febrile seizures likewise had complex partial seizures; another mentally retarded patient suffered from generalized tonic-clonic, axial tonic and myoclonic-astatic seizures. The seizure type of 3 remote relatives was not known. The first seizure occurred in 16 family members during childhood, in 3 in adolescence and in only 1 in adulthood (1 unknown). Eight showed mental retardation of slight degree in most. It is interesting that only one-third of the patients with a family history with seizures were seizure-free after the operation; 5 still had seizures, mostly reduced in frequency, 3 had seizures and isolated auras and 2 had only isolated auras. On comparing the findings in patients with and without a family history with seizures, those with family members with epileptic seizures showed a lower rate of an intellectual deficit (7 vs 47%) and brain tumours (13 vs 44%). Our earlier findings with a different group of patients are thus confirmed: that genetics play a role in symptomatic epilepsies.
Adolescent↗
Practice parameter: temporal lobe and localized neocortical resections for epilepsy.
PURPOSE: To examine evidence for effectiveness of anteromesial temporal lobe and localized neocortical resections for disabling complex partial seizures. METHODS: Systemic review and analysis of the literature since 1990. RESULTS: One intention-to-treat Class I randomized controlled trial of surgery for mesial temporal lobe epilepsy found that 58% of patients randomized to be evaluated for surgical therapy (64% of those who received surgery) were free of disabling seizures and 10 to 15% were unimproved at the end of 1 year, compared with 8% free of disabling seizures in the group randomized to continued medical therapy. There was a significant improvement in quantitative quality-of-life scores and a trend toward better social function at the end of 1 year for patients in the surgical group, no surgical mortality, and infrequent morbidity. Twenty-four Class IV series of temporal lobe resections yielded essentially identical results. There are similar Class IV results for localized neocortical resections; no Class I or II studies are available. CONCLUSIONS: A single Class I study and 24 Class IV studies indicate that the benefits of anteromesial temporal lobe resection for disabling complex partial seizures is greater than continued treatment with antiepileptic drugs, and the risks are at least comparable. For patients who are compromised by such seizures, referral to an epilepsy surgery center should be strongly considered. Further studies are needed to determine if neocortical seizures benefit from surgery, and whether early surgical intervention should be the treatment of choice for certain surgically remediable epileptic syndromes.
Anticonvulsants↗
Polygenic burden and its association with baseline cognitive function and postoperative cognitive outcome in temporal lobe epilepsy.
OBJECTIVE: Demographic and disease factors are associated with cognitive deficits and postoperative cognitive declines in adults with pharmacoresistant temporal lobe epilepsy (TLE), but the role of genetic factors in cognition in TLE is not well understood. Polygenic scores (PGS) for neurological and neuropsychiatric disorders and IQ have been associated with cognition in patient and healthy populations. In this exploratory study, we examined the relationship between PGS for Alzheimer's disease (AD), depression, and IQ and cognitive outcomes in adults with TLE. METHODS: 202 adults with pharmacoresistant TLE had genotyping and completed neuropsychological evaluations as part of a presurgical work-up. A subset (n = 116) underwent temporal lobe resection and returned for postoperative cognitive testing. Logistic regression was used to determine if PGS for AD, depression, and IQ predicted baseline domain-specific cognitive function and cognitive phenotypes as well as postoperative language and memory decline. RESULTS: No significant findings survived correction for multiple comparisons. Prior to correction, higher PGS for AD and depression (i.e., increased genetic risk for the disorder), but lower PGS for IQ (i.e., decreased genetic likelihood of high IQ) appeared possibly associated with baseline cognitive impairment in TLE. In comparison, higher PGS for AD and IQ appeared as possible risk factors for cognitive decline following temporal lobectomy, while the possible relationship between PGS for depression and post-operative cognitive outcome was mixed. SIGNIFICANCE: We did not observe any relationships of large effect between PGS and cognitive function or postsurgical outcome; however, results highlight several promising trends in the data that warrant future investigation in larger samples better powered to detect small genetic effects.
Adult↗
Temporal and extended temporal resections for the treatment of intractable seizures in early childhood.
In our series of 33 children who underwent temporal and extended temporal lobe resections because of seizures, the average age at surgery was 7 years, 11 months. Sixteen cases (48%) were diagnosed as having tumors: low-grade astrocytoma (6), hamartoma (5), and ganglioglioma/neuroma (5). Other pathologic diagnoses included one or more cytoarchitectural abnormalities and/or reactive changes. Due to a more aggressive and early radiologic and electrophysiologic investigation of children with seizures, a resectable focus, e.g. neoplasm or structural abnormality, was found in a much younger age group of patients than previously reported. In children who had intractable seizures but normal radiologic studies, positron emission tomography was of great value in localizing the seizure focus. In a group of children with infantile spasms, seizures were controlled following the identification and resection of a focal lesion. Prompt detection and precise localization of lesions in the temporal lobe in the pediatric population may lead to surgical management and seizure control.
Adolescent↗
Awake craniotomy: controversies, indications and techniques in the surgical treatment of temporal lobe epilepsy.
In 1886, Victor Horsley excised an epileptogenic posttraumatic cortical scar in a 23-year-old man under general anaesthesia and discussed his choice of anaesthesia: "I have not employed ether in operations on man, fearing that it would tend to cause cerebral excitement; chloroform, of course, producing on the contrary, well-marked depression." His concerns regarding anaesthesia are reiterated 100 years later as evidenced by the ongoing controversy over the choice of anaesthetic in surgical procedures for epilepsy. The current controversies regarding the necessity for local anaesthesia in temporal lobe epilepsy operations concern the utility of electrocorticography in surgical decision making, its relationship to seizure outcome and the value of intraoperative language mapping in dominant temporal lobe resections. The increasing sophistication of pre-operative investigation and localization of both areas of epileptogenesis and normal brain function and the introduction of minimally invasive surgical techniques and smaller focal resections are changing the indications for local anaesthesia in temporal lobe epilepsy. Thus, indications which were previously absolute are now perhaps relative. This article reviews the current indications for craniotomy under local anaesthesia in the surgical treatment of temporal lobe epilepsy.
Anesthesia, Local↗
Presurgical electroencephalographic patterns and outcome from anterior temporal lobectomy.
We reviewed data from 48 patients after anterior temporal lobe resection for medically intractable epilepsy. All had ictal electro-encephalographic (EEG) evidence of unilateral temporal lobe onset. Depth electrodes were used in 19 patients. Successful surgical outcome correlated significantly with factors that suggested a temporal lobe focus, particularly in the interictal scalp EEG. The most successful outcome occurred in patients with well-localized unilateral interictal temporal spikes (100% improved). The group with well-localized bilateral temporal spikes also did well (76% improved). Patients with extratemporal spread of the interictal spike on scalp EEG, either unilaterally or bilaterally, did less well. Only one third improved, despite extensive extracranial and intracranial monitoring, when indicated. The interictal scalp EEG may be the only EEG necessary for the presurgical evaluation of selected patients with intractable temporal lobe epilepsy.
Adolescent↗