Resective surgery for medically intractable epilepsy associated with schizencephaly

1994 ◽  
Vol 80 (5) ◽  
pp. 820-825 ◽  
Author(s):  
Daniel L. Silbergeld ◽  
John W. Miller
Keyword(s):  
Temporal Lobe ◽  
Intractable Epilepsy ◽  
The Other ◽  
Temporal Lobectomy ◽  
Eeg Monitoring ◽  
Resonance Imaging ◽  
Ipsilateral Hemisphere ◽  
Content Type ◽  
Intracranial Electrodes ◽  
Fine Print

✓ Four adults with unilateral (three cases) or bilateral (one case) closed schizencephaly, medically intractable epilepsy, and otherwise normal neurological examinations are presented. Three were examined preoperatively with magnetic resonance imaging and one with computerized tomography. Scalp electroencephalographic (EEG) studies in all four patients and electrocorticography via intracranial electrodes in two showed seizure origin in the cleft regions in two patients and in the ipsilateral temporal lobe in the other two. Temporal lobectomy was performed in the two patients with temporal lobe foci. Resection of superficial pachygyria around the cleft was performed in one patient. The authors conclude that the abnormal cortical mantle lining schizencephalic clefts may be epileptogenic. Alternatively, temporal allocortex may become the source of seizures. Therefore, these patients require careful EEG monitoring of the entire ipsilateral hemisphere as well as the cleft region.

Preserved musical abilities following right temporal lobectomy

1996 ◽  
Vol 85 (6) ◽  
pp. 1000-1004 ◽  
Author(s):  
Atsushi Koike ◽  
Hiroyuki Shimizu ◽  
Ichiro Suzuki ◽  
Buichi Ishijima ◽  
Morihiro Sugishita
Keyword(s):  
Standard Deviation ◽  
Temporal Lobe ◽  
Intractable Epilepsy ◽  
Sylvian Fissure ◽  
Temporal Lobectomy ◽  
Content Type ◽  
Before And After ◽  
The Right ◽  
Lines Of Evidence ◽  
Fine Print

✓ It has been widely accepted that the right temporal lobe plays a major role in the processing of music. One of the main lines of evidence was derived from Milner's study, published in 1962, which reported that right temporal lobectomy led to a decline in patient scores on four of the six subtests (Tonal Memory, Timbre, Loudness, and Time subtests) of the Seashore Measures of Musical Talents. That finding had led some surgeons and patients to hesitate in choosing right temporal lobectomy as a treatment for intractable epilepsy. The authors examined performance on the Seashore Measures before and after operations in 20 patients with right temporal lobectomy and nine patients with left temporal lobectomy. No disturbances in the Seashore Measures were detected after temporal lobectomy on either side. The extent of these temporal lobectomies was smaller than that of the temporal lobectomies in Milner's study, as measured along the sylvian fissure (1.5–4 cm; mean 2.7 cm, standard deviation (SD) 0.92 cm) and the base of the temporal lobe (3.5–5.5 cm; mean 4.7 cm, SD 0.63 cm). These findings indicate that the region resected on right temporal lobectomy in the present study is not essential for basic musical processing.

Significance of surgery for temporal lobe epilepsy in childhood and adolescence

1970 ◽  
Vol 33 (3) ◽  
pp. 233-252 ◽  
Author(s):  
Murray A. Falconer
Keyword(s):  
Temporal Lobe Epilepsy ◽  
Temporal Lobe ◽  
Temporal Lobectomy ◽  
Mesial Temporal Sclerosis ◽  
Childhood And Adolescence ◽  
Content Type ◽  
Pathological Lesion ◽  
Fine Print

✓ The problem of childhood temporal lobe epilepsy is reviewed and illustrated from three cases in which the patients were freed from fits by temporal lobectomy. The pathological lesion (mesial temporal sclerosis) is discussed and the likelihood that many adult cases have gone unrecognized in childhood is emphasized.

Preoperative predictors of anterior temporal language areas

1998 ◽  
Vol 89 (6) ◽  
pp. 962-970 ◽  
Author(s):  
Theodore H. Schwartz ◽  
Orrin Devinsky ◽  
Werner Doyle ◽  
Kenneth Perrine
Keyword(s):  
Temporal Lobe ◽  
Right Hemisphere ◽  
Temporal Lobectomy ◽  
Seizure Onset ◽  
Anterior Temporal Lobe ◽  
Verbal Iq ◽  
Content Type ◽  
Language Areas ◽  
Fine Print

Object. Although it is known that 5 to 10% of patients have language areas anterior to the rolandic cortex, many surgeons still perform standard anterior temporal lobectomies for epilepsy of mesial onset and report minimal long-term dysphasia. The authors examined the importance of language mapping before anterior temporal lobectomy. Methods. The authors mapped naming, reading, and speech arrest in a series of 67 patients via stimulation of long-term implanted subdural grids before resective epilepsy surgery and correlated the presence of language areas in the anterior temporal lobe with preoperative demographic and neuropsychometric data. Naming (p < 0.03) and reading (p < 0.05) errors were more common than speech arrest in patients undergoing surgery in the anterior temporal lobe. In the approximate region of a standard anterior temporal lobectomy, including 2.5 cm of the superior temporal gyrus and 4.5 cm of both the middle and inferior temporal gyrus, the authors identified language areas in 14.5% of patients tested. Between 1.5 and 3.5 cm from the temporal tip, patients who had seizure onset before 6 years of age had more naming (p < 0.02) and reading (p < 0.01) areas than those in whom seizure onset occurred after age 6 years. Patients with a verbal intelligence quotient (IQ) lower than 90 had more naming (p < 0.05) and reading (p < 0.02) areas than those with an IQ higher than 90. Finally, patients who were either left handed or right hemisphere memory dominant had more naming (p < 0.05) and reading (p < 0.02) areas than right-handed patients with bilateral or left hemisphere memory lateralization. Postoperative neuropsychometric testing showed a trend toward a greater decline in naming ability in patients who were least likely to have anterior language areas, that is, those with higher verbal IQ and later seizure onset. Conclusions. Preoperative identification of markers of left hemisphere damage, such as early seizure onset, poor verbal IQ, left handedness, and right hemisphere memory dominance should alert neurosurgeons to the possibility of encountering essential language areas in the anterior temporal lobe (1.5–3.5 cm from the temporal tip). Naming and reading tasks are required to identify these areas. Whether removal of these areas necessarily induces long-term impairment in verbal abilities is unknown; however, in patients with a low verbal IQ and early seizure onset, these areas appear to be less critical for language processing.

Surgical management of epilepsy using epidural recordings to localize the seizure focus

1984 ◽  
Vol 60 (3) ◽  
pp. 457-466 ◽  
Author(s):  
Sidney Goldring ◽  
Erik M. Gregorie
Keyword(s):  
Temporal Lobe ◽  
Focal Epilepsy ◽  
Temporal Lobectomy ◽  
Epileptogenic Focus ◽  
Electrode Arrays ◽  
Content Type ◽  
Seizure Focus ◽  
Depth Electrodes ◽  
Sensory Evoked ◽  
Fine Print

✓ One hundred patients with focal epilepsy (44 were children) were evaluated with extraoperative electrocorticography via epidural electrode arrays. Localization of the epileptogenic focus was derived predominantly from recordings made during spontaneously occurring seizures. All resection procedures were carried out under general anesthesia. During anesthesia, the recording of sensory evoked responses made it possible to readily identify the sensorimotor region. Of the 100 patients, 72 underwent resection of an epileptogenic focus, and 33 of these were children. Those who did not have a resection either exhibited a diffuse seizure focus, failed to show an electrical seizure discharge in association with the clinical seizure, failed to have a seizure during the period of monitoring, or failed to exhibit conclusive changes for identifying a focus in the interictal record. Fifty-seven patients (29 children and 28 adults) who had a resection have been followed for between 1 and 12 years. Eighteen (62%) of the 29 children and 18 (64%) of the 28 adults enjoyed a good result. Twenty of the 100 patients reported here had temporal lobe epilepsy. They were candidates for recordings with depth electrodes to identify their focus, but they were evaluated instead with epidural recordings; the method is described. In 15 of them, a unilateral focus was identified and they underwent an anterior temporal lobectomy. Pathological changes were found in every case and, in 11 patients, the epidural recordings distinguished between a medial and a lateral focus. Ten of these patients have been followed for 9 months to 3½ years, and seven have had a good result. The observations suggest that epidural electrodes may be used in lieu of depth electrodes for identifying the symptomatic temporal lobe.

Intrachiasmatic craniopharyngioma: a rare cause of chiasmal thickening

1988 ◽  
Vol 68 (2) ◽  
pp. 300-302 ◽  
Author(s):  
Michael C. Brodsky ◽  
William F. Hoyt ◽  
Stanley L. Barnwell ◽  
Charles B. Wilson
Keyword(s):  
Magnetic Resonance Imaging ◽  
The Other ◽  
Lamina Terminalis ◽  
Normal Vision ◽  
Central Scotoma ◽  
Resonance Imaging ◽  
Optic Nerves ◽  
Content Type ◽  
Anterior Extension ◽  
Fine Print

✓ The authors describe the case of a young man who presented with a central scotoma in one eye and a temporal hemianopsia in the other. Magnetic resonance imaging showed distinctive bilobed thickening of the chiasm and a “potbelly” expansion of the contiguous optic nerves. The distal portions of the intracranial optic nerves appeared normal. At craniotomy, incision of the lamina terminalis exposed intraventricular craniopharyngioma with anterior extension into the chiasm and proximal optic nerves. Partial resection of the tumor restored normal vision.

Multiple choroid plexus papillomas of the lateral ventricle distinct from villous hypertrophy

1998 ◽  
Vol 88 (3) ◽  
pp. 581-585 ◽  
Author(s):  
Atsuo Yoshino ◽  
Yoichi Katayama ◽  
Takao Watanabe ◽  
Jun Kurihara ◽  
Shigeyoshi Kimura
Keyword(s):  
Choroid Plexus ◽  
Lateral Ventricle ◽  
The Other ◽  
Review Of The Literature ◽  
Resonance Imaging ◽  
Content Type ◽  
Left Lateral Ventricle ◽  
The Right ◽  
Choroid Plexus Papillomas ◽  
Fine Print

✓ Except for villous hypertrophy of the choroid plexus that may not be true tumors, multiple choroid plexus papillomas are extremely rare. The authors report a case involving multiple choroid plexus papillomas that were distinct from villous hypertrophy. These lesions were localized, one in the atrium of the right lateral ventricle and the other in the inferior horn of the left lateral ventricle. A review of the literature revealed that this case represented the first reported case of true multiple choroid plexus papillomas documented by findings on magnetic resonance imaging.

Individual variations in the sulcal anatomy of the basal temporal lobe and its relevance for epilepsy surgery: an anatomical study performed using magnetic resonance imaging

2002 ◽  
Vol 96 (3) ◽  
pp. 464-473 ◽  
Author(s):  
Klaus Novak ◽  
Thomas Czech ◽  
Daniela Prayer ◽  
Wolfgang Dietrich ◽  
Wolfgang Serles ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Temporal Lobe ◽  
Anatomical Landmarks ◽  
Resonance Imaging ◽  
Mr Images ◽  
Hippocampal Region ◽  
Content Type ◽  
Individual Variations ◽  
Fine Print

Object. The concept of selective amygdalohippocampectomy is based on pathophysiological insights into the epileptogenicity of the hippocampal region and the definition of the clinical syndrome of mesial temporal lobe epilepsy (TLE). High-resolution magnetic resonance (MR) imaging allows correlation of the site of histologically conspicuous tissue with anatomical structure. The highly variable sulcal pattern of the basal temporal lobe, however, definitely complicates the morphometric analysis of histomorphologically defined subdivisions of the hippocampal region. The goal of this study was to define individual variations in the sulcal anatomy on the basis of preoperative MR images obtained in patients suffering from TLE. Methods. The authors analyzed coronal MR images obtained in 50 patients for the presence of and intrinsic relationships among the rhinal, collateral, and occipitotemporal sulci. The surface relief of consecutive sections of 100 temporal lobes was graphically outlined and the resulting maps were used for visual analysis. The sulci were characterized by measurement of their depth, distance to the temporal horn, and laterality. The anatomical measurements and frequencies of sulcal patterns were assessed for statistical correlation with patients' histories and the lateralization of the seizure focus. Conclusions. Statistical assessment shows that patient sex is a significant factor in sulcal patterns. Anatomical measurements are significantly decreased on the side of the seizure origin, which relates to loss of white matter, a known morphological abnormality associated with TLE. Magnetic resonance imaging allows for accurate preoperative knowledge of individual sulcal patterns and facilitates intraoperative orientation to anatomical landmarks.

Surgical therapy for medically intractable epilepsy

1987 ◽  
Vol 66 (4) ◽  
pp. 489-499 ◽  
Author(s):  
George A. Ojemann
Keyword(s):  
Temporal Lobe ◽  
Surgical Therapy ◽  
Imaging Techniques ◽  
Intractable Epilepsy ◽  
Content Type ◽  
Human Epilepsy ◽  
Depth Electrodes ◽  
Positron Emission ◽  
Intraoperative Management ◽  
Fine Print

✓ There has been a recent renewal of interest in surgical therapy for medically intractable epilepsies. Cortical resection and callosotomy are the most widely accepted modes of surgical management. The indications for each of these approaches are reviewed. Although there has been much interest in imaging techniques, including positron emission tomography, to identify epileptogenic zones, identification still depends primarily on the electroencephalogram (EEG). There are several approaches to the evaluation and intraoperative management of patients undergoing cortical resection for temporal lobe epileptogenic zones. These range from selection based on scalp interictal EEG criteria, with resections guided by electrocorticography and functional mapping, to selection based on the location of ictal onset as recorded by chronically implanted depth electrodes, with an anatomically standard resection of the temporal lobe or resection limited to amygdalohippocampectomy. No one approach provides the optimum balance of benefits to risks and costs for all patients. The relative value of the different approaches for various populations of patients with medically intractable partial complex seizures is reviewed. Techniques for minimizing the morbidity of these operations, especially in regard to language and memory, are also discussed, as are the contributions to an understanding of the neurobiology of human epilepsy and human higher functions derived from the surgical therapy of epilepsy.

Prospective analysis of diplopia after anterior temporal lobectomy for mesial temporal lobe sclerosis

2003 ◽  
Vol 99 (3) ◽  
pp. 496-499 ◽  
Author(s):  
Aaron A. Cohen-Gadol ◽  
Jacqueline A. Leavitt ◽  
James J. Lynch ◽  
W. Richard Marsh ◽  
Gregory D. Cascino
Keyword(s):  
Temporal Lobe ◽  
Temporal Lobectomy ◽  
Palpebral Fissure ◽  
Ophthalmological Examination ◽  
Trochlear Nerve ◽  
Anterior Temporal Lobectomy ◽  
Content Type ◽  
Nerve Dysfunction ◽  
Mesial Temporal Lobe ◽  
Fine Print

Object. In this prospective study the authors investigated the incidence and natural history of postoperative diplopia in patients undergoing anterior temporal lobectomy (ATL) and amygdalohippocampectomy for medically intractable mesial temporal lobe epilepsy. Methods. Forty-seven patients scheduled for ATL for medically refractory seizures were examined preoperatively, 2 to 7 days postoperatively, and 3 to 6 months postoperatively. Ophthalmological examination including pupillary measurements, stereoacuity measurements, palpebral fissure measurements, vertical fusional amplitudes, Lancaster red green testing, visual field testing, and alternate cover testing was performed. Antiepileptic drug levels were monitored. Nine (19%) of 47 patients developed diplopia postoperatively. The diplopia was caused by trochlear nerve palsy in every case. No oculomotor nerve dysfunction was documented. Trochlear nerve function recovered completely in all patients within 3 to 6 months postoperatively. Conclusions. Postoperative diplopia following ATL occurs more often than previously thought and is primarily due to trochlear nerve dysfunction. Awareness of this transient complication is important in preoperative patient counseling.

Compulsive polydipsia following meningioma resection: an epileptic phenomenon?

1991 ◽  
Vol 75 (5) ◽  
pp. 798-799
Author(s):  
Adrian L. Rabinowicz ◽  
Martin H. Weiss ◽  
Christopher M. DeGiorgio
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Temporal Lobe ◽  
Response To Treatment ◽  
Imaging Findings ◽  
Resonance Imaging ◽  
Content Type ◽  
Fine Print

✓ The authors report the case of an individual who developed compulsive polydipsia following resection of a left sphenoidal ridge meningioma. The episodic, stereotyped nature of his symptoms, response to treatment, and electroencephalographic and magnetic resonance imaging findings are all highly consistent with temporal lobe-onset epilepsy. The pathophysiology of this underrecognized phenomenon is discussed.

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