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Results for “Temporal Lobe Resection”

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PubMed2005

Distribution and functional activity of P-glycoprotein and multidrug resistance-associated proteins in human brain microvascular endothelial cells in hippocampal sclerosis.

Multidrug resistance protein, also referred as P-glycoprotein (P-gp, MDR1; ABCB1) and multidrug resistance-associated protein (MRP) 1 (ABCC1) and 2 (ABCC2) are, thus far, candidates to cause antiepileptic drug (AED) resistance epilepsy. In this study, we investigated P-gp, MRP1 and MRP2 expression, localization and functional activity on cryosections and isolated human brain-derived microvascular endothelial cells (HBMEC) from epileptic patients (HBMEC-EPI) with hippocampal sclerosis (HS), as compared with HBMEC isolated from normal brain cortex (HBMEC-CTR). We examined the expression and distribution of three transporters, P-gp, MRP1 and MRP2 on two major parts of the resected tissue, the hippocampus and the parahippocampal gyrus (Gph). P-gp showed diffuse expression not only in endothelium but also by parenchymal cells in both the hippocampus and the Gph. MRP1 labeling was observed in parenchymal cells in the Gph. By contrast, MRP2 was mainly found in endothelium of the hippocampus. P-gp and MRP1 expression in the Gph was relatively high in the patient with long-term seizure history. Quantitative RT-PCR analysis of HBMEC revealed that MDR1, MRP1 as well as MRP5 (ABCC5) and MRP6 (ABCC6) were overexpressed in HBMEC-EPI at the mRNA level. HBMEC from both normal and epilepsy groups displayed protein expression of P-gp, whereas MRP1 and MRP2 were seen only in HBMEC-EPI. Accordingly, it is of particular interest that MRP functional activities were observed in HBMEC-EPI, but not in HBMEC-CTR. Our results suggest that complex MDR expression changes not only in the hippocampus but in the Gph may play a role in AED pharmacoresistance in intractable epilepsy patients with mesial temporal lobe epilepsy (MTLE) by altering the permeability of AEDs across the blood-brain barrier (BBB).

ATP Binding Cassette Transporter, Subfamily B, Mem↗

PubMedDate not supplied

Surgical pathology of epilepsy: a review.

This review discusses the neuropathological issues pertaining to temporal lobectomies and neocortical resections for medically refractory seizures of childhood. Most cases in our pediatric series are "lesional" and have CT/MRI abnormalities that contribute to a higher incidence of "dual pathology" lesions rather than pure mesial temporal sclerosis. Almost up to two thirds of our cases are represented by neuronal migration disorders and low grade gliomas. We have also encountered lesions that have both neoplastic and malformative foci, some of which behave more like tumors, while others defy precise classification as tumor or malformation. Our preliminary data indicate a role for cytomegalovirus in some cases of Rasmussen's encephalitis.

Adolescent↗

PubMed1996

[Results of surgery treatment of epilepsy].

The recent advances in the surgical treatment of epilepsy have resulted in great improvement in the overall outcome of these patients. The pediatric group has probably benefited the most as patients who previously were not candidate for this form of treatment are now able to undergo epilepsy surgery with results which are as good as those of adults. In fact, children may now benefit the most, as the control of their epilepsy and our ability to stop their anticonvulsants may allow them to better develop from a psychosocial aspect. Also, because of their plasticity, young children may tolerate surgery involving loss of eloquent cortex without subsequent permanent deficits. The most recent reported results from different centers indicate that 68-90% of patients undergoing temporal lobectomy remain seizure free while the percentage of patients remaining seizure free after extratemporal resections is approximately 50-66%. However, one of the problems with these results is that they vary significantly from one center to another because of the methodology used to evaluate results and the selection of patients depending on the strength of the centers. At present we do not have an optimal method to evaluate results of epilepsy surgery that takes in consideration not only seizure control but also psychosocial outcome. It is our goal to develop such method which will ultimately help us identify the best surgical candidates and predict their outcome.

Age Factors↗

PubMed1998

Accuracy of electroencephalographic dipole localization of epileptiform activities associated with focal brain lesions.

We evaluated the accuracy of an electroencephalographic (EEG) localization technique (dipole inverse solution) in a consecutive series of 12 focal intracerebral lesions of diverse etiologies whose EEGs showed interictal spike activity or rhythmic activity at seizure onset. The calculated equivalent dipole was plotted on three axes in the patients' magnetic resonance image, and the distance between the dipole and the lesion margin was measured assuming that the shell of the lesion constituted an epileptogenic region. In all cases the dipole localized closer than 0.8 cm to the nearest lesion margin. In addition, we compared the postsurgical outcome of 6 patients to the dipole localization and the resection margins. In all 6 patients in whom the dipole, and hence the estimated seizure generator, was removed the surgical outcome was favorable. We conclude that the inverse solution algorithm is a promising method for using the scalp EEG to localize the sources of electrical activity in the human brain in routine clinical electroencephalography and provides three-dimensional data not available from conventional analysis.

Adult↗

PubMed2006

Gliosarcoma with multiple extracranial metastases: case report and review of the literature.

Gliosarcoma is a rare malignant neoplasm of the central nervous system with a propensity for metastasis. There are fewer than 20 reported cases of extracranial metastases of gliosarcoma with the majority of cases reflecting a tendency for hematogenous dissemination. Here we describe the case of a 47-year-old man who developed pervasive extracranial metastases from a temporal gliosarcoma following radio- and chemotherapy for a primary glioblastoma. The patient initially presented with progressively worsening headaches, left-sided weakness and numbness associated with right temporo-parietal mass for which he underwent craniotomy with stereotactic gross-total excision. Two months postoperatively, interstitial brachytherapy and external beam radiotherapy were initiated. The patient initially declined chemotherapy. The tumor recurred twice and the patient underwent re-operation and multiple courses of chemotherapy; histopathological diagnosis remained glioblastoma multiforme. Nineteen months following initial resection the patient's clinical status deteriorated and CT scan demonstrated multiple intrathoracic, hepatic and splenic lesions. Postmortem examination revealed widespread, infiltrating gliosarcoma with intravascular gliomatosis and extensive visceral metastases. This is the first report of pervasive extracranial metastases to numerous sites, several of which have not been previously reported. The histogenesis and the potential role of therapeutic irradiation in the development of gliosarcoma are briefly reviewed.

Brain Neoplasms↗

PubMed1988

Subdural electrodes in the evaluation for epilepsy surgery in children and adults.

To evaluate the utility and safety of chronic extraoperative subdural EEG and functional localization studies in children compared to adults, we studied 61 patients each of whom had similar evaluations for epilepsy surgery, regardless of age. The 23 children and adolescents (3 to 18 years old) and the 38 adults (20 to 41 years old) each had several days and nights of extraoperative EEG from scalp and chronically-implanted subdural electrodes, and the same percentage of children and adults also had functional localization studies including cortical electrical stimulation. The methods and results of these studies and of the subsequent resections did not differ between the two groups, and they both had similar rate of complications and similar incidence of good outcome. The subdural technique was as effective and well-tolerated in children and adolescents as in adults. Other invasive EEG techniques have not yet been systematically compared between children and adults, but the subdural technique, at least, appears to be suitable for patients over a wide age range.

Adolescent↗

PubMed2000

Generalised cerebral atrophy following temporal lobectomy for intractable epilepsy associated with mesial temporal sclerosis.

Studies of post-operative imaging data have mainly concentrated on brain atrophy following radiotherapy and/or chemotherapy. We have investigated the effect of conventional surgery on the unresected brain tissue based on the comparison of magnetic resonance images acquired pre- and post-operatively in 13 subjects with a history of mesio-temporal epilepsy. The pre- and post-operative scans were co-registered prior to volumetric analysis. The total brain volume (TBV) was calculated by semi-automated segmentation, and the total volume loss was the difference between the post-operative and pre-operative TBV. The total volume of resection was determined by manual delineation in the post-operative scan. The atrophy volume in the post-operative scan was calculated as the difference between the total volume loss and the resection volume. In 6 cases, there was generalised cerebral atrophy of the order 4-5% of the total brain volume. In addition to the automated volumetric technique, the images were assessed by two expert neuroradiologists. There was complete correspondence between their assessment and the automated technique. The causes and significance of this phenomenon are unknown but it requires further investigation as it may be related to seizure control and neuropsychological changes following epilepsy surgery.

Adolescent↗

PubMed1994

Influence of extent of surgery and tumor location on treatment outcome of patients with glioblastoma multiforme treated with combined modality approach.

Between 1988 and 1991, eighty-six patients with glioblastoma multiforme were evaluated in order to define the influence of extent of surgery and tumor location on treatment outcome. Patients underwent surgery followed by postoperative hyperfractionated radiotherapy and chemotherapy delivered according to one of two consecutive protocols. Surgery consisted of biopsy in 25 (29%) patients and subtotal or gross total tumor resection in 61 (71%) patients. Frontally located tumors were noted in 26 (30%) patients and other tumor locations were noted in 60 (70%) patients. Patients having more radical surgery had longer median survival time (MST) and higher 1- and 2-year survival rates than those with biopsy only (56 vs 29 weeks, respectively; 62% and 23% vs 16% and 0%, respectively; p = 0.00000). Patients having frontally located tumors had longer MST and higher 1- and 2-year survival rates than those with other tumor locations (101 vs 47 weeks, respectively; 76% and 44% vs 37% and 2.5%, respectively; p = 0.00001). Multivariate analysis confirmed that extent of surgery and tumor location were independent prognostic factors in patients with glioblastoma multiforme. Regarding progression-free survival, patients having more radical surgery had longer median time to tumor progression (MTP) than those with biopsy only (33 weeks vs 21 weeks, respectively). Also, progression-free survival at 1 year was higher in radically resected group than in biopsy only group (20% vs 0%, respectively; p = 0.00000). Patients with frontally located tumors had longer MTP (42 weeks) and higher progression-free survival at 1 year (42%) than those with other tumor location (28 weeks and 1.7%, respectively; p = 0.00002).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1996

Magnetic properties of human hippocampal tissue--evaluation of artefact and contamination sources.

To investigate the possibility that postmortem chemical alteration or contamination is responsible for recent results indicating the presence of magnetite in human brain tissue and to determine whether magnetite is present in living brain tissue, we examined tissue samples resected from six patients during amygdalohippocampectomy operations. The tissue samples were sealed in sterilized vials in the operating theater and placed into liquid nitrogen directly after removal to prevent changes in tissue chemistry after the death of the brain cells. The low temperature magnetic properties of the tissue were measured to determine the presence of ferro- or ferrimagnetic material in the tissue. The results of these experiments indicate that magnetite is present in the tissue. In addition, results of experiments designed to control for airborne contamination and contamination during cauterization of vessels during surgery indicate that these are not significant sources of magnetite contamination in the tissue.

Epilepsy, Temporal Lobe↗

PubMed2000

Subepicranial varix mimicking sinus pericranii: usefulness of three-dimensional computed tomography angiography and bone window computed tomography--case report.

A 16-year-old female presented with a rare case of subepicranial varix in the left temporal area manifesting as a soft mass in the left temporal area when she laid down in the left lateral position. Bulging of the mass was observed when intracranial venous pressure was raised by the Valsalva maneuver, the left lateral position, or the prone position. Bone window computed tomography (CT) revealed a tiny hole, 1 mm in diameter, in the outer bone table. Three-dimensional CT (3D-CT) angiography clearly visualized a mass with a diameter of approximately 10 mm connected to the diploic vein. The mass was totally resected by operation. Venous bleeding was observed from the tiny hole. Histological examination revealed a venous lesion mimicking sinus pericranii and containing endothelial cells. No communication with the intracranial venous sinuses was identified, so the diagnosis was subepicranial varix. Radiological examination by direct injection of contrast medium is usually performed to identify subepicranial varix, but 3D-CT angiography is a non-invasive preoperative examination that can visualize this small venous lesion. Adjustment of the CT acquisition conditions may allow 3D-CT angiography to identify sinus pericranii in the future.

Adolescent↗

PubMed1991

Radical excision of craniopharyngioma by the temporal route: a review of 50 patients.

Attempts at radical excision of craniopharyngioma have been made increasingly possible by progress in neuroradiological imaging and the use of microscopic technique. Between 1977 and 1990, 50 patients of The National Hospital for Neurology and Neurosurgery, London, have undergone radical surgical excision of craniopharyngioma by the temporal route, with a small anterior temporal resection. Surgical mortality was 4%. Thirty-eight (76%) patients remain well at average follow-up of 30 months; 15% had major complications (hypothalamic damage, subdural haematoma, scalp collections requiring shunt drainage). There were three recurrences in those patients where the initial operations were considered as complete microscopic excision. It is concluded that maximal control of tumour recurrence by removal of all tumour accessible and visible to the surgical microscope is best achieved by a radical excision at the first operation.

Adolescent↗

PubMed1984

Arteriovenous malformations of the medial cerebral hemisphere and the limbic system.

In a series of 164 resected arteriovenous malformations (AVM's), 25 were located on the medial aspect of the cerebral hemispheres. These AVM's require special attention because of the following characteristics: 1) their obscure location, making resection more difficult than the usual AVM; 2) a high incidence of intraventricular hemorrhage; 3) their frequent involvement of the choroid plexus of the ventricles and the arteries and veins related to the choroid plexus; and 4) the configuration of their venous drainage, which is often to superficial veins as well as to the deep venous systems. The results achieved with excision of these difficult AVM's were good. There was no mortality and the morbidity rate was under 4%. The surgical exposures, which were tailored to the location of these malformations, are described in detail.

Cerebral Angiography↗

PubMedDate not supplied

The neurosurgical treatment of epilepsy.

Despite the new advancements in antiepileptic drug development, thousands of people with epilepsy will remain intractable to medication. For a considerable proportion of these people, epilepsy surgery is a consideration for better control of their seizures. Resective surgery is now standard practice for patients with medication-refractory epilepsy. Temporal lobectomy continues to be the most common surgery performed. Once patients fail 2 to 3 optimal trials of antiepileptic medication, further drug therapy offers a minimal number of patients freedom from seizures. In contrast, temporal lobectomy in carefully selected patients may result in seizure-free outcomes in more than 70% to 90% of patients with intractable seizures. As technology and drug availability increases in the new millennium, it is important for the primary care physician to be aware of epilepsy surgery as a means to treat patients with antiepileptic drug-refractory epilepsy. Arch Fam Med. 2000;9:1142-1147

Brain↗

PubMed1999

18F-FDG PET studies in patients with extratemporal and temporal epilepsy: evaluation of an observer-independent analysis.

UNLABELLED: The aim of this study was to evaluate an observer-independent analysis of 18F-fluorodeoxyglucose (FDG) PET studies in patients with temporal or extratemporal epilepsy. METHODS: Twenty-seven patients with temporal epilepsy and 22 patients with extratemporal epilepsy were included in the study. All patients with temporal epilepsy and 7 patients with extratemporal epilepsy underwent surgical treatment. In patients who showed significant postoperative improvement (temporal, n = 23; extratemporal, n = 6), the epileptogenic focus was assumed to be located in the area of surgical resection. In extratemporal epilepsy patients who did not undergo surgery, the focus localization was determined using a combination of semiology, ictal and interictal electroencephalography, [99mTc]ethyl cysteinate dimer SPECT, MRI and [11C]flumazenil PET. Visual analysis was performed by two experienced and two less experienced blinded observers using sagittal, axial and coronal images. In the automated analysis after anatomic standardization and generation of three-dimensional stereotactic surface projections (SSPs), a pixelwise comparison of 18F-FDG uptake with an age-matched reference database (n = 20) was performed, resulting in z score images. Pixels with the maximum deviation were detected, summarized and attached to one of 20 predefined surface regions of interest. For comparison with 18F-FDG PET and MR images, three-dimensional overlay images were generated. RESULTS: In patients with temporal epilepsy, the sensitivity was comparable for visual and observer-independent analysis (three-dimensional SSP 86%, experienced observers 86%-90%, less experienced observers 77%-86%). In patients with extratemporal epilepsy, three-dimensional SSP showed a significantly higher sensitivity in detecting the epileptogenic focus (67%) than did visual analysis (experienced 33%-38%, each less experienced 19%). In temporal lobe epilepsy, there was moderate to good agreement between the localization found with three-dimensional SSP and the different observers. In patients with extratemporal epilepsy, there was a high interobserver variability and only a weak agreement between the localization found with three-dimensional SSP and the different observers. Although three-dimensional SSP detected multiple lesions more often than visual analysis, the determination of the highest deviation from the reference database allowed the identification of the epileptogenic focus with a higher accuracy than subjective criteria, especially in extratemporal epilepsy. CONCLUSION: Three-dimensional SSP increases sensitivity and reduces observer variability of the analysis of 18F-FDG PET images in patients with extratemporal epilepsy and is, therefore, a useful tool in the evaluation of this patient group. The benefit of this analytical approach in patients with temporal epilepsy is less apparent.

Adolescent↗

PubMed1995

Intraoperative hippocampal cooling and Wada memory testing in the evaluation of amnesia risk following anterior temporal lobectomy.

OBJECTIVE: To determine the efficacy of memory testing following localized thermal inactivation (cooling) of the hippocampus during epilepsy surgery to assess risk for postoperative memory decline. DESIGN: Memory was assessed after intraoperative thermal inactivation of the hippocampus and during the Wada procedure to help determine the clinical utility of each procedure. SETTING: A university hospital, comprehensive epilepsy surgery program. PATIENTS: Individuals undergoing unilateral temporal lobectomy for relief of intractable seizures. PROCEDURE: After temporal tip resection, iced liquid was irrigated into the temporal horn of the lateral ventricle until the hippocampus was "cooled." MAIN OUTCOME MEASURES: Multiple neuropsychological measures of learning and memory. RESULTS: Wada memory testing suggested risk for memory impairment in 15 patients while cooling indicated risk in only five patients. Predictions arising from the two procedures were concordant in 13 patients and discordant in 12 patients. Among the 12 inconsistent predictions, hippocampal cooling suggested adequate contralateral memory support in 11 (92%) of 12 patients, and none of these 11 patients had a postoperative anterograde amnesia. CONCLUSION: Intraoperative hippocampal cooling may be useful in determining the risk of postoperative memory disorder among selected patients undergoing epilepsy surgery.

Adult↗

PubMed2002

Electrophysiological properties of interneurons from intraoperative spiking areas of epileptic human temporal neocortex.

We combined visual-assisted whole-cell recordings with Lucifer Yellow labelling to record in vitro from interneuron-like cells from human epileptic neocortical tissue that exhibited spiking activity in situ. Information from intraoperative electrocorticography, which was performed to tailor resection, were used to select those areas that participate in interictal spiking. Whole-cell recordings from slices prepared from these areas showed that both pyramidal and interneuron-like cells were present and retained their main intrinsic firing patterns, i.e. regular spiking and fast spiking, respectively. Moreover, non-pyramidal interneuron-like cells remained innervated by excitatory inputs as both spontaneous and evoked non-NMDA mediated excitatory postsynaptic potentials were recorded. We conclude that putative inhibitory GABAergic cells are present and functional in the human epileptic tissue.

Action Potentials↗

PubMed2003

Transient postoperative prosopagnosia.

A 23-year-old right-handed woman developed isolated transient prosopagnosia following surgical resection of a right posterior temporal seizure focus. At 18 years of age she had developed secondarily generalized tonic-clonic seizures. Preoperative neuropsychological evaluation was normal, and neurological examination revealed only a left superior quadrant achromatopsia. MRI revealed a circumscribed lesion in the right inferolateral temporo-occipital junction. Following surgery she was agitated for 36 hours, and afterward, when her attention and orientation improved, she was unable to recognize familiar faces. She could, however, recognize familiar voices. Her prosopagnosia resolved over the next 6-7 days. This case demonstrates that isolated prosopagnosia can occur in patients with lesions restricted to the right inferior posterior temporal-anterior occipital region. The temporary nature of the prosopagnosia may result from postsurgical tissue injury, including focal cerebral edema, with compensation by ipsilateral or contralateral areas.

Adult↗

PubMed2004

Long-term effects of temporal lobectomy on intelligence.

OBJECTIVE: To characterize the long-term effects of anterior temporal resection on intelligence. METHODS: Twenty-eight left temporal lobectomy (LTL) and 43 right temporal lobectomy (RTL) patients were followed at standard time points for at least 6 years after surgery. RESULTS: The average gain 6 years after operation was 3.6 Verbal IQ (VIQ) points and 10.3 Performance IQ (PIQ) points in LTL patients and 2.9 VIQ points and 7.7 PIQ points in RTL patients. A seizure-free outcome did not influence the increase in IQ, nor was the extent of resection related to IQ scores at the 6-year follow-up. Patients with exclusively mesial temporal sclerosis did not perform as well as patients with other pathologies, both before and after surgery. Major predictors of improved performance at 6 years were initial higher level of performance and lower age at surgery. Much of the observed improvement may be related to retest effects. CONCLUSIONS: The effects of epilepsy surgery on intelligence in the long term are limited. The largest gain in VIQ is seen from 2 to 6 years after surgery.

Adolescent↗