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Electrical neuromodulation of the epileptic focus in cases of temporal lobe seizures
Published in Hans O Lüders, Deep Brain Stimulation and Epilepsy, 2020
Francisco Velasco, Ana Luisa Velasco, Marcos Velasco, Luisa Rocha, Diana Menes
Anterior temporal lobectomy (ATL) is highly successful in controlling seizures in cases with unilateral temporal lobe foci. However, surgery is not indicated in patients with independent bilateral temporal lobe foci, especially when magnetic resonance imaging (MRI) does not show unilateral mesial sclerosis or when a unilateral epileptic focus is associated with contralateral mesial temporal sclerosis (MTS). In these cases, unilateral ATL frequently fails to control seizures,1 or may lead to memory deficits.2 In our experience, such cases represent about 18% of the total number of cases evaluated for ATL. These cases call for alternative therapeutic techniques, such as ES of the nervous system to interfere with the propagation of epileptic activity or to inhibit the epileptic activity originated in the temporal lobe. Previous studies showed that bilateral stimulation of the centro-median thalamic nucleus (CM) results in a significant improvement of generalized tonic-clonic convulsions, but neither complex-partial (CxP) seizure nor focal interictal tem poral lobe spikes are significantly reduced.3 On the other hand, vagal nerve stimulation only results in a significant improvement in seizure control in approximately one-third of the cases with CxP seizures.4
Epilepsy surgery
Published in Michael Y. Wang, Andrea L. Strayer, Odette A. Harris, Cathy M. Rosenberg, Praveen V. Mummaneni, Handbook of Neurosurgery, Neurology, and Spinal Medicine for Nurses and Advanced Practice Health Professionals, 2017
Often epilepsy surgery is performed to treat mesial temporal sclerosis. In these cases, the medial structures of the temporal lobe, the hippocampus, and to some degree the amygdala, are thought to be epileptogenic. In some cases, the lateral temporal cortex may also be a focus of epilepsy. When the temporal lobe is viewed laterally, the superior, middle, and inferior temporal gyri are evident. Viewed medially, the uncus and parahippocampal gyrus are evident (Figure 40.2 and 40.3). A coronal section of the anterior temporal lobe demonstrates the hippocampus, temporal horn, optic tract, and parahippocampal gyrus (Figure 40.4). Traditionally, a portion of the lateral temporal cortex is removed with the hippocampus and amygdala (anterior temporal lobectomy); however, there are procedures that preserve the lateral temporal cortex and only remove the medial temporal lobe structures (selective amygdalohippocampectomy). On the dominant side, the left brain for most people, the surgeon may choose to limit the posterior extent of resection of the temporal lobe to avoid creating language deficits (taking the resection back to only 3.5–4 cm from the temporal pole on the dominant side as opposed to 5–5.5 cm from the temporal pole on the nondominant side) (Van Hoesen, 1995).
Epilepsy and Sleep Disorders
Published in John W. Scadding, Nicholas A. Losseff, Clinical Neurology, 2011
There are two main strategies for the surgical treatment of seizures. The first involves resective surgery, in which the aim of the surgery is the removal of the epileptic focus itself. Examples of this type of surgery are: anterior temporal lobectomy; selective amygdalo-hippocampectomy (in which only the mesial temporal structures are removed); or resection of a frontal lobe lesion. At the other extreme of resective surgery are patients in whom most or all of one hemisphere is abnormal, as in hemimegalencephaly or Rasmussen’s encephalitis (an uncommon inflammatory condition causing seizures, progressive hemiparesis and intellectual deterioration), hemispherectomy may be necessary. The other strategy for surgical treatment is to interrupt the pathways of seizure spread, so isolating the epileptic focus from the rest of the brain. Examples of this type of surgery include section of the corpus callosum, and multiple subpial transection. Callosotomy is used to prevent secondary generalization of seizures, and its chief indication is in the treatment of intractable generalized seizures, particularly tonic seizures. Multiple subpial transection is a technique that relies upon the theory that seizure spread occurs tangentially through the cerebral cortex, while impulses controlling voluntary movement travel radially. In this operation, multiple cuts are made vertically in the cortex in an effort to isolate the epileptogenic area from the surrounding cortex. It may be helpful in the treatment of seizures arising in eloquent areas of the brain, such as the speech area or motor cortex.
Surgical resection of dysembryoplatic neuroepithelioma tumor associated with epilepsy based on imaging classification
Published in Neurological Research, 2022
Yang Yao, Dong Zhang, Yinbao Qi, Ruobing Qian, Chaoshi Niu, Xiaorui Fei
Based on the preoperative investigation, all surgeries were undergone under intraoperative cortical electroencephalogram monitoring (ECoG) and MR-based neuro-navigation. Many experts believe that the application of ECoG can significantly improve the outcome of seizure control [13–15]. At the same time, the use of preoperative 3D image processing to plan a suitable surgical approach and resection range can also increase the total tumor resection rate. The aim of surgery was the removal of the lesion identified on MRI and the possible epileptogenic zone (EZ)[16]. The tumor resection range was categorized as gross total (no distinct residual tumor), subtotal (>90% of tumor removal), partial (<90% of tumor removal), and enlarged resection. The enlarged excision included resection of tumors and peripheral discharge cortex. On the other hand, most resection performed in the lesions involving the medial temporal lobe consisted in a lesionectomy associated with a corticectomy, including amygdalohippocampectomy and anterior temporal lobectomy [17].
Emerging indications for stereotactic laser interstitial thermal therapy in pediatric neurosurgery
Published in International Journal of Hyperthermia, 2020
Madison Remick, Michael M. McDowell, Kanupriya Gupta, James Felker, Taylor J. Abel
Complications with LITT are frequently transient in nature but can be severe. In early experiences of mixed adult and pediatric cohorts, up to 40–50% of patients experienced temporary neurological symptoms such as hemiparesis, speech difficulty, or vision changes, warranting pre-operative counseling [16]. Patients, particularly those with a history of anterior temporal lobectomy, may be more prone to memory dysfunction after treatment that injures the adjacent mammillothalamic tracts. Low energy settings are, therefore, critical in order to avoid thermal injury to adjacent deep limbic and brainstem structures. Other complications include hyponatremia, weight gain, procedural related hemorrhage, transient seizure worsening, and hormonal dysfunction [5]. While laser ablation for palliative treatment of intrinsic hypothalamic tumors has been shown to be associated with a higher risk of serious adverse events, LITT is increasingly being utilized as a safe and effective treatment intervention for patients with deep or previously inoperable HH [37]. In a series of 71 adult HH patients who underwent laser ablation by Curry et al., over 90% achieved gelastic seizure freedom at 1-year follow-up with less than 25% of patients requiring a subsequent additional ablation [3]. Often the complication profile of LITT for HH outweighs the severity of drug-resistant epilepsy associated with HH.
Radical Treatment: Wilder Penfield’s Life in Neuroscience
Published in Journal of the History of the Neurosciences, 2023
The second section addresses Penfield’s improvements in epilepsy surgery, as well as his work on the “dreamy state” of John Hughlings Jackson (1835–1911) in patients with temporal lobe epilepsy (i.e., elaborate psychic states with a sensation of déjà vu and/or complex visual hallucinations), and on incisural sclerosis—work that earned Penfield similar recognition as a neurosurgeon. His approach to the surgical treatment of focal epilepsy used precise electrocortical mapping and complete resection of pathologic tissue while sparing functionally critical areas. Penfield’s surgical approach to anterior temporal lobectomy (the “Montreal procedure”), which included removal of the amygdala and hippocampus, produced unprecedented control of previously intractable epilepsy.