Operative Approaches for Intractable Temporal Lobe Epilepsy

CNS Spectrums ◽  
1997 ◽  
Vol 2 (7) ◽  
pp. 59-67
Author(s):  
Kris A. Smith ◽  
Andrew G. Shetter
Keyword(s):  
Temporal Lobe Epilepsy ◽  
Temporal Lobe ◽  
Surgical Approaches ◽  
Invasive Monitoring ◽  
Preoperative Workup ◽  
The Past ◽  
Selective Amygdalohippocampectomy ◽  
Past Half Century ◽  
Past Half ◽  
Made In

AbstractOver the past half century, a number of advances have been made in surgical approaches to treating refractory temporal lobe epilepsy. This article explains some of the newer approaches and provides support for selective amygdalohippocampectomy. Appropriate preoperative workup, including various invasive monitoring techniques, is also described.

scholarly journals Mental health services in Sri Lanka

2004 ◽  
Vol 1 (3) ◽  
pp. 10-12 ◽  
Author(s):  
Nalaka Mendis
Keyword(s):  
Mental Health ◽  
Health Status ◽  
Sri Lanka ◽  
Mortality Rates ◽  
Literacy Rate ◽  
Live Births ◽  
The Past ◽  
Past Half Century ◽  
Past Half ◽  
Made In

Relative to its economic indicators, Sri Lanka has a high health status. The life expectancy in the year 2001 was 70.7 years for males and 75.4 years for females. Maternal and infant mortality rates have shown a downward trend over the past half century and now are around 2.3 per 10 000 live births and 16 per 1000 live births, respectively. These trends are mainly due to the high literacy rate and comparatively large investments made in health and social welfare.

Selective amygdalohippocampectomy via the transsylvian approach

2008 ◽  
Vol 25 (3) ◽  
pp. E5 ◽  
Author(s):  
Badih Adada
Keyword(s):  
Visual Field ◽  
Temporal Lobe Epilepsy ◽  
Temporal Lobe ◽  
Seizure Control ◽  
Temporal Lobectomy ◽  
Surgical Approaches ◽  
Neuropsychological Outcome ◽  
Transsylvian Approach ◽  
Selective Amygdalohippocampectomy ◽  
Established Treatment

Surgery is an established treatment for temporal lobe epilepsy refractory to medication. Several surgical approaches have been used to treat this condition including temporal lobectomy, transcortical selective amygdalohippocampectomy, subtemporal amygdalohippocampectomy, and transsylvian amygdalohippocampectomy. In this article the author reviews the transsylvian amygdalohyppocampectomy and pertinent anatomy. He also discusses the procedure's results with regard to seizure control, neuropsychological outcome, and visual field preservation.

Seizure outcomes and mesial resection volumes following selective amygdalohippocampectomy and temporal lobectomy

2012 ◽  
Vol 32 (3) ◽  
pp. E8 ◽  
Author(s):  
Oren Sagher ◽  
Jayesh P. Thawani ◽  
Arnold B. Etame ◽  
Diana M. Gomez-Hassan
Keyword(s):  
Temporal Lobe Epilepsy ◽  
Temporal Lobe ◽  
Test Scores ◽  
Memory Function ◽  
Mesial Temporal Lobe Epilepsy ◽  
Temporal Lobectomy ◽  
Surgical Approaches ◽  
Seizure Outcome ◽  
Selective Amygdalohippocampectomy ◽  
Significant Difference

Object Anterior temporal lobectomy (ATL) and selective amygdalohippocampectomy (SelAH) are the preferred surgical approaches for the treatment of medically refractory epilepsy involving the nondominant and dominant temporal lobes, respectively. Both techniques provide access to mesial structures—with the ATL providing a wider surgical corridor than SelAH. Because the extent of mesial temporal resection potentially impacts seizure outcome, the authors examined mesial resection volumes, seizure outcomes, and neuropsychiatric test scores in patients undergoing either ATL or transcortical SelAH at a single institution. Methods A retrospective study was conducted in 96 patients with medically refractory mesial temporal lobe epilepsy. Fifty-one patients who had nondominant temporal lobe epilepsy underwent standard ATL, and 45 patients with language-dominant temporal lobe epilepsy underwent transcortical SelAH. Volumetric MRI analysis was used to quantify the mesial resection in both groups. In addition, the authors examined seizure outcomes and the change in neuropsychiatric test scores. Results Seizure-free outcome in the entire patient cohort was 94% at a mean follow-up of 44 months. There was no significant difference in the seizure outcome between the 2 groups. The extent of resection of the mesial structures following ATL was slightly higher than for SelAH (98% vs 91%, p < 0.0001). The change in neuropsychiatric test scores largely reflected the side of surgery, but overall IQ and memory function did not change significantly in either group. Conclusions Transcortical SelAH provides adequate access to the mesial structures, and allows for a resection that is nearly as extensive as that achieved with standard ATL. Seizure outcomes and neuropsychiatric sequelae are similar in both procedures.

scholarly journals Remote effects of temporal lobe epilepsy surgery: long-term morphological changes after surgical resection

2020 ◽  
Author(s):  
T. Campbell Arnold ◽  
Lohith G. Kini ◽  
John M. Bernabei ◽  
Andrew Y. Revell ◽  
Sandhitsu R. Das ◽  
...  
Keyword(s):  
Temporal Lobe Epilepsy ◽  
Temporal Lobe ◽  
Cortical Thickness ◽  
Structural Changes ◽  
Brain Regions ◽  
Temporal Lobectomy ◽  
Surgical Approaches ◽  
Cortical Thinning ◽  
Selective Amygdalohippocampectomy ◽  
Automated Method

ABSTRACTObjectiveWe present a semi-automated method for quantifying structural changes after epilepsy surgery that accounts for tissue deformation caused by resection. We demonstrate its utility by comparing the remote structural effects of two surgical approaches, the anterior temporal lobectomy (ATL) and the selective amygdalohippocampectomy (SAH).MethodsWe studied 37 temporal lobe epilepsy (TLE) patients who underwent resective surgery. Patients were treated with either an anterior temporal lobectomy (ATL, N=21) or a selective amygdalohippocampectomy (SAH, N=16). All patients received same-scanner MR imaging preoperatively and postoperatively (5+ months after surgery). To analyze structural changes in remote brain regions, we (1) implemented an automated method for segmenting resections with manual review, (2) applied cost function masking to the resection zone, and (3) estimated longitudinal cortical thickness changes using Advanced Normalization Tools (ANTs). We then compared post-operative changes in cortical thickness between the two surgical groups in brain regions outside the resected area.ResultsPatients treated with ATL exhibited significantly greater cortical thinning globally when compared to patients treated with SAH (p = 0.049). There were significant focal differences between the two treatment groups in the ipsilateral frontal lobe (superior medial and medial orbital regions) and insula (p > 0.001, α = 0.05 Bonferroni corrected). No significant effects were seen in the contralateral hemisphere.SignificanceWe present and share a semi-automated pipeline for quantifying remote longitudinal changes in cortical thickness after neurosurgery. The technique is applicable to a broad array of applications, including surgical planning and mapping neuropsychological function to brain structure. Using this tool, we demonstrate that patients treated with SAH for refractory temporal lobe epilepsy have less postoperative cortical thinning in remote brain regions than those treated with ATL. We share all algorithm code and results to accelerate collaboration and clinical translation of our work.KEY POINTS BOXDifferent epilepsy surgical approaches lead to distinct patterns of postoperative cortical atrophy in remote brain regionsPatients treated with SAH have less postoperative cortical thinning than patients treated with ATLThe insula and frontal lobe demonstrated the greatest focal differences in postoperative cortical thinning when comparing SAH and ATLPostoperative cortical thinning analyses may inform surgical planning and our understanding of cognitive sequelae

Memory outcome after temporal lobe epilepsy surgery: corticoamygdalohippocampectomy versus selective amygdalohippocampectomy

2010 ◽  
Vol 113 (6) ◽  
pp. 1164-1175 ◽  
Author(s):  
Taner Tanriverdi ◽  
Roy William Roland Dudley ◽  
Alya Hasan ◽  
Ahmed Al Jishi ◽  
Qasim Al Hinai ◽  
...  
Keyword(s):  
Temporal Lobe Epilepsy ◽  
Temporal Lobe ◽  
Verbal Memory ◽  
Hippocampal Sclerosis ◽  
Surgical Approaches ◽  
Seizure Outcome ◽  
Nonverbal Memory ◽  
Selective Amygdalohippocampectomy ◽  
Significant Difference

Object The aim of this study was to compare IQ and memory outcomes at the 1-year follow-up in patients with medically refractory mesial temporal lobe epilepsy (MTLE) due to hippocampal sclerosis. All patients were treated using a corticoamygdalohippocampectomy (CAH) or a selective amygdalohippocampectomy (SelAH). Methods The data of 256 patients who underwent surgery for MTLE were retrospectively evaluated. One hundred twenty-three patients underwent a CAH (63 [right side] and 60 [left side]), and 133 underwent an SelAH (61 [right side] and 72 [left side]). A comprehensive neuropsychological test battery was assessed before and 1 year after surgery, and the results were compared between the surgical procedures. Furthermore, seizure outcome was compared using the Engel classification scheme. Results At 1-year follow-up, there was no statistically significant difference between the surgical approaches with respect to seizure outcome. Overall, IQ scores showed improvement, but verbal IQ decreased after left SelAH. Verbal memory impairment was seen after left-sided resections especially in cases of SelAH, and nonverbal memory decreased after right-sided resection, especially for CAH. Left-sided resections produced some improvement in nonverbal memory. Older age at surgery, longer duration of seizures, greater seizure frequency before surgery, and poor seizure control after surgery were associated with poorer memory. Conclusions Both CAH and SelAH can lead to several cognitive impairments depending on the side of the surgery. The authors suggest that the optimal type of surgical approach should be decided on a case-by-case basis.

Long-term seizure outcome after mesial temporal lobe epilepsy surgery: corticalamygdalohippocampectomy versus selective amygdalohippocampectomy

2008 ◽  
Vol 108 (3) ◽  
pp. 517-524 ◽  
Author(s):  
Taner Tanriverdi ◽  
Andre Olivier ◽  
Nicole Poulin ◽  
Frederick Andermann ◽  
François Dubeau
Keyword(s):  
Temporal Lobe Epilepsy ◽  
Temporal Lobe ◽  
Seizure Control ◽  
Surgical Approaches ◽  
Seizure Outcome ◽  
Selective Amygdalohippocampectomy ◽  
Selective Approach ◽  
Significant Difference ◽  
The Impact

Object Resection strategies for the treatment of temporal lobe epilepsy (TLE) are a matter of discussion, and little information is available. The aim of this study was to compare seizure outcomes at the 5-year follow-up in patients with medically refractory unilateral mesial TLE (MTLE) due to hippocampal sclerosis (HS) who were treated using a cortical amygdalohippocampectomy (CorAH) or a selective AH (SelAH). Methods The authors obtained data from 100 adult patients who underwent surgery for MTLE. Fifty patients underwent a CorAH and 50 underwent an SelAH. Seizure control achieved with each technique was compared using the Engel classification scheme. Results Overall, at the 5-year follow-up, favorable (Engel Classes I and II) seizure outcomes were noted in 82 and 90% of patients who had undergone CorAH and SelAH, respectively. Furthermore, 40% of the patients who had undergone a CorAH and 58% of those who had undergone an SelAH were seizure free (Engel Class Ia). There was no statistically significant difference between the 2 surgical approaches in terms of seizure outcome at the 5-year follow-up (p = 0.38). Conclusions Both CorAH and SelAH can lead to similar favorable seizure control in patients with MTLE/HS. However, the authors suggest that the transcortical selective approach has the great advantage of minimizing or completely abolishing the impact of dividing several venous and arterial adhesions which are tedious, time consuming, and, at times, associated with some degree of cerebral swelling.

EDITORIAL: Migration and competitiveness: Japan and the United States

2013 ◽  
Vol 10 (2) ◽  
pp. 115-124
Author(s):  
Philip L. Martin
Keyword(s):  
United States ◽  
The United States ◽  
Variable Cost ◽  
Fixed Cost ◽  
Special Issue ◽  
Science And Engineering ◽  
The Past ◽  
Past Half Century ◽  
Key Sectors ◽  
Past Half

Japan and the United States, the world’s largest economies for most of the past half century, have very different immigration policies. Japan is the G7 economy most closed to immigrants, while the United States is the large economy most open to immigrants. Both Japan and the United States are debating how immigrants are and can con-tribute to the competitiveness of their economies in the 21st centuries. The papers in this special issue review the employment of and impacts of immigrants in some of the key sectors of the Japanese and US economies, including agriculture, health care, science and engineering, and construction and manufacturing. For example, in Japanese agriculture migrant trainees are a fixed cost to farmers during the three years they are in Japan, while US farmers who hire mostly unauthorized migrants hire and lay off workers as needed, making labour a variable cost.

Reframing the Sciences of the Long Eighteenth Century

2020 ◽  
Vol 50 (1-2) ◽  
pp. 58-66
Author(s):  
Giuliano Pancaldi
Keyword(s):  
Eighteenth Century ◽  
History Of Science ◽  
Science Policy ◽  
Special Issue ◽  
Half Century ◽  
The Past ◽  
Past Half Century ◽  
History Of ◽  
Long Eighteenth Century ◽  
Past Half

Here I survey a sample of the essays and reviews on the sciences of the long eighteenth century published in this journal since it was founded in 1969. The connecting thread is some historiographic reflections on the role that disciplines—in both the sciences we study and the fields we practice—have played in the development of the history of science over the past half century. I argue that, as far as disciplines are concerned, we now find ourselves a bit closer to a situation described in our studies of the long eighteenth century than we were fifty years ago. This should both favor our understanding of that period and, hopefully, make the historical studies that explore it more relevant to present-day developments and science policy. This essay is part of a special issue entitled “Looking Backward, Looking Forward: HSNS at 50,” edited by Erika Lorraine Milam.

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