Seizure Outcome in Children with Hemispheric Tumors and Associated Intractable Epilepsy: The Role of Tumor Removal Combined with Seizure Foci Resection

✓ The authors report the results obtained in 11 patients with tuberous sclerosis (TS) who underwent cortical resection surgery for medically intractable epilepsy. Patients' ages at time of surgery ranged from 3 to 46 years (mean 19.6 years). Preoperative epileptiform electroencephalographic abnormalities were focal spike wave discharges in six patients (55%), multifocal in four patients (36%), and generalized in one patient (9%). In the multifocal and generalized groups, all patients (45%) were evaluated by means of subdural grid and strip electrode recordings, whereas electrophysiological localization in the remaining patients was derived from ictal and interictal scalp recordings. The seizure foci were found to be extratemporal in six patients (55%) and temporal in five patients (45%). Surgical intervention consisted of craniotomy and seizure foci resection guided by electrocorticographic monitoring and functional mapping in five awake (45%) and six asleep (55%) patients. Neuropathological examination of the resected seizure foci revealed cortical tubers in eight patients and diffuse gliosis in three patients. Follow up ranged from 8 to 127 months (mean 35 months). Six patients (55%) were seizure free, half of whom were not receiving antiepileptic drugs (AEDs); three patients (27%) had a greater than 70% reduction in seizure frequency, although they required AEDs; one patient (9%) had a 50% temporary reduction in seizure frequency during the initial 6-month postoperative period; and one patient (9%) was lost to follow-up study. From this small but adequately followed patient population with TS, the authors conclude that cortical resection of seizure foci tailored to electrocorticographic findings and functional mapping is encouraging for this difficult to manage patient population with medically intractable epilepsy.

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Subdural Monitoring in the Evaluation of Children for Epilepsy Surgery

Journal of Child Neurology ◽

10.1177/0883073894009002091 ◽

1994 ◽

Vol 9 (2_suppl) ◽

pp. 2S61-2S66 ◽

Cited By ~ 24

Author(s):

Prasarma Jayakar ◽

Michael Duchowny ◽

Trevor J. Resnick

Keyword(s):

Epilepsy Surgery ◽

Intractable Epilepsy ◽

Childhood Epilepsy ◽

Chronic Epilepsy ◽

Subdural Electrodes ◽

Noninvasive Assessment ◽

Seizure Foci

Noninvasive assessment of children with chronic epilepsy is often imprecise and localization of seizure foci requires intracranial electroencephalographic monitoring. Subdural electrodes provide coverage of large areas of neocortex and are ideally suited for evaluating children with intractable epilepsy and to functionally map critical cortex. This report discusses the role of subdural electroencephalography in the evaluation of childhood epilepsy. (J Child Neurol 1994; 9(Suppl):2S61-2S66).

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Pediatric intractable epilepsy: the role of presurgical evaluation and seizure outcome

Child s Nervous System ◽

10.1007/s003810050514 ◽

2000 ◽

Vol 16 (5) ◽

pp. 278-285 ◽

Cited By ~ 17

Author(s):

Seung-Ki Kim ◽

Kyu-Chang Wang ◽

Yong-Seung Hwang ◽

Ki Joong Kim ◽

I.-O. Kim ◽

...

Keyword(s):

Intractable Epilepsy ◽

Seizure Outcome ◽

Presurgical Evaluation

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Seizure outcome of lesional vs nonlesional frontal lobectomy for intractable epilepsy

Electroencephalography and Clinical Neurophysiology ◽

10.1016/s0013-4694(97)88615-8 ◽

1997 ◽

Vol 103 (1) ◽

pp. 136 ◽

Cited By ~ 5

Author(s):

R Mosewich

Keyword(s):

Intractable Epilepsy ◽

Seizure Outcome ◽

Frontal Lobectomy

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The Neuroinflammatory Role of Pericytes in Epilepsy

Biomedicines ◽

10.3390/biomedicines9070759 ◽

2021 ◽

Vol 9 (7) ◽

pp. 759

Author(s):

Gaku Yamanaka ◽

Fuyuko Takata ◽

Yasufumi Kataoka ◽

Kanako Kanou ◽

Shinichiro Morichi ◽

...

Keyword(s):

Proinflammatory Cytokines ◽

Current Knowledge ◽

Morphological Changes ◽

Cell Damage ◽

Neurovascular Unit ◽

Experimental Studies ◽

Intractable Epilepsy ◽

In Vivo Studies

Pericytes are a component of the blood–brain barrier (BBB) neurovascular unit, in which they play a crucial role in BBB integrity and are also implicated in neuroinflammation. The association between pericytes, BBB dysfunction, and the pathophysiology of epilepsy has been investigated, and links between epilepsy and pericytes have been identified. Here, we review current knowledge about the role of pericytes in epilepsy. Clinical evidence has shown an accumulation of pericytes with altered morphology in the cerebral vascular territories of patients with intractable epilepsy. In vitro, proinflammatory cytokines, including IL-1β, TNFα, and IL-6, cause morphological changes in human-derived pericytes, where IL-6 leads to cell damage. Experimental studies using epileptic animal models have shown that cerebrovascular pericytes undergo redistribution and remodeling, potentially contributing to BBB permeability. These series of pericyte-related modifications are promoted by proinflammatory cytokines, of which the most pronounced alterations are caused by IL-1β, a cytokine involved in the pathogenesis of epilepsy. Furthermore, the pericyte-glial scarring process in leaky capillaries was detected in the hippocampus during seizure progression. In addition, pericytes respond more sensitively to proinflammatory cytokines than microglia and can also activate microglia. Thus, pericytes may function as sensors of the inflammatory response. Finally, both in vitro and in vivo studies have highlighted the potential of pericytes as a therapeutic target for seizure disorders.

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Resection of cerebral gangliogliomas causing drug-resistant epilepsy: short- and long-term outcomes using intraoperative MRI and neuronavigation

Neurosurgical FOCUS ◽

10.3171/2014.10.focus14616 ◽

2015 ◽

Vol 38 (1) ◽

pp. E5 ◽

Cited By ~ 14

Author(s):

Björn Sommer ◽

Cornelia Wimmer ◽

Roland Coras ◽

Ingmar Blumcke ◽

Bogdan Lorber ◽

...

Keyword(s):

Diffusion Tensor ◽

Intraoperative Imaging ◽

Intractable Epilepsy ◽

Complete Resection ◽

Blood Oxygenation ◽

Seizure Outcome ◽

Incomplete Resection ◽

Brain Areas ◽

Total Resection

OBJECT Cerebral gangliogliomas (GGs) are highly associated with intractable epilepsy. Incomplete resection due to proximity to eloquent brain regions or misinterpretation of the resection amount is a strong negative predictor for local tumor recurrence and persisting seizures. A potential method for dealing with this obstacle could be the application of intraoperative high-field MRI (iopMRI) combined with neuronavigation. METHODS Sixty-nine patients (31 female, 38 male; median age 28.5 ± 15.4 years) suffering from cerebral GGs were included in this retrospective study. Five patients received surgery twice in the observation period. In 48 of the 69 patients, 1.5-T iopMRI combined with neuronavigational guidance was used. Lesions close to eloquent brain areas were resected with the implementation of preoperative diffusion tensor imaging tractography and blood oxygenation level–dependent functional MRI (15 patients). RESULTS Overall, complete resection was accomplished in 60 of 69 surgical procedures (87%). Two patients underwent biopsy only, and in 7 patients, subtotal resection was accomplished because of proximity to critical brain areas. Excluding the 2 biopsies, complete resection using neuronavigation/iopMRI was documented in 33 of 46 cases (72%) by intraoperative imaging. Remnant tumor mass was identified intraoperatively in 13 of 46 patients (28%). After intraoperative second-look surgery, the authors improved the total resection rate by 9 patients (up to 91% [42 of 46]). Of 21 patients undergoing conventional surgery, 14 (67%) had complete resection without the use of iopMRI. Regarding epilepsy outcome, 42 of 60 patients with seizures (70%) became completely seizure free (Engel Class IA) after a median follow-up time of 55.5 ± 36.2 months. Neurological deficits were found temporarily in 1 (1.4%) patient and permanently in 4 (5.8%) patients. CONCLUSIONS Using iopMRI combined with neuronavigation in cerebral GG surgery, the authors raised the rate of complete resection in this series by 19%. Given the fact that total resection is a strong predictor of long-term seizure control, this technique may contribute to improved seizure outcome and reduced neurological morbidity.

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Endoscopic Management of Frontal Sinus Osteomas Revisited

American Journal of Rhinology and Allergy ◽

10.2500/ajra.2009.23.3321 ◽

2009 ◽

Vol 23 (3) ◽

pp. 331-336 ◽

Cited By ~ 48

Author(s):

Kristin Seiberling ◽

Steve Floreani ◽

Simon Robinson ◽

Peter-John Wormald

Keyword(s):

Endoscopic Resection ◽

Frontal Sinus ◽

Ct Scans ◽

Endoscopic Management ◽

Grading System ◽

Tumor Removal ◽

Successful Removal ◽

Grade Iii

Background Recent articles have published guidelines regarding the role of endoscopic surgery in the removal of frontal sinus osteomas. These guidelines recommend the endoscopic approach for small osteomas but recommend an osteoplastic flap for larger tumors. This study presents a series of endoscopically resected tumors both large and small. Methods Retrospective chart reviews were performed. Charts were reviewed of all patients who underwent surgical resection of a frontal sinus osteoma from 1998 to 2008. Sinus CT scans were reviewed and each tumor was staged according to Kennedy's grading system proposed in 2005. Results Twenty-three patients, 8 with a grade IV tumor, 6 with a grade III tumor, and the remaining with a grade I or II tumor, underwent endoscopic resection of a frontal sinus osteoma. In 15 patients a modified Lothrop procedure was performed for tumor removal. In addition, a blepharoplasty incision was used in one patient for removal of a large orbital extension of the tumor and another underwent an enlarged frontal sinus trephine performed via a browline incision. In the remaining patients a frontal sinusotomy with minitrephination provided enough access for tumor removal. Over an average follow-up of 36 months no recurrences were noted. Symptoms improved in all but one patient. There were no postoperative complications. Conclusion Endoscopic resection of both large and small frontal sinus osteomas is feasible. In this article we have shown successful removal of large osteomas that fill the entire frontal sinus with the modified Lothrop procedure.

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