Through the Choroidal Fissure

2010 ◽  
Vol 66 (suppl_2) ◽  
pp. ons221-ons229 ◽  
Author(s):  
Anhua Wu ◽  
Steve W. Chang ◽  
Pushpa Deshmukh ◽  
Robert F. Spetzler ◽  
Mark C. Preul
Keyword(s):  
Temporal Lobe ◽  
Cerebral Artery ◽  
Posterior Cerebral Artery ◽  
Temporal Region ◽  
Mesial Temporal Lobe ◽  
Optimal Approach

Abstract BACKGROUND We compared the transsylvian transchoroidal (TSTC) approach with the lateral transtemporal (LTT) approach. Both approaches proceed through the choroidal fissure but through different incisions and along different trajectories. METHODS Four fixed, silicon-injected heads (8 sides) were used. Nine strategic anatomic points within the dissections were compared between the TSTC and LTT approaches in 7 other silicon-injected heads (14 sides). Neuronavigation was used to gather coordinates from selected points of both approaches to calculate surgical angles and distances to common targets. RESULTS The surgical angle of the TSTC approach for the inferior choroidal point was wider compared with the LTT approach (P < .05). The surgical angles for the P2a-P2p point were similar for both approaches. In the TSTC approach, the P2-P3 point angle was smaller than in the LTT approach (P < .05). The TSTC approach provided (except for the P2-P3 point) significantly shorter distances to all defined anatomic targets compared with the LTT approach. When the posterior cerebral artery was the target in the TSTC approach, the hippocampus was retracted 3 to 8 mm compared with 8 to 13 mm in the LTT approach. CONCLUSION We quantitatively described anatomic features of the TSTC approach and compared them with the LTT approach. For approaching the mesial temporal region, the TSTC approach offers an adequate surgical angle and shorter or similar distances proximal to P2-P3 and requires less temporal lobe and hippocampal retraction than the LTT approach. Such information can help surgeons select the optimal approach to the mesial temporal lobe and its surrounding structures. The TSTC approach should be considered for lesions located in the medial temporal region.

scholarly journals Temporal lobe seizures from a posterior cerebral artery aneurysm presenting as memory flashbacks

CJEM ◽  
2009 ◽  
Vol 11 (04) ◽  
pp. 389-392 ◽  
Author(s):  
Mohamed A. Peera ◽  
Michael LoCurto
Keyword(s):  
Temporal Lobe ◽  
Cerebral Artery ◽  
Posterior Cerebral Artery ◽  
Artery Aneurysm ◽  
Unruptured Aneurysm ◽  
Psychiatric Condition ◽  
Temporal Lobe Seizures ◽  
Psychiatric Conditions ◽  
Cerebral Artery Aneurysm ◽  
With Memory

ABSTRACT Memory flashbacks are usually attributed to recreational drugs or psychiatric conditions. The differential diagnosis for memory flashbacks is diverse and challenging; moreover, management is influenced by the working diagnosis. We describe the case of a 35-year-old man who presented with memory flashbacks secondary to temporal lobe seizures from an unruptured aneurysm of the posterior cerebral artery. To our knowledge, a case of this nature has not been previously reported. This case demonstrates the need to recognize that, on rare occasions, a complaint of memory flashbacks can be the result of an organic etiology. We also discuss the challenging presentations of temporal lobe seizures, as they can easily be misdiagnosed as a psychiatric condition.

scholarly journals Selective posterior cerebral artery amobarbital test in patients with temporal lobe epilepsy for surgical treatment

Seizure ◽  
2006 ◽  
Vol 15 (2) ◽  
pp. 117-124 ◽  
Author(s):  
Der-Jen Yen ◽  
Jiing-Feng Lirng ◽  
Yang-Hsin Shih ◽  
Ian-Kai Shan ◽  
Tung-Ping Su ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Temporal Lobe Epilepsy ◽  
Temporal Lobe ◽  
Cerebral Artery ◽  
Posterior Cerebral Artery

scholarly journals Electroencephalography in Mesial Temporal Lobe Epilepsy: A Review

2012 ◽  
Vol 2012 ◽  
pp. 1-17 ◽  
Author(s):  
Manouchehr Javidan
Keyword(s):  
Temporal Lobe Epilepsy ◽  
Temporal Lobe ◽  
Mesial Temporal Lobe Epilepsy ◽  
General Information ◽  
Seizure Freedom ◽  
Temporal Region ◽  
Epileptiform Discharges ◽  
Mesial Temporal Lobe ◽  
Magnetic Resonance Imaging Mri ◽  
Sensitivity Specificity

Electroencephalography (EEG) has an important role in the diagnosis and classification of epilepsy. It can provide information for predicting the response to antiseizure drugs and to identify the surgically remediable epilepsies. In temporal lobe epilepsy (TLE) seizures could originate in the medial or lateral neocortical temporal region, and many of these patients are refractory to medical treatment. However, majority of patients have had excellent results after surgery and this often relies on the EEG and magnetic resonance imaging (MRI) data in presurgical evaluation. If the scalp EEG data is insufficient or discordant, invasive EEG recording with placement of intracranial electrodes could identify the seizure focus prior to surgery. This paper highlights the general information regarding the use of EEG in epilepsy, EEG patterns resembling epileptiform discharges, and the interictal, ictal and postictal findings in mesial temporal lobe epilepsy using scalp and intracranial recordings prior to surgery. The utility of the automated seizure detection and computerized mathematical models for increasing yield of non-invasive localization is discussed. This paper also describes the sensitivity, specificity, and predictive value of EEG for seizure recurrence after withdrawal of medications following seizure freedom with medical and surgical therapy.

scholarly journals P.189 Unruptured Posterior Cerebral Artery aneurysm causing temporal lobe epilepsy

2021 ◽  
Vol 48 (s3) ◽  
pp. S74-S75
Author(s):  
M Fatehi Hassanabad ◽  
G Redekop ◽  
LS Yefet
Keyword(s):  
Temporal Lobe Epilepsy ◽  
Temporal Lobe ◽  
Cerebral Artery ◽  
Rare Case ◽  
Posterior Cerebral Artery ◽  
Cerebral Aneurysms ◽  
Artery Aneurysm ◽  
Parahippocampal Gyrus ◽  
Temporal Lobe Seizures ◽  
Cerebral Artery Aneurysm

Background: Cerebral aneurysms are an unusal cause of epilepsy. To date, several groups have reported temporal lobe seizures caused by aneurysms projecting into the parahippocampal gyrus. Given the low incidence of posterior cerebral artery aneurysms, they are a very rare cause of temporal lobe seizures. Methods: Here, we report a rare case of temporal lobe epilepsy caused by an unruptured aneurysm. We also present a review of the literature yielding two similar cases. Results: A previosuly well 56 year old male presented to a neurologist with symptoms consistent with temporal lobe epilepsy. He was started on carbamzepine and underwent imaging and neuropsychological assessments. An MRI suggested the existance of a 7mm posterior cerebral artery aneurysm arising from the P2 segment of the posterior cerebral artery and projecting into the parahippocampal gyrus. This was also confirmed with CT angiography and the patient elected to have the aneurysm clipped. Conclusions: Temporal lobe epilepsy is an uncommon presentation for unruptured cerebral aneurysms. We report a rare case wherein a laterally pointing PCA aneurysm was buried in the posterior parahippocampal gyrus. This aneurysm had caused perifocal gliosis leading to stereotyped seizures. Post-operatively, the patient has been seizure free.

scholarly journals Hippocampal transection for stereo-electroencephalography–proven dominant mesial temporal lobe epilepsy in a child: a detailed case report and critical review

2018 ◽  
Vol 22 (5) ◽  
pp. 497-503
Author(s):  
Jun T. Park ◽  
Guadalupe Fernandez Baca Vaca ◽  
Rachel Tangen ◽  
Jonathan Miller
Keyword(s):  
Temporal Lobe Epilepsy ◽  
Temporal Lobe ◽  
Verbal Memory ◽  
Mesial Temporal Lobe Epilepsy ◽  
Hemispheric Dominance ◽  
Seizure Outcome ◽  
Temporal Region ◽  
Detailed Case ◽  
Epileptiform Discharges ◽  
Mesial Temporal Lobe

Resection of the hippocampus ipsilateral to the verbal memory–dominant hemisphere frequently results in severe memory deficits. In adults with epilepsy, multiple hippocampal transections (MHTs) have resulted in excellent seizure outcome with preservation of verbal memory. The authors report the first detailed case of a child undergoing MHTs for mesial temporal lobe epilepsy. A 13-year-old right-handed boy had intractable seizures characterized by epigastric discomfort evolving to unresponsiveness and chewing automatisms, lasting 1 minute and occurring 2–3 times weekly, sometimes ending in a generalized tonic-clonic seizure. He had no seizure risk factors and nonfocal examination results. Interictal electroencephalography (EEG) showed frequent left temporal epileptiform discharges (maximum FT9) and intermittent slowing. Video EEG, FDG-PET, and 1.5-T MRI were nonlocalizing. Neuropsychological evaluation suggested left temporal lobe dysfunction. A stereo-EEG investigation using 8 electrodes localized the seizure onset zone to the anterior mesial temporal region, immediately involving the hippocampus. The temporal pole and amygdala were resected en bloc with 3 MHTs. Comparison of neuropsychological tests 4 months before and 6 months after the surgery showed a significant decline only in confrontational naming and no significant change in verbal memory. Six and a half years later, the patient remains seizure free with no antiepileptic drugs. In children with established hemispheric dominance suffering from mesial temporal lobe epilepsy, MHTs may be an option.

T2/FLAIR hyperintensity in the mesial temporal lobe: challenging differential diagnosis

2021 ◽  
Vol 17 ◽  
Author(s):  
Sungjun Moon
Keyword(s):  
Temporal Lobe ◽  
Herpes Simplex Encephalitis ◽  
Posterior Cerebral Artery ◽  
Imaging Finding ◽  
Hippocampal Sclerosis ◽  
Magnetic Resonance Imaging Finding ◽  
Autoimmune Encephalitis ◽  
Gliomatosis Cerebri ◽  
Human Virus ◽  
Mesial Temporal Lobe

: T2/FLAIR hyperintensity in the mesial temporal lobe is the most common MR finding of herpes simplex encephalitis but may be observed in other infectious and non-infectious diseases. The former includes herpes human virus 6 encephalitis, Japanese encephalitis, and neurosyphilis, and the latter autoimmune encephalitis, gliomatosis cerebri, bilateral or paradoxical posterior cerebral artery infarction, status epilepticus, and hippocampal sclerosis. Thus, T2/FLAIR hyperintensity in the mesial temporal lobe is not a disease-specific magnetic resonance imaging finding, and these conditions must be differentiated to ensure proper treatment. We review diseases that are presented with T2/FLAIR hyperintensity in the mesial temporal lobe and provide a helpful flow chart based on clinical and radiologic features.

Computed Tomographic Diagnosis of Ruptured Giant Posterior Cerebral Artery Aneurysms

Neurosurgery ◽  
1988 ◽  
Vol 22 (3) ◽  
pp. 553-558 ◽  
Author(s):  
LCDR Brett A. Scott ◽  
Zelig Weinstein ◽  
CDR Morris W. Pulliam
Keyword(s):  
Ct Scan ◽  
Temporal Lobe ◽  
Cerebral Artery ◽  
Posterior Cerebral Artery ◽  
Filling Defect ◽  
Intracerebral Hematoma ◽  
Intravenous Contrast ◽  
Diagnostic Features ◽  
Computed Tomographic ◽  
Diagnostic Ct

Abstract Ruptured giant posterior cerebral artery (PCA) aneurysms are encountered rarely. Although computed tomographic (CT) scan features of giant intracranial aneurysms have been described. CT scan features of acutely ruptured giant saccular PCA aneurysms have not been reported. A case of an acutely ruptured giant saccular PCA aneurysm with diagnostic CT scan features and autopsy confirmation is presented. Two additional cases of apoplexy with identical clinical courses and CT scan appearances, both attributed to giant saccular PCA aneurysms, are described. Diagnostic CT scan features included evidence of intraparenchymal temporal lobe and intraventricular hemorrhage, the presence of a filling defect in the temporal lobe hematoma that enhanced after intravenous contrast administration, and evidence of proximal PCA entrance into the contrast-enhanced filling defect in the intracerebral hematoma. The incidence of PCA aneurysms and the anatomy of the PCA as it relates to these giant aneurysms, their clinical presentation, and diagnostic features of the CT scan are discussed. (Neurosurgery 22:553-558, 1988)

Selective Posterior Cerebral Artery Amobarbital Test: Its Role in Presurgical Memory Assessment in Temporal Lobe Epilepsy

Epilepsia ◽  
2004 ◽  
Vol 45 (7) ◽  
pp. 817-825 ◽  
Author(s):  
Kirsten E. Stabell ◽  
Soren J. Bakke ◽  
Sverre Andresen ◽  
Helge Bjornaes ◽  
Hans M. Borchgrevink ◽  
...  
Keyword(s):  
Temporal Lobe Epilepsy ◽  
Temporal Lobe ◽  
Cerebral Artery ◽  
Posterior Cerebral Artery ◽  
Memory Assessment
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