Seizure outcome of surgical treatment of focal epilepsy associated with low-grade tumors in children

2013 ◽  
Vol 11 (2) ◽  
pp. 214-223 ◽  
Author(s):  
Micol Babini ◽  
Marco Giulioni ◽  
Ercole Galassi ◽  
Gianluca Marucci ◽  
Matteo Martinoni ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Focal Epilepsy ◽  
Class I ◽  
Seizure Outcome ◽  
Low Grade ◽  
Epileptogenic Zone ◽  
Group A ◽  
Children And Young Adults ◽  
Group B ◽  
Age Range

Object Low-grade tumor (LGT) is an increasingly recognized cause of focal epilepsies, particularly in children and young adults, and is frequently associated with cortical dysplasia. The optimal surgical treatment of epileptogenic LGTs in pediatric patients has not been fully established. Methods In the present study, the authors retrospectively reviewed 30 patients (age range 3–18 years) who underwent surgery for histopathologically confirmed LGTs, in which seizures were the only clinical manifestation. The patients were divided into 2 groups according to the type of surgical treatment: patients in Group A (20 cases) underwent only tumor removal (lesionectomy), whereas patients in Group B (11 cases) underwent removal of the tumor and the adjacent epileptogenic zone (tailored surgery). One of the patients, who underwent 2 operations, is included in both groups. Follow-up ranged from 1 to 17 years. Results Sixteen (80%) of 20 patients in Group A had an Engel Class I outcome. In this group, 3 of 4 patients who were in Engel Classes II and III had temporomesial lesions. All patients in Group B had temporomesial tumors and were seizure free (Engel Class I). In this series, in temporolateral and extratemporal tumor locations, lesionectomy yielded a good seizure outcome. In addition, a young age at seizure onset (in particular < 4 years) was associated with a poor seizure outcome. Conclusions Tailored resection in temporomesial LGTs was associated with excellent seizure outcome, indicating that an adequate presurgical evaluation including extensive neurophysiological evaluation (long-term videoelectroencephalography monitoring) to plan appropriate surgical strategy is advised.

Seizure outcome of epilepsy surgery in focal epilepsies associated with temporomesial glioneuronal tumors: lesionectomy compared with tailored resection

2009 ◽  
Vol 111 (6) ◽  
pp. 1275-1282 ◽  
Author(s):  
Marco Giulioni ◽  
Guido Rubboli ◽  
Gianluca Marucci ◽  
Matteo Martinoni ◽  
Lilia Volpi ◽  
...  
Keyword(s):  
Epilepsy Surgery ◽  
Seizure Outcome ◽  
Epileptogenic Zone ◽  
Patients Âgés ◽  
Group A ◽  
Group B ◽  
Postoperative Seizure ◽  
The Right ◽  
Glioneuronal Tumors

Object The authors retrospectively analyzed and compared seizure outcome in a series of 28 patients with temporomesial glioneuronal tumors associated with epilepsy who underwent 1 of 2 different epilepsy surgery procedures: lesionectomy or tailored resection. Methods The 28 patients were divided into 2 groups, with 14 cases in each group. In Group A, surgery was limited to the tumor (lesionectomy), whereas Group B patients underwent tailored resection involving removal of the tumor and the epileptogenic zone as identified by a neurophysiological noninvasive presurgical study. Results In Group A (10 male and 4 female patients) the interval between onset of seizures and surgery ranged from 1 to 33 years (mean 10.6 years). Patients' ages ranged from 3 to 61 years (mean 23.1 years). The epileptogenic lesion was on the left side in 6 patients and the right in 8 patients. Mean follow-up was 9.8 years (range 6.5–15 years). The Engel classification system, used to determine postoperative seizure outcome, showed 6 patients (42.8%) were Engel Class I and 8 (57.1%) were Engel Class II. In Group B (6 male and 8 female patients) the interval between onset of seizures and surgery ranged from 0.5 to 25 years (mean 8.6 years). Patients' ages ranged from 3 to 48 years (mean 22.3 years). The tumor and associated epileptogenic area was on the right side in 8 patients and the left in 6 patients. Mean follow-up duration was 3.5 years (range 1–6.5 years). Postoperative seizure outcome was Engel Class I in 13 patients (93%) and Engel Class II in 1 (7.1%). Conclusions The authors' results demonstrate a better seizure outcome for temporomesial glioneuronal tumors associated with epilepsy in patients who underwent tailored resection rather than simple lesionectomy (p = 0.005). For temporomesial glioneuronal tumors associated with epilepsy, performing a presurgical noninvasive neurophysiological study intended to identify the epileptogenic zone is necessary for planning a tailored surgery. Using this surgical strategy, the presence of temporomesial glioneuronal tumors constitutes a predictive factor of excellent seizure outcome, and therefore surgical treatment can be offered early to avoid both the consequences of uncontrolled seizures as well as the side effects of pharmacological therapy.

scholarly journals AS2-1 TREATMENT OF BENIGN INTRA-AXIAL BRAIN TUMORS IN CHILDREN ASSOCIATED WITH EPILEPSY

2019 ◽  
Vol 1 (Supplement_2) ◽  
pp. ii1-ii2
Author(s):  
Takeshi Matsuo
Keyword(s):  
Early Onset ◽  
Focal Epilepsy ◽  
Tumor Resection ◽  
Benign Tumors ◽  
Seizure Outcome ◽  
Low Grade ◽  
Epileptogenic Zone ◽  
Term Survival ◽  
Daily Lives ◽  
Epithelial Tumors

Abstract Low grade neuro-epithelial tumors presenting early-onset epilepsy as the major neurological symptom have recently been categorized as low-grade epilepsy-associated neuro-epithelial tumors, LEAT. Ganglioglioma and dysembryoplastic neuroepithelial tumors consist up to 60% of LEAT. Common characteristics of LEAT being early onset seizure, younger than the age of 15, and temporal lobe localization, its criteria do not include histological or genetic features; LEAT is an independent classification, unrelated to WHO classification. Treatment for epilepsy associated with LEAT includes medication and surgery. As for drug therapy, most tumor-related seizures are controlled well with anti-epileptic drugs for focal epilepsy such as sodium channel blocker. On the other hand, those who are drug-resistant are candidates for surgical therapy. Because epileptogenic zone mostly exists not in tumor itself but in the marginal brain tissue, pure tumor resection without resection of peripheral epileptogenic zone sometimes fails to achieve satisfactory seizure outcome. Concept of epilepsy surgery is indispensable in pre-operative evaluation and in planning surgical strategy. Related association fibers in addition to five zones, epileptogenic zone, seizure onset zone, irritative zone, symptomatogenic zone and functional deficit zone should be taken into consideration. Long-term survival is expected in children who underwent total resection of benign tumors. Therefore, good seizure control is crucial in improving activities of daily lives.

Simultaneous Frame-assisted Stereotactic Placement of Subdural Grid Electrodes and Intracerebral Depth Electrodes

2019 ◽  
Vol 80 (05) ◽  
pp. 353-358 ◽  
Author(s):  
Peter C. Reinacher ◽  
Dirk-Matthias Altenmüller ◽  
Marie T. Krüger ◽  
Andreas Schulze-Bonhage ◽  
Horst Urbach ◽  
...  
Keyword(s):  
Focal Epilepsy ◽  
Epileptogenic Zone ◽  
Drug Resistant ◽  
Surgical Time ◽  
Depth Electrodes ◽  
Group A ◽  
The Mean ◽  
Group B ◽  
Intracranial Electrodes ◽  
Complex Cases

Background and Study Aims In complex cases of drug-resistant focal epilepsy, the precise localization of the epileptogenic zone requires simultaneous implantation of depth and subdural grid electrodes. This study describes a new simple frame-assisted method that facilitates the simultaneous placement of both types of intracranial electrodes. Material and Methods Ten consecutive patients were evaluated and divided into two groups. Group A included patients with simultaneous frame-assisted placement of depth and subdural grid electrodes. In group B, depth electrodes were implanted stereotactically; grid electrodes were implanted in a separate surgery. Results The placement of the subdural grid was accurate as individually designed by the epileptologists in all five patients from group A. In group B, one patient showed a slight and another one a significant deviation of the subdural grid position postoperatively. The mean surgical time in group A was shorter (280±62 minutes) compared with the mean duration of the surgical procedures in group B (336±51 minutes). Conclusion The frame-assisted placement of subdural grid electrodes facilitates the surgical procedure for invasive video-electroencephalography monitoring in complex cases of drug-resistant focal epilepsy in which a combination of depth electrodes and subdural grid electrodes is needed, by reducing the surgical time and guaranteeing highly accurate electrode localizations.

scholarly journals Panoramic radiographs for investigating skeletal patternsA comparative study

2019 ◽  
Vol 4 (2) ◽  
pp. 66-78
Author(s):  
Taruna Puri ◽  
Keyword(s):  
Class I ◽  
Regression Equations ◽  
Linear Measurements ◽  
Lateral Cephalogram ◽  
Panoramic Radiographs ◽  
Lateral Cephalograms ◽  
Angular Measurements ◽  
Group A ◽  
Group B ◽  
Age Range

Introduction: The most commonly used diagnostic aids in orthodontics are lateral cephalograms and panoramic radiographs (OPG). The OPG forms an indispensible orthodontic screening tool in providing information about the teeth, their root length, axial inclinations, morphology and structure, eruption sequence and spatial relationships [1] which is mostly qualitative in nature. The purpose of this study was to evaluate whether the use of OPG could be extended for evaluating skeletal patterns and dentofacial characteristics which are routinely measured on lateral cephalograms. Materials and Methods: A total of 80 subjects were chosen, they were divided into two groups: Group A and Group B. Group A included 40 skeletal Class I, dental Class I adults with age range of 18-27 years. Group B included 40 skeletal ClassII, dental Class II Div 1 children with age range of 10 -15 years. The lateral cephalogram and OPG were taken under standard conditions using skeletal cephalostat and various parameters were measured and compared. Results and Conclusion: From this study it was concluded that angular measurements on OPG can be used to predict the corresponding angular measurements from the lateral cephalograms, both for the dental and skeletal parameters but the vertical linear measurements cannot be predicted accurately from OPG. The regression equations obtained from this study showed that the Go-Gn/S-N, ANS-PNS/Go-Me (palatal plane/mandibular plane), and Co-Go/Go-Me parameters could be predicted from OPG within statistically significant levels, and their predictability levels were 20.47%, 31.7%, and 10.88%, respectively for group A and 32.0%.22.08% and 52.36% respectively for group B.

scholarly journals The Impact of Lesional Factors on Seizure Outcome Following Lesionectomy as a Surgical Management of Extratemporal Epilepsy, Case Series from a Developing Country and Review of Literature.

2021 ◽  
Author(s):  
Amr Ali Hasanain ◽  
Mohamed Sawan ◽  
Ahmed Mohamed Ali
Keyword(s):  
Focal Epilepsy ◽  
Focal Lesion ◽  
Seizure Outcome ◽  
Seizure Freedom ◽  
Low Grade ◽  
Epileptogenic Zone ◽  
Seizure Semiology ◽  
Radiological Data ◽  
The Impact

Abstract BACKGROUNDExtratemporal lesional epilepsy can be managed with various surgical techniques such as simple lesionectomy or more extensive resections, all of which aim at targeting the epileptogenic zone which is the key for achieving a favorable outcome. This study aimed at evaluating the effectiveness of lesionectomy in the treatment of extra-temporal epilepsy associated with a lesion on radiological imaging, and to show the effect of lesional factors on seizure outcome including the anatomical location, the relation to cerebral parenchyma, the extent of surgical excision and the histopathological nature of the lesion.METHODSA prospective study on 20 patients presenting with focal epilepsy, or focal epilepsy with secondary generalized seizures with evidence of focal lesion in an extratemporal location on MRI. Lesionectomy was done and we used the Engel’s classification for seizure outcome.RESULTSLesions were mostly tumors (85 %). The frontal lobe is the most frequent locations (60 %). Low-grade glioma represented 35 % while meningioma represented 45 % of all lesions (both intra-axial and extra-axial). Four patients were lost during follow up (mean 23.31 months). For the remaining 16 patients, 13 cases were tumors (81.25%). Lesionectomy achieved seizure freedom in 68.75 %.CONCLUSIONSIn a country with limited resources, lesionectomy is a valid technique for epilepsy surgery as long as the radiological data and the seizure semiology are concordant. Total lesionectomy provides good seizure control when the clinical and radiological data are concordant with seizure semiology, in particular with tumor-related epilepsy. A study comparing postoperative seizure outcome between intra-axial and extra-axial lesions on a larger scale and with a longer follow up period is recommended.

scholarly journals Surgical Treatment of Epilepsy in Pediatric Patients

2000 ◽  
Vol 27 (2) ◽  
pp. 106-110 ◽  
Author(s):  
Elaine Wyllie
Keyword(s):  
Pediatric Patients ◽  
Focal Epilepsy ◽  
Hippocampal Sclerosis ◽  
Intractable Epilepsy ◽  
Postoperative Outcome ◽  
Seizure Outcome ◽  
Low Grade ◽  
Epileptogenic Zone ◽  
Developmental Issues ◽  
Relative Risks

ABSTRACT:Surgery has become an accepted treatment modality for carefully selected adults with intractable focal epilepsy. More recently, increasing numbers of pediatric patients with intractable epilepsy are also being referred for surgical consideration. Key elements of surgical candidacy include medically intractable focal epilepsy, a localized epileptogenic zone, and a low risk for new postoperative neurologic deficits. The most common etiologies of the epilepsies in pediatric surgical candidates are malformation of cortical development and low grade tumor but some patients with childhood onset temporal lobe epilepsy due to hippocampal sclerosis also present for early surgery. Based on results from several recent pediatric surgical series, the chance for favorable seizure outcome after surgery is not adversely affected by young age, with seizure-free postoperative outcome reported for 60% to 65% of infants, 59% to 67% of children, and 69% of adolescents, compared to 64% reported in a large, predominantly adult series. Some subgroups of patients have higher percentages of seizure-free outcome, including those with hippocampal sclerosis or low grade tumor. In addition to seizures, developmental issues are also a major concern in children with intractable epilepsy. Few quantitative data are available, but some anecdotal experience suggests that surgical relief of catastrophic epilepsy may result in resumption of developmental progression after surgery, although the rate of development often remains abnormal. In one series, best developmental outcomes were seen in patients with earliest surgery and highest level of preoperative development. For each patient, the timing of surgery must be carefully considered, based on a full assessment of the relative risks and benefits, derived from a detailed presurgical evaluation.

Lesionectomy versus electrophysiologically guided resection for temporal lobe tumors manifesting with complex partial seizures

1995 ◽  
Vol 83 (2) ◽  
pp. 231-236 ◽  
Author(s):  
Rashid Jooma ◽  
Hwa-shain Yeh ◽  
Michael D. Privitera ◽  
Maureen Gartner
Keyword(s):  
Surgical Treatment ◽  
Temporal Lobe ◽  
Analysis Of Covariance ◽  
Temporal Lobectomy ◽  
Epileptogenic Zone ◽  
Partial Seizures ◽  
Complex Partial Seizures ◽  
Group A ◽  
Group B

✓ Complex partial seizures associated with tumors and other mass lesions are readily diagnosed by modern imaging techniques but their optimum surgical treatment remains unresolved. Lesionectomy has been reported to produce seizure outcomes equal to outcomes after resection that ablates the epileptogenic cortex with the lesion. However, some evidence suggests that when the lesion is in the temporal lobe, simple excision of the tumor or lesion more often fails to control seizures. After retrospectively reviewing the records of 30 patients with complex partial seizures and temporal lobe tumors who underwent surgical treatment at the University of Cincinnati hospitals (1985–1992), the authors divided them into two groups: Group A (16 patients) underwent lesionectomy only and Group B (14 patients) received surgical treatment for seizures with electroencephalographic delineation of the epileptogenic zone and resection of the lesion. Seizure control was best achieved in Group B patients with 13 (92.8%) seizure free at follow up (mean 52 months). Only three (18.8%) of the Group A patients became seizure free after lesionectomy at follow up (mean 33 months). In eight Group A patients, who underwent temporal lobectomy as a second procedure after lesionectomy failed to control seizures, five (62.5%) became seizure free. Group B patients had a longer duration of seizures and were more likely to have lesions smaller than 2.5 cm compared with Group A. Analysis of covariance demonstrated that the differences in outcome between the groups remained significant even with adjustment for the variation in duration of seizures (p = 0.0006) and size of tumor (p = 0.0001). Based on this study, the authors found that the probable relief from seizures caused by a temporal lobe lesion is greater if the region of epileptogenicity, usually the amygdalohippocampal complex, is resected along with the tumor in a temporal lobectomy.

Study the Relationship Between Estrogen Hormone and Calcium in Normal Females Before and After Menopause in Baghdad / Iraq

2018 ◽  
Vol 2 (1) ◽  
Author(s):  
Sameerah Mustafa ◽  
Asal Tawfeeq ◽  
Hadeel Hasan
Keyword(s):  
Oral Contraceptive ◽  
Healthy Controls ◽  
Serum Samples ◽  
Oral Contraceptive Pills ◽  
Contraceptive Pills ◽  
Menopausal Women ◽  
Before And After ◽  
Group A ◽  
Group B ◽  
Age Range

This study involved the collection of (90) samples of women serum which included (30) serum samples collected from women before menopause (reproductive women) in the age range of (22-43) years and were considered as (group A- control). While, (group B) included (30) serum samples collected from women using oral contraceptive pills between the ages of (22-43) years old. Whereas, another (30) serum samples were collected from women after menopause between the ages of (43-54) years and were considered as (group C). All of the collected serum samples were subjected to a number of serological and chemical tests for the measurement of (E2, HDL, LDL and Ca). Then, the obtained data were statistical analyzed and results showed a significant decrease (p˂ 0.05) in (E2 ,Ca and HDL) levels in menopausal women compared to that of the normal healthy controls. While, there were non-significant decrease (p> 0.05) in (E2, Ca and HDL) levels in women taking oral contraceptive when compared to the normal healthy controls. On the other hand, a significant increase (p˂ 0.05) was recorded in LDL level in menopausal women compared to that of the normal healthy controls whereas, no-significant increase (p˃ 0.05) in the LDL level in women taking oral contraceptives when compared to the control women.

scholarly journals Re-operation rate after surgical treatment of osteochondral lesions of the talus in paediatric and adolescent patients

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Daniel Körner ◽  
Christoph E. Gonser ◽  
Stefan Döbele ◽  
Christian Konrads ◽  
Fabian Springer ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Bone Grafting ◽  
Cartilage Damage ◽  
Osteochondral Lesions ◽  
Retrograde Drilling ◽  
Autologous Bone Grafting ◽  
Operation Rate ◽  
Group A ◽  
Autologous Bone ◽  
Group B

Abstract Background The aim of this study is to analyse the re-operation rate after surgical treatment of osteochondral lesions of the talus (OCLTs) in children and adolescents. Methods Between 2009 and 2019, 27 consecutive patients with a solitary OCLT (10 male, 17 female; mean age 16.9 ± 2.2 years; 8 idiopathic vs. 19 traumatic) received primary operative treatment (arthroscopy + bone marrow stimulation [BMS], n = 8; arthroscopy + retrograde drilling, n = 8; autologous chondrocyte implantation [ACI]/autologous bone grafting, n = 9; arthroscopy + BMS + retrograde drilling; n = 1; flake fixation, n = 1). Seventeen OCLTs were located at the medial and ten at the lateral talus. ‘Re-operation’ as the outcome measure was evaluated after a median follow-up of 42 months (range 6–117 months). Patients were further subdivided into groups A (re-operation, n = 7) and B (no re-operation, n = 20). Groups A and B were compared with respect to epidemiological, lesion- and therapy-related variables. Results Seven of 27 patients needed a re-operation (re-operation rate 25.9% after a median interval of 31 months [range 13–61 months]). The following operative techniques were initially used in these seven patients: arthroscopy + BMS n = 2, arthroscopy + retrograde drilling n = 4, ACI + autologous bone grafting n = 1. A comparison of group A with group B revealed different OCLT characteristics between both groups. The intraoperative findings according to the International Cartilage Repair Society (ICRS) classification revealed significantly more advanced cartilage damage in group B than in group A (p = 0.001). Conclusions We detected a re-operation rate of 25.9% after primary surgical OCLT treatment. Patients with re-operation had significantly lower ICRS classification stages compared to patients without re-operation.

scholarly journals Influence of Ulnar Bow Sign on Surgical Treatment of Missed Bado Type I Monteggia Fracture in Children

2020 ◽  
Author(s):  
Shijie Liao ◽  
Tiantian Wang ◽  
Qian Huang ◽  
Yun Liu ◽  
Rongbin Lu ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Radial Head ◽  
Monteggia Fracture ◽  
Type I ◽  
Ulnar Osteotomy ◽  
Group A ◽  
The Mean ◽  
Group B ◽  
Stable Reduction

Abstract PurposeThe present study aimed to explore the influence of ulnar bow on the surgical treatment of Bado type I missed Monteggia fracture in children.MethodsThis study is a retrospective review of 24 patients between November 2010 and March 2019. All patients were treated with open reduction of the radial head and ulnar opening wedge osteotomy without annular ligament reconstruction. The mean interval between injury onset and surgery was five months (range: 2–12 months). The average age of participants at the time of surgery was 6.4 years (range: 3–10 years). We evaluated the maximum ulnar bow (MUB) and MUB position (P-MUB) via radiography. The patients were divided into middle group (group A: 14 cases, MUB located at 40% to 60% of the distal ulna) and distal group (group B: 10 cases, MUB located at 20% to 40% from the distal end of the ulna) based on P-MUB. The mean period of follow-up was 37 months (range: 6–102 months).ResultsAt the last follow-up, all the children showed stable reduction of the radial head, and the flexion function of elbow joint improved after operation (P<0.05). Group A presented a larger the ratio of maximum ulnar bow(R-MUB) and angle of ulnar osteotomy(OA) than group B (P<0.05). There was statistically significant difference between group A and Group B in the P-MUB (P < 0.05). The osteotomy angle was positively correlated with the R-MUB (R2 =0.497,P=0.013), The osteotomy angle was positively correlated with the P-MUB (R2=0.731,P=0.000), The R-MUB is proportional to the P-MUB (R2 =0.597,P=0.002). The regression equation of P-MUB and osteotomy angle: Angle=7.064+33.227* P-MUB (R2=0.459, P =0.000).ConclusionWhen the ulnar bow is positioned at the middle ulna, a stable reduction of radial head need to be achieved through a larger angle in the ulnar osteotomy. If the position of maximum ulnar bow (P-MUB) is closer to the middle of the ulna or the ratio of maximum ulnar bow (R-MUB) is larger, the osteotomy angle is larger.

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