White matter tract recovery following medial temporal lobectomy and selective amygdalohippocampectomy for tumor resection via a ROVOT-m port-guided technique: A case report and review of literature

Abstract BACKGROUND Selective amygdalohippocampectomy (SelAH) is designed to treat medically refractory mesial temporal lobe epilepsy with reduced morbidity compared to standard anterior temporal lobectomy. At our institution, we perform SelAH via a transcortical approach via small corticectomy in the middle temporal gyrus. OBJECTIVE To discuss the surgical anatomy and nuances of SelAH, share our institutional experience, and perform a review of literature. METHODS Institutional experience was recorded by collecting demographic and outcome data from 1999 to 2017 under an Institutional Review Board protocol in a prospective manner using a REDCap database. RESULTS A total of 211 SelAH procedures were performed at our institution between 1999 and 2017. Of these patients, 54% (113/211) were females. The average age at surgery was 39.4 yr. Two-year Engel outcome data were available for 168 patients, of which 73% (123/168) had Engel I outcomes. Engel II outcomes were reported in 16.6% (28/168), III in 4.7% (8/168), and IV in 5.3% (9/168). Our review of literature showed that this is comparable to the seizure freedom rates reported by other groups. We then reviewed our surgical methodology based on operative reports and created illustrations of the surgical anatomy of temporal lobe approach. These illustrations were compared with postoperative magnetic resonance imaging to provide a better 3D understanding of the complex architecture of mesial temporal structures. CONCLUSION SelAH is a minimally invasive, safe, and effective approach for the treatment of medically refractory epilepsy with good surgical outcomes and low morbidity. We feel that mastering the complex anatomy of this approach helps achieve successful outcomes.

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A rare case of cervical metastatis of glioblastoma after cranial tumor resection: case report and review of literature

British Journal of Neurosurgery ◽

10.1080/02688697.2020.1814994 ◽

2020 ◽

pp. 1-7

Author(s):

Okan Turk ◽

Nuriye Guzin Ozdemir ◽

Ibrahim Burak Atci ◽

Hakan Yilmaz ◽

Feray Gunver ◽

...

Keyword(s):

Case Report ◽

Rare Case ◽

Tumor Resection ◽

Review Of Literature

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Presence of Temporal Gray-White Matter Abnormalities Does Not Influence Epilepsy Surgery Outcome in Temporal Lobe Epilepsy With Hippocampal Sclerosis

Neurosurgery ◽

10.1227/neu.0b013e3181fc60ff ◽

2011 ◽

Vol 68 (1) ◽

pp. 98-107 ◽

Cited By ~ 21

Author(s):

Olaf E M G. Schijns ◽

Christian G. Bien ◽

Michael. Majores ◽

Marec. von Lehe ◽

Horst. Urbach ◽

...

Keyword(s):

White Matter ◽

Temporal Lobe ◽

Clinical Characteristics ◽

Hippocampal Sclerosis ◽

Temporal Lobectomy ◽

Seizure Outcome ◽

Anterior Temporal Lobectomy ◽

Selective Amygdalohippocampectomy ◽

Group 2 ◽

Group 1

Abstract BACKGROUND: Temporal lobe gray-white matter abnormalities (GWMA) are frequent morphological aberrances observed on MRI in patients with temporal lobe epilepsy (TLE) in addition to hippocampal sclerosis (HS). OBJECTIVE: To study the influence of temporal pole GWMA on clinical characteristics and seizure outcome in patients with HS operated on for TLE. METHODS: A cohort of 370 patients undergoing surgery for intractable TLE was prospectively collected in an epilepsy surgery data base. Clinical characteristics and seizure outcome of all 58 TLE patients with identified HS and GWMA (group 1) were compared with those of a matched control group of 58 HS patients without GWMA (group 2). Both groups were further subdivided into patients undergoing transsylvian selective amygdalohippocampectomy (sAH) and anterior temporal lobectomy with amygdalohippocampectomy (ATL). RESULTS: The HS plus GWMA patients were significantly younger at epilepsy onset than those without GWMA. In the HS plus GWMA group, 41% of patients were younger than 2 years when they experienced their first seizure in contrast to only 17% of patients with pure HS (P = .004). Seizure outcome was not statistically different between the 2 groups: 75.9% of the patients in group 1 were seizure free (Engel class I) compared with 81% of patients in group 2. Seizure outcome in both groups was about equally successful with selective amygdalohippocampectomy and anterior temporal lobectomy (ns). CONCLUSION: Limited and standard resections in TLE patients with HS are equally successful regardless of the presence of GWMA.

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Tumor resection from retromolar trigone, posterolateral maxilla, and anterior mandibular ramus using lower cheek flap approach: a case report and review of literature

Journal of the Korean Association of Oral and Maxillofacial Surgeons ◽

10.5125/jkaoms.2017.43.3.186 ◽

2017 ◽

Vol 43 (3) ◽

pp. 186

Author(s):

Young-Hoon Kang ◽

June-Ho Byun ◽

Su-Jin Sung ◽

Bong-Wook Park

Keyword(s):

Case Report ◽

Tumor Resection ◽

Review Of Literature ◽

Mandibular Ramus ◽

Retromolar Trigone ◽

Cheek Flap

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Diffusion Tensor Imaging Color-Coded Maps: An Alternative to Tractography

Stereotactic and Functional Neurosurgery ◽

10.1159/000512092 ◽

2021 ◽

pp. 1-10

Author(s):

Julia R. Schneider ◽

Ami B. Raval ◽

Karen Black ◽

Michael Schulder

Keyword(s):

Diffusion Tensor Imaging ◽

White Matter ◽

Diffusion Tensor ◽

Pyramidal Tract ◽

Tumor Resection ◽

Cavernous Angioma ◽

Tumor Location ◽

White Matter Tract ◽

White Matter Tracts ◽

Neurological Outcomes

Introduction: White matter tracts can be observed using tractograms generated from diffusion tensor imaging (DTI). However, the dependence of these white matter tract images on subjective variables, including how seed points are placed and the preferred level of fractional anisotropy, introduces interobserver inconsistency and potential lack of reliability. We propose that color-coded maps (CCM) generated from DTI can be a preferred method for the visualization of important white matter tracts, circumventing bias in preoperative brain tumor resection planning. Methods: DTI was acquired retrospectively in 25 patients with brain tumors. Lesions included 15 tumors of glial origin, 9 metastatic tumors, 2 meningiomas, and 1 cavernous angioma. Tractograms of the pyramidal tract and/or optic radiations, based on tumor location, were created by marking seed regions of interest using known anatomical locations. We compared the degree of tract involvement and white matter alteration between CCMs and tractograms. Neurological outcomes were obtained from chart reviews. Results: The pyramidal tract was evaluated in 20/25 patients, the visual tracts were evaluated in 10/25, and both tracts were evaluated in 5/25. In 19/25 studies, the same patterns of white matter alternations were found between the CCMs and tractograms. In the 6 patients where patterns differed, 2 tractograms were not useful in determining pattern alteration; in the remaining 4/6, no practical difference was seen in comparing the studies. Two patients were lost to follow-up. Thirteen patients were neurologically improved or remained intact after intervention. In these, 10 of the 13 patients showed tumor-induced white matter tract displacement on CCM. Twelve patients had no improvement of their preoperative deficit. In 9 of these 12 patients, CCM showed white matter disruption. Conclusion: CCMs provide a convenient, practical, and objective method of visualizing white matter tracts, obviating the need for potentially subjective and time-consuming tractography. CCMs are at least as reliable as tractograms in predicting neurological outcomes after neurosurgical intervention.

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