Epilepsy Surgery of the Cingulate Gyrus and the Frontomesial Cortex

Neurosurgery ◽  
2011 ◽  
Vol 70 (4) ◽  
pp. 900-910 ◽  
Author(s):  
Marec von Lehe ◽  
Jan Wagner ◽  
Joerg Wellmer ◽  
Hans Clusmann ◽  
Thomas Kral
Keyword(s):  
Epilepsy Surgery ◽  
Supplementary Motor Area ◽  
Focal Epilepsy ◽  
Case Reports ◽  
Motor Area ◽  
Seizure Outcome ◽  
Cingulate Gyrus ◽  
Long Term Follow Up ◽  
Magnetic Resonance Imaging Mri

Abstract BACKGROUND: Epilepsy surgery involving the cingulate gyrus has been mostly presented as case reports, and larger series with long-term follow-up are not published yet. OBJECTIVE: To report our experience with focal epilepsy arising from the cingulate gyrus and surrounding structures and its surgical treatment. METHODS: Twenty-two patients (mean age, 36; range, 12–63) with a mean seizure history of 23 years (range, 2–52) were retrospectively analyzed. We report presurgical diagnostics, surgical strategy, and postoperative follow-up concerning functional morbidity and seizures (mean follow-up, 86 months; range, 25–174). RESULTS: Nineteen patients showed potential epileptogenic lesions on preoperative magnetic resonance imaging (MRI). All patients had noninvasive presurgical workup; 15 (68%) underwent invasive Video-electroencephalogram (EEG)-Monitoring. In 12 patients we performed extended lesionectomy according to MRI; an extension with regard to EEG results was done in 6 patients. In 4 patients, the resection was incomplete because of the involvement of eloquent areas according to functional mapping results. Eight pure cingulate resections (36%, 3 in the posterior cingulate gyrus) and 14 extended supracingular frontal resections were performed. Nine patients experienced temporary postoperative supplementary motor area syndrome after resection in the superior frontal gyrus. Two patients retained a persistent mild hand or leg paresis, respectively. Postoperatively, 62% of patients were seizure-free (International League Against Epilepsy [ILAE] 1), and 76% had a satisfactory seizure outcome (ILAE 1–3). CONCLUSION: Epilepsy surgery for lesions involving the cingulate gyrus represents a small fraction of all epilepsy surgery cases, with good seizure outcome and low rates of postoperative permanent deficits. In case of extended supracingular resection, supplementary motor area syndrome should be considered.

scholarly journals Factors predicting 10-year seizure freedom after temporal lobe resection

2020 ◽  
Vol 33 (1) ◽  
pp. 50-61 ◽  
Author(s):  
Friedhelm C. Schmitt ◽  
H.‑Joachim Meencke
Keyword(s):  
Temporal Lobe ◽  
Epilepsy Surgery ◽  
Univariate Analysis ◽  
Class I ◽  
Seizure Outcome ◽  
Seizure Freedom ◽  
Patient Counseling ◽  
Long Term Follow Up

Abstract Background Resective surgery is an established and evidence-based treatment approach in pharmacoresistant temporal lobe epilepsy (TLE). Extra-long-term follow-up data are important to allow for good patient counseling. So far, only few trials provide prospective or retrospective data exceeding 5 years. Objective This study aimed to present data of continuous seizure outcome over an extended time period, with a particular focus on patients who remained seizure free for 10 years. Methods We analyzed seizure outcome after epilepsy surgery for TLE in 46 consecutive patients, who were seen on an annual basis for 10 years in a single center (Epilepsy Center Berlin Brandenburg). Factors for remaining seizure free for 10 years were determined by univariate analysis. Results The class I outcome changed each year by 74–78%. Of the patients, 63% remained continuously in Engel class I (48% Engel Class IA for 10 years) for 10 years. Six patients were never seizure free (12.5%). After 10 years, 35% of the patients were cured (i.e., seizure-free without medication). A higher number of antiepileptic drugs and seizures before surgery as well as the indication for invasive presurgical monitoring were associated with “unsuccessful surgery.” Conclusion With almost half of the patients completely seizure free and more than a third “cured,” epilepsy surgery remains the mainstay of therapy for TLE patients. Analysis in larger cohorts with extra-long-term follow-up is needed to assess good prognostic factors and other postsurgical outcome issues such as neuropsychological, psychiatric, and psychosocial outcomes.

scholarly journals Cingulate gyrus epilepsy: semiology, invasive EEG, and surgical approaches

2020 ◽  
Vol 48 (4) ◽  
pp. E8 ◽  
Author(s):  
Chien-Chen Chou ◽  
Cheng-Chia Lee ◽  
Chun-Fu Lin ◽  
Yi-Hsiu Chen ◽  
Syu-Jyun Peng ◽  
...  
Keyword(s):  
Focal Epilepsy ◽  
Focal Cortical Dysplasia ◽  
Surgical Approaches ◽  
Seizure Outcome ◽  
Cingulate Gyrus ◽  
Scalp Eeg ◽  
3D Electrodes ◽  
History Of ◽  
Epileptogenic Foci

OBJECTIVEThe semiology of cingulate gyrus epilepsy is varied and may involve the paracentral area, the adjacent limbic system, and/or the orbitofrontal gyrus. Invasive electroencephalography (iEEG) recording is usually required for patients with deeply located epileptogenic foci. This paper reports on the authors’ experiences in the diagnosis and surgical treatment of patients with focal epilepsy originating in the cingulate gyrus.METHODSEighteen patients (median age 24 years, range 5–53 years) with a mean seizure history of 23 years (range 2–32 years) were analyzed retrospectively. The results of presurgical evaluation, surgical strategy, and postoperative pathology are reported, as well as follow-up concerning functional morbidity and seizures (median follow-up 7 years, range 2–12 years).RESULTSPatients with cingulate gyrus epilepsy presented with a variety of semiologies and scalp EEG patterns. Prior to ictal onset, 11 (61%) of the patients presented with aura. Initial ictal symptoms included limb posturing in 12 (67%), vocalization in 5, and hypermotor movement in 4. In most patients (n = 16, 89%), ictal EEG presented as widespread patterns with bilateral hemispheric origin, as well as muscle artifacts obscuring the onset of EEG during the ictal period in 11 patients. Among the 18 patients who underwent resection, the pathology revealed mild malformation of cortical development in 2, focal cortical dysplasia (FCD) Ib in 4, FCD IIa in 4, FCD IIb in 4, astrocytoma in 1, ganglioglioma in 1, and gliosis in 2. The seizure outcome after surgery was satisfactory: Engel class IA in 12 patients, IIB in 3, IIIA in 1, IIIB in 1, and IVB in 1 at the 2-year follow-up.CONCLUSIONSIn this study, the authors exploited the improved access to the cingulate epileptogenic network made possible by the use of 3D electrodes implanted using stereoelectroencephalography methodology. Under iEEG recording and intraoperative neuromonitoring, epilepsy surgery on lesions in the cingulate gyrus can result in good outcomes in terms of seizure recurrence and the incidence of postoperative permanent deficits.

scholarly journals Fibromuscular dysplasia with recurrence after “long-term” following percutaneous transcatheter renal angioplasty: two case reports with a review of 26 patients

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Shuntaro Oribe ◽  
Takafumi Toyohara ◽  
Eikan Mishima ◽  
Takehiro Suzuki ◽  
Koichi Kikuchi ◽  
...  
Keyword(s):  
Fibromuscular Dysplasia ◽  
Age Of Onset ◽  
Case Reports ◽  
Case Presentation ◽  
Renal Angioplasty ◽  
Long Term Follow Up ◽  
Percutaneous Transluminal Renal Angioplasty ◽  
The Difference

Abstract Background Fibromuscular dysplasia (FMD) often causes renal artery stenosis with renovascular hypertension. Recent clinical outcomes encourage percutaneous transluminal renal angioplasty (PTRA) to treat FMD; however, the necessary follow-up period remains unclear. Moreover, previous studies have not revealed the difference in the period until recurrence between two major types of FMD—multifocal and focal. Case presentation We describe two patients with multifocal FMD who developed hypertension during their teenage years and had recurrence of FMD > 10 years after PTRA. We further examined the types of FMD and age of onset in 26 patients who underwent PTRA. The period until recurrence of multifocal FMD was longer than that of focal FMD. Moreover, patients with early-onset multifocal FMD are likely to have a delayed recurrence after PTRA compared to other types. Conclusions Our report suggests that patients with multifocal FMD, especially those with onset at an early age, may need long-term follow-up for at least ≥ 10 years.

Long-Term Follow-Up after Radiotherapy of Hidradenitis Suppurativa

Dermatology ◽  
2021 ◽  
pp. 1-7
Author(s):  
Jurr Boer
Keyword(s):  
Total Dose ◽  
Hidradenitis Suppurativa ◽  
Early Stage ◽  
Case Reports ◽  
Case Series ◽  
Postal Survey ◽  
Long Term Follow Up ◽  
Late Treatment

<b><i>Background:</i></b> Patients with hidradenitis suppurativa (HS) are still often disappointed with the current treatments offered and there is a clear demand for more effective options. Since the late 1990s there has been a revival in the use of radiotherapy (RT) for different benign diseases, including HS. During the past 20 years one case series and some scattered case reports have described promising results of RT. <b><i>Objectives:</i></b> To evaluate the long-term efficacy of RT in early-stage HS. <b><i>Methods:</i></b> A postal survey-based long-term follow-up with simple factual questions of partly retrospective and partly contemporary characteristics was performed. Sixty-four patients (96 axillae), diagnosed with mild to moderate HS were irradiated with a orthovoltage unit with 100 kV, 3 mm Al or 200 kV, 0.5 Cu filtering, respectively. Four to six biweekly fractional doses ranging from 0.75 to 1 Gy up to a total dose of 6 Gy in one series, and in chronic cases followed by four daily fractions of 2 Gy up to a total dose of 14 Gy, were given. Late treatment toxicity and the rate of remission of the disease were evaluated. <b><i>Results:</i></b> The overall response rate of the survey was 64.1% with 40.6% (26/64) valid, complete questionnaires. In total, 40 axillae were irradiated in these 26 patients. After a median follow-up of 40 years (range 32–52) complete remission of the lesions occurred in 34 of the 40 sites (85%). None of the 26 patients with 40 irradiated sites reported adverse effects at the time of the survey. <b><i>Conclusions:</i></b> RT appears to be an effective treatment for early and mild HS in the majority of patients. In this case series, no side effects were reported after a median follow-up period of 40 years.

54. Long term surgical results in supplementary motor area epilepsy surgery

2016 ◽  
Vol 127 (9) ◽  
pp. e315 ◽  
Author(s):  
Mario A. Alonso-Vanegas ◽  
Ricardo M. Buentello Garcia ◽  
Carlos Castillo-Montoya ◽  
Daniel San-Juan ◽  
Horacio Senties-Madrid ◽  
...  
Keyword(s):  
Epilepsy Surgery ◽  
Supplementary Motor Area ◽  
Motor Area ◽  
Surgical Results

scholarly journals Bone marrow abnormalities detected by magnetic resonance imaging as initial sign of hematologic malignancies

2018 ◽  
Author(s):  
Ida Sofie Grønningsæter ◽  
Aymen Bushra Ahmed ◽  
Nils Vetti ◽  
Silje Johansen ◽  
Øystein Bruserud ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Bone Marrow ◽  
Magnetic Resonance ◽  
Case Reports ◽  
Cell Types ◽  
Hematologic Malignancies ◽  
Resonance Imaging ◽  
Initial Sign ◽  
Magnetic Resonance Imaging Mri

The increasing use of radiological examination, especially magnetic resonance imaging (MRI), will probably increase the risk of unintended discovery of bone marrow abnormalities in patients where a hematologic disease would not be expected. In this paper we present four patients with different hematologic malignancies of nonplasma cell types. In all patients the MRI bone marrow abnormalities represent an initial presentation of the disease. These case reports illustrate the importance of a careful diagnostic follow-up without delay of patients with MRI bone marrow abnormalities, because such abnormalities can represent the first sign of both acute promyelocytic leukemia as well as other variants of acute leukemia.

Therapeutic Hypothermia in Brazil: A MultiProfessional National Survey

2018 ◽  
Vol 36 (11) ◽  
pp. 1150-1156 ◽  
Author(s):  
G. F. Variane ◽  
L. M. Cunha ◽  
P. Pinto ◽  
P. Brandao ◽  
R. S. Mascaretti ◽  
...  
Keyword(s):  
Therapeutic Hypothermia ◽  
National Survey ◽  
Health Care Professionals ◽  
Brain Magnetic Resonance Imaging ◽  
Significant Heterogeneity ◽  
Online Questionnaire ◽  
Cross Sectional ◽  
Long Term Follow Up ◽  
Magnetic Resonance Imaging Mri

Objective To determine the rate of therapeutic hypothermia (TH) use, current practices, and long-term follow-up. Study Design Prospective cross-sectional national survey with 19 questions related to the assessment of hypoxic–ischemic encephalopathy (HIE) and TH practices. An online questionnaire was made available to health care professionals working in neonatal care in Brazil. Results A total of 1,092 professionals replied, of which 681 (62%) reported using TH in their units. Of these, 624 (92%) provided TH practices details: 136 (20%) did not use any neurologic score or amplitude-integrated electroencephalogram (aEEG) to assess encephalopathy and 81(13%) did not answer this question. Any specific training for encephalopathy assessment was provided to only 81/407 (19%) professionals. Infants with mild HIE are cooled according to 184 (29%) of the respondents. Significant variations in practice were noticed concerning time of initiation and cooling methods, site of temperature measurements and monitoring, and access to aEEG, electroencephalogram (EEG), and neurology consultation. Only 19% could perform a brain magnetic resonance imaging (MRI), and 31% reported having a well-established follow-up program for these infants. Conclusion TH has been implemented in Brazil but with significant heterogeneity for most aspects of hypothermia practices, which may affect safety or efficacy of the therapy. A step forward toward quality improvement is important.

scholarly journals The proportion of seizure onset zone contacts resected is not associated with outcome following SEEG-guided resective epilepsy surgery in children

2021 ◽  
Author(s):  
Mehdi Khan ◽  
Aswin Chari ◽  
Kiran Seunarine ◽  
Christin Eltze ◽  
Friederike Moeller ◽  
...  
Keyword(s):  
Epilepsy Surgery ◽  
Univariate Analysis ◽  
Seizure Outcome ◽  
Epileptogenic Zone ◽  
Imaging Data ◽  
Seizure Onset ◽  
Binary Logistic Regression Model ◽  
Primary Analysis ◽  
Seizure Onset Zone

AbstractPurposeChildren undergoing stereoelectroencephalography (SEEG)-guided epilepsy surgery represent a complex cohort. We aimed to determine whether the proportion of putative seizure onset zone (SOZ) contacts resected associates with seizure outcome in a cohort of children undergoing SEEG-guided resective epilepsy surgery.MethodsPatients who underwent SEEG-guided resective surgery over a six-year period were included. The proportion of SOZ contacts resected was determined by co-registration of pre- and post-operative imaging. Seizure outcomes were classified as seizure free (SF, Engel class I) or not seizure-free (NSF, Engel class II-IV) at last clinical follow-up.ResultsOf 94 patients undergoing SEEG, 29 underwent subsequent focal resection of whom 22 had sufficient imaging data to be included in the primary analysis (median age at surgery of 10 years, range 5-18). Fifteen (68.2%) were SF and 7 (31.8%) NSF at median follow-up of 19.5 months (range 12-46). On univariate analysis, histopathology, was the only significant factor associated with SF (p<0.05). The percentage of defined SOZ contacts resected ranged from 25-100% and was not associated with SF (p=0.89). In a binary logistic regression model, it was highly likely that histology was the only independent predictor of outcome, although the interpretation was limited by pseudo-complete separation of the data.ConclusionHistopathology is a significant predictor of surgical outcomes in children undergoing SEEG-guided resective epilepsy surgery. The percentage of SOZ contacts resected was not associated with SF. Factors such as spatial organisation of the epileptogenic zone, neurophysiological biomarkers and the prospective identification of pathological tissue may therefore play an important role.

scholarly journals Outline and effect of splint therapy—2nd report Long-term follow-up and case reports

2015 ◽  
Vol 35 (3) ◽  
pp. 174-184
Author(s):  
Naoya Tachibana ◽  
Erika Tachibana
Keyword(s):  
Case Reports ◽  
Splint Therapy ◽  
Long Term Follow Up

Vertical Bone Growth after Autotransplantation of Mature Third Molars: 2 Case Reports with Long-term Follow-up

2015 ◽  
Vol 41 (8) ◽  
pp. 1371-1374 ◽  
Author(s):  
Sunil Kim ◽  
Seung-Jong Lee ◽  
Yooseok Shin ◽  
Euiseong Kim
Keyword(s):  
Bone Growth ◽  
Case Reports ◽  
Third Molars ◽  
Long Term Follow Up
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