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Mezjan I, Brissart H, Masson D, Vignal JP, Aron O, Ferrand M, Civit T, Maillard L, Colnat-Coulbois S. Epilepsy surgery for drug-resistant temporal lobe epilepsy in over-50 year-olds: seizure outcome, surgical complications and neuropsychological outcome. Neurochirurgie 2022; 68:510-517. [DOI: 10.1016/j.neuchi.2022.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 02/19/2022] [Accepted: 04/07/2022] [Indexed: 10/18/2022]
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Abstract
Temporal lobe epilepsy (TLE) is the most common cause of refractory epilepsy amenable for surgical treatment and seizure control. Surgery for TLE is a safe and effective strategy. The seizure-free rate after surgical resection in patients with mesial or neocortical TLE is about 70%. Resective surgery has an advantage over stereotactic radiosurgery in terms of seizure outcomes for mesial TLE patients. Both techniques have similar results for safety, cognitive outcomes, and associated costs. Stereotactic radiosurgery should therefore be seen as an alternative to open surgery for patients with contraindications for or with reluctance to undergo open surgery. Laser interstitial thermal therapy (LITT) has also shown promising results as a curative technique in mesial TLE but needs to be more deeply evaluated. Brain-responsive stimulation represents a palliative treatment option for patients with unilateral or bilateral MTLE who are not candidates for temporal lobectomy or who have failed a prior mesial temporal lobe resection. Overall, despite the expansion of innovative techniques in recent years, resective surgery remains the reference treatment for TLE and should be proposed as the first-line surgical modality. In the future, ultrasound therapies could become a credible therapeutic option for refractory TLE patients.
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Affiliation(s)
- Bertrand Mathon
- Department of Neurosurgery, La Pitié-Salpêtrière University Hospital, Paris, France; Sorbonne University, Paris, France; Paris Brain Institute, Paris, France
| | - Stéphane Clemenceau
- Department of Neurosurgery, La Pitié-Salpêtrière University Hospital, Paris, France
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Kohlhase K, Zöllner JP, Tandon N, Strzelczyk A, Rosenow F. Comparison of minimally invasive and traditional surgical approaches for refractory mesial temporal lobe epilepsy: A systematic review and meta-analysis of outcomes. Epilepsia 2021; 62:831-845. [PMID: 33656182 DOI: 10.1111/epi.16846] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 01/29/2021] [Accepted: 01/29/2021] [Indexed: 01/10/2023]
Abstract
Magnetic resonance-guided laser interstitial laser therapy (MRgLITT) and radiofrequency ablation (RFA) represent two minimally invasive methods for the treatment of drug-refractory mesial temporal lobe epilepsy (mTLE). We performed a systematic review and a meta-analysis to compare outcomes and complications between MRgLITT, RFA, and conventional surgical approaches to the temporal lobe (i.e., anterior temporal lobe resection [ATL] or selective amygdalohippocampectomy [sAHE]). Forty-three studies (13 MRgLITT, 6 RFA, and 24 surgery studies) involved 554, 123, 1504, and 1326 patients treated by MRgLITT, RFA, ATL, or sAHE, respectively. Engel Class I (Engel-I) outcomes were achieved after MRgLITT in 57% (315/554, range = 33.3%-67.4%), RFA in 44% (54/123, range = 0%-67.2%), ATL in 69% (1032/1504, range = 40%-92.9%), and sAHE in 66% (887/1326, range = 21.4%-93.3%). Meta-analysis revealed no significant difference in seizure outcome between MRgLITT and RFA (Q = 2.74, p = .098), whereas ATL and sAHE were both superior to MRgLITT (ATL: Q = 8.92, p = .002; sAHE: Q = 4.33, p = .037) and RFA (ATL: Q = 6.42, p = .0113; sAHE: Q = 5.04, p = .0247), with better outcome in patients at follow-up of 60 months or more. Mesial hippocampal sclerosis (mTLE + hippocampal sclerosis) was associated with significantly better outcome after MRgLITT (Engel-I outcome in 64%; Q = 8.55, p = .0035). The rate of major complications was 3.8% for MRgLITT, 3.7% for RFA, 10.9% for ATL, and 7.4% for sAHE; the differences did not show statistical significance. Neuropsychological deficits occurred after all procedures, with left-sided surgeries having a higher rate of verbal memory impairment. Lateral functions such as naming or object recognition may be more preserved in MRgLITT. Thermal therapies are effective techniques but show a significantly lower rate of Engel-I outcome in comparison to ATL and sAHE. Between MRgLITT and RFA there were no significant differences in Engel-I outcome, whereby the success of treatment seems to depend on the approach used (e.g., occipital approach). MRgLITT shows a similar rate of complications compared to RFA, whereas patients undergoing MRgLITT may experience fewer major complications compared to ATL or sAHE and might have a more beneficial neuropsychological outcome.
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Affiliation(s)
- Konstantin Kohlhase
- Department of Neurology, Epilepsy Center Frankfurt Rhine-Main, University Hospital Frankfurt, Frankfurt am Main, Germany.,Landes-Offensive zur Entwicklung wissenschaftlich-ökonomischer Exzellen, Center for Personalized and Translational Epilepsy Research, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Johann Philipp Zöllner
- Department of Neurology, Epilepsy Center Frankfurt Rhine-Main, University Hospital Frankfurt, Frankfurt am Main, Germany.,Landes-Offensive zur Entwicklung wissenschaftlich-ökonomischer Exzellen, Center for Personalized and Translational Epilepsy Research, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Nitin Tandon
- Department of Neurosurgery, McGovern Medical School at University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Adam Strzelczyk
- Department of Neurology, Epilepsy Center Frankfurt Rhine-Main, University Hospital Frankfurt, Frankfurt am Main, Germany.,Landes-Offensive zur Entwicklung wissenschaftlich-ökonomischer Exzellen, Center for Personalized and Translational Epilepsy Research, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Felix Rosenow
- Department of Neurology, Epilepsy Center Frankfurt Rhine-Main, University Hospital Frankfurt, Frankfurt am Main, Germany.,Landes-Offensive zur Entwicklung wissenschaftlich-ökonomischer Exzellen, Center for Personalized and Translational Epilepsy Research, Goethe University Frankfurt, Frankfurt am Main, Germany
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Khan MQ, Cirjan C, Quadri N, Alexopoulos G, Coppens J. Symptomatic cerebral vasospasm in the setting of carmustine wafer placement for glioblastoma: A case presentation and review of literature. Surg Neurol Int 2020; 11:168. [PMID: 32637221 PMCID: PMC7332710 DOI: 10.25259/sni_257_2020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Accepted: 06/08/2020] [Indexed: 12/31/2022] Open
Abstract
Background: Gliadel placement in glioblastoma resection, particularly with concurrent chemoradiation, has demonstrated an improvement in survival. There have been several reported adverse effects, some of which lend to significantly increased morbidity and mortality. With only two other cases described in literature, cerebral vasospasm secondary to carmustine-impregnated wafers is an extremely rare side effect. Case Description: We report the case of a 51-year-old female who presented with the left lower limb paresis 8 days after high-grade glioma resection provoked by carmustine wafer placement. Conclusion: We urge surgeons to reconsider placement of carmustine wafers in nations where the surgical resection cavity includes exposed large cerebral vasculature. We also propose the early identification of this devastating complication in the postoperative period by maintaining a high clinical suspicion and prompt utilization of computed tomography and digital subtraction angiography in the management and treatment of these patients accordingly.
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Affiliation(s)
- Maheen Qamar Khan
- Department of Neurosurgery, Saint Louis University, 3635 Vista Avenue, St, Louis, Missouri, United States
| | - Cristian Cirjan
- Department of Neurosurgery, Saint Louis University, 3635 Vista Avenue, St, Louis, Missouri, United States
| | - Nabiha Quadri
- Department of Neurosurgery, Saint Louis University, 3635 Vista Avenue, St, Louis, Missouri, United States
| | - Georgios Alexopoulos
- Department of Neurosurgery, Saint Louis University, 3635 Vista Avenue, St, Louis, Missouri, United States
| | - Jeroen Coppens
- Department of Neurosurgery, Saint Louis University, 3635 Vista Avenue, St, Louis, Missouri, United States
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Agarwal N, Dutta Satyarthee G. Symptomatic Diffuse Vasospasm After Resection of Temporal Ganglioglioma: Review of the Literature with Case Illustration. World Neurosurg 2019; 132:230-235. [PMID: 31505290 DOI: 10.1016/j.wneu.2019.08.239] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 08/28/2019] [Accepted: 08/29/2019] [Indexed: 12/01/2022]
Abstract
BACKGROUND Symptomatic cerebral vasospasm may occur in the setting of aneurysmal subarachnoid hemorrhage, traumatic brain injury, or after anterior skull base surgery, but its occurrence is extremely rare in the background of glioma surgical resection. CASE DESCRIPTION We present a rare case of symptomatic diffuse vasospasm, which is the fourth reported case of symptomatic vasospasm after temporal lobectomy and the third in the setting of a glial tumor. This patient, a 10-year-old boy, developed bilateral, progressive cerebral infarcts because of diffuse vasospasm after anteromesial temporal lobectomy for a left temporal ganglioglioma leading to significant morbidity. CONCLUSIONS The risk factors, likely pathogenesis and the importance of early diagnosis and timely institution of treatment, in such cases are discussed in the background of relevant literature. The current case represents the first report of symptomatic diffuse vasospasm occuring after surgical resection of intracranial ganglioglioma in the Western literature.
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Affiliation(s)
- Nitish Agarwal
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Guru Dutta Satyarthee
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India.
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Parker WE, Weidman EK, Chazen JL, Niogi SN, Uribe-Cardenas R, Kaplitt MG, Hoffman CE. Magnetic resonance-guided focused ultrasound for ablation of mesial temporal epilepsy circuits: modeling and theoretical feasibility of a novel noninvasive approach. J Neurosurg 2019; 133:63-70. [PMID: 31200385 DOI: 10.3171/2019.4.jns182694] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2018] [Accepted: 04/05/2019] [Indexed: 01/29/2023]
Abstract
OBJECTIVE The authors tested the feasibility of magnetic resonance-guided focused ultrasound (MRgFUS) ablation of mesial temporal lobe epilepsy (MTLE) seizure circuits. Up to one-third of patients with mesial temporal sclerosis (MTS) suffer from medically refractory epilepsy requiring surgery. Because current options such as open resection, laser ablation, and Gamma Knife radiosurgery pose potential risks, such as infection, hemorrhage, and ionizing radiation, and because they often produce visual or neuropsychological deficits, the authors developed a noninvasive MRgFUS ablation strategy for mesial temporal disconnection to mitigate these risks. METHODS The authors retrospectively reviewed 3-T MRI scans obtained with diffusion tensor imaging (DTI). The study group included 10 patients with essential tremor (ET) who underwent pretreatment CT and MRI prior to MRgFUS, and 2 patients with MTS who underwent MRI. Fiber tracking of the fornix-fimbria pathway and inferior optic radiations was performed, ablation sites mimicking targets of open posterior hippocampal disconnection were modeled, and theoretical MRgFUS surgical plans were devised. Distances between the targets and optic radiations were measured, helmet angulations were prescribed, and the numbers of available MRgFUS array elements were calculated. RESULTS Tractograms of fornix-fimbria and optic radiations were generated in all ET and MTS patients successfully. Of the 10 patients with both the CT and MRI data necessary for the analysis, 8 patients had adequate elements available to target the ablation site. A margin (mean 8.5 mm, range 6.5-9.8 mm) of separation was maintained between the target lesion and optic radiations. CONCLUSIONS MRgFUS offers a noninvasive option for seizure tract disruption. DTI identifies fornix-fimbria and optic radiations to localize optimal ablation targets and critical surrounding structures, minimizing risk of postoperative visual field deficits. This theoretical modeling study provides the necessary groundwork for future clinical trials to apply this novel neurosurgical technique to patients with refractory MTLE and surgical contraindications, multiple prior surgeries, or other factors favoring noninvasive treatment.
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Affiliation(s)
| | - Elizabeth K Weidman
- 2Radiology, NewYork-Presbyterian Hospital/Weill Cornell Medical Center, New York, New York
| | - J Levi Chazen
- 2Radiology, NewYork-Presbyterian Hospital/Weill Cornell Medical Center, New York, New York
| | - Sumit N Niogi
- 2Radiology, NewYork-Presbyterian Hospital/Weill Cornell Medical Center, New York, New York
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Dickerson JC, Hidalgo JA, Smalley ZS, Shiflett JM. Diffuse vasospasm after transcortical temporal lobectomy for intractable epilepsy. Acta Neurochir (Wien) 2018; 160:1883-1887. [PMID: 29987392 DOI: 10.1007/s00701-018-3606-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Accepted: 06/25/2018] [Indexed: 11/26/2022]
Abstract
Cerebral delayed ischemia due to arterial vasospasm is a rare complication following epilepsy surgery. Here we report the third known case and first of diffuse vasospasm. A 48-year-old woman underwent a transcortical anterior left temporal lobectomy. Eleven days later, she had new-onset expressive aphasia with narrowing of the anterior, middle, and posterior cerebral arteries, and increased velocities via transcranial Doppler. She was treated with fluids, nimodipine, and permissive hypertension. At 6 months, her speech was near baseline. Cerebral vasospasm may represent a rare cause of morbidity after anterior temporal lobectomy; a literature review on the subject is presented.
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Affiliation(s)
- James Charles Dickerson
- Department of Neurosurgery, University of Mississippi Medical Center, 2500 North State Street, Jackson, MS, 39216, USA.
| | - Joaquin Andres Hidalgo
- Department of Neurosurgery, University of Mississippi Medical Center, 2500 North State Street, Jackson, MS, 39216, USA
| | - Zachary Stidham Smalley
- Department of Neurosurgery, University of Mississippi Medical Center, 2500 North State Street, Jackson, MS, 39216, USA
| | - James Mason Shiflett
- Department of Neurosurgery, University of Mississippi Medical Center, 2500 North State Street, Jackson, MS, 39216, USA
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Rao S, Narayanan S, Nanjireddy R, Mittal S, Basha M. Pearls & Oy-sters: Symptomatic cerebral vasospasm on conventional angiography following temporal lobe epilepsy surgery. Neurology 2017; 88:e230-e232. [PMID: 28583939 DOI: 10.1212/wnl.0000000000004011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Shyam Rao
- From the Departments of Neurology (S.R., S.N., R.N., M.B.) and Neurosurgery (S.N., S.M.) and Comprehensive Epilepsy Center (S.M., M.B.), Wayne State University and Detroit Medical Center, MI
| | - Sandra Narayanan
- From the Departments of Neurology (S.R., S.N., R.N., M.B.) and Neurosurgery (S.N., S.M.) and Comprehensive Epilepsy Center (S.M., M.B.), Wayne State University and Detroit Medical Center, MI
| | - Reena Nanjireddy
- From the Departments of Neurology (S.R., S.N., R.N., M.B.) and Neurosurgery (S.N., S.M.) and Comprehensive Epilepsy Center (S.M., M.B.), Wayne State University and Detroit Medical Center, MI
| | - Sandeep Mittal
- From the Departments of Neurology (S.R., S.N., R.N., M.B.) and Neurosurgery (S.N., S.M.) and Comprehensive Epilepsy Center (S.M., M.B.), Wayne State University and Detroit Medical Center, MI
| | - Maysaa Basha
- From the Departments of Neurology (S.R., S.N., R.N., M.B.) and Neurosurgery (S.N., S.M.) and Comprehensive Epilepsy Center (S.M., M.B.), Wayne State University and Detroit Medical Center, MI.
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Complications After Surgery for Mesial Temporal Lobe Epilepsy Associated with Hippocampal Sclerosis. World Neurosurg 2017; 102:639-650.e2. [DOI: 10.1016/j.wneu.2017.03.128] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2016] [Revised: 03/26/2017] [Accepted: 03/27/2017] [Indexed: 01/03/2023]
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Affiliation(s)
- Ashish Chakravarty
- Department of Neuroanaesthesiology and Critical Care, Medanta - The Medicity, Gurgaon, Haryana, India
| | - Saurabh Anand
- Department of Neuroanaesthesiology and Critical Care, Medanta - The Medicity, Gurgaon, Haryana, India
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Chang EF, Englot DJ, Vadera S. Minimally invasive surgical approaches for temporal lobe epilepsy. Epilepsy Behav 2015; 47:24-33. [PMID: 26017774 PMCID: PMC4814159 DOI: 10.1016/j.yebeh.2015.04.033] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2015] [Revised: 04/09/2015] [Accepted: 04/10/2015] [Indexed: 11/26/2022]
Abstract
Surgery can be a highly effective treatment for medically refractory temporal lobe epilepsy (TLE). The emergence of minimally invasive resective and nonresective treatment options has led to interest in epilepsy surgery among patients and providers. Nevertheless, not all procedures are appropriate for all patients, and it is critical to consider seizure outcomes with each of these approaches, as seizure freedom is the greatest predictor of patient quality of life. Standard anterior temporal lobectomy (ATL) remains the gold standard in the treatment of TLE, with seizure freedom resulting in 60-80% of patients. It is currently the only resective epilepsy surgery supported by randomized controlled trials and offers the best protection against lateral temporal seizure onset. Selective amygdalohippocampectomy techniques preserve the lateral cortex and temporal stem to varying degrees and can result in favorable rates of seizure freedom but the risk of recurrent seizures appears slightly greater than with ATL, and it is not clear whether neuropsychological outcomes are improved with selective approaches. Stereotactic radiosurgery presents an opportunity to avoid surgery altogether, with seizure outcomes now under investigation. Stereotactic laser thermo-ablation allows destruction of the mesial temporal structures with low complication rates and minimal recovery time, and outcomes are also under study. Finally, while neuromodulatory devices such as responsive neurostimulation, vagus nerve stimulation, and deep brain stimulation have a role in the treatment of certain patients, these remain palliative procedures for those who are not candidates for resection or ablation, as complete seizure freedom rates are low. Further development and investigation of both established and novel strategies for the surgical treatment of TLE will be critical moving forward, given the significant burden of this disease.
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Affiliation(s)
- Edward F. Chang
- UCSF Comprehensive Epilepsy Center, University of California, San Francisco, CA, USA, Department of Neurological Surgery, University of California, San Francisco, CA, USA, Corresponding author at: Department of Neurological Surgery, University of California, San Francisco, 505 Parnassus Avenue, Box 0112, San Francisco, CA 94143-0112, USA. Tel.: +1 415 353 3904. (E.F. Chang)
| | - Dario J. Englot
- UCSF Comprehensive Epilepsy Center, University of California, San Francisco, CA, USA, Department of Neurological Surgery, University of California, San Francisco, CA, USA
| | - Sumeet Vadera
- Department of Neurological Surgery, University of California, Irvine, CA, USA
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Kovanda TJ, Tubbs RS, Cohen-Gadol AA. Transsylvian selective amygdalohippocampectomy for treatment of medial temporal lobe epilepsy: Surgical technique and operative nuances to avoid complications. Surg Neurol Int 2014; 5:133. [PMID: 25298915 PMCID: PMC4174670 DOI: 10.4103/2152-7806.140651] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2014] [Accepted: 07/03/2014] [Indexed: 11/08/2022] Open
Abstract
Background: A number of different surgical techniques are effective for treatment of drug-resistant medial temporal lobe epilepsy. Of these, transsylvian selective amygdalohippocampectomy (SA), which was originally developed to maximize temporal lobe preservation, is arguably the most technically demanding to perform. Recent studies have suggested that SA may result in better neuropsychological outcomes with similar postoperative seizure control as standard anterior temporal lobectomy, which involves removal of the lateral temporal neocortex. Methods: In this article, the authors describe technical nuances to improve the safety of SA. Results: Wide sylvian fissure opening and use of neuronavigation allows an adequate exposure of the amygdala and hippocampus through a corticotomy within the inferior insular sulcus. Avoidance of rigid retractors and careful manipulation and mobilization of middle cerebral vessels will minimize ischemic complications. Identification of important landmarks during amygdalohippocampectomy, such as the medial edge of the tentorium and the third nerve within the intact arachnoid membranes covering the brainstem, further avoids operator disorientation. Conclusion: SA is a safe technique for resection of medial temporal lobe epileptogenic foci leading to drug-resistant medial temporal lobe epilepsy.
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Affiliation(s)
- Timothy J Kovanda
- Goodman Campbell Brain and Spine, Department of Neurological Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - R Shane Tubbs
- Pediatric Neurosurgery, Children's Hospital, Birmingham, Alabama, USA
| | - Aaron A Cohen-Gadol
- Goodman Campbell Brain and Spine, Department of Neurological Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA
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Zhu W, Liu S, Zhao J, Liu S, Jiang S, Li B, Yang H, Fan C, Cui W. Highly flexible and rapidly degradable papaverine-loaded electrospun fibrous membranes for preventing vasospasm and repairing vascular tissue. Acta Biomater 2014; 10:3018-28. [PMID: 24704697 DOI: 10.1016/j.actbio.2014.03.023] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2013] [Revised: 02/21/2014] [Accepted: 03/20/2014] [Indexed: 10/25/2022]
Abstract
Vasospasm is a common post-operative complication after vascular anastomosis. Currently, the main treatment is a local injection of antispasmodic drugs. However, this method has a high rate of relapse and is subject to a large degree of individual variation, and repeated injections cause additional pain for patients. In this study, we developed highly flexible and rapidly degradable papaverine-loaded electrospun fibrous membranes to be wrapped around vascular suturing to prevent vasospasm. Poly-l-lactic acid/polyethylene glycol (PLLA/PEG) electrospun fibers containing papaverine maintained a high degree of flexibility and could withstand any folding, and are therefore suitable for wrapping vascular suturing. A rapid release of papaverine, between 2 and 7 days, was achieved by adjusting the proportions of PEG and PLLA. PLLA electrospun fibers containing 40% PEG (PLLA-40%) could control drug release and polymer degradation most effectively during the first 2 weeks post-operation. Testing using an in vivo rabbit model showed that PLLA-40% fibrous membranes produced significant antispasmodic effect without observable inflammation or hyperplasia, and the fibrous membranes were ideally biodegradable, with no impact on regional blood flow, pressure, vessel diameter or surrounding tissue hyperplasia. Therefore, papaverine-loaded electrospun fibrous membranes show the potential to greatly reduce post-operative vasospasm and maintain regular vascular morphology during antispasmodic therapy.
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Temporal lobe resective surgery for medically intractable epilepsy: a review of complications and side effects. EPILEPSY RESEARCH AND TREATMENT 2013; 2013:752195. [PMID: 24288602 PMCID: PMC3833403 DOI: 10.1155/2013/752195] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/26/2013] [Revised: 09/04/2013] [Accepted: 09/06/2013] [Indexed: 11/17/2022]
Abstract
Object. It is widely accepted that temporal resective surgery represents an efficacious treatment option for patients with epilepsy of temporal origin. The meticulous knowledge of the potential complications, associated with temporal resective procedures, is of paramount importance. In our current study, we attempt to review the pertinent literature for summating the complications of temporal resective procedures for epilepsy. Method. A PubMed search was performed with the following terms: “behavioral,” “cognitive,” “complication,” “deficit,” “disorder,” “epilepsy,” “hemianopia,” “hemianopsia,” “hemorrhage,” “lobectomy,” “medial,” “memory,” “mesial,” “neurobehavioral,” “neurocognitive,” “neuropsychological,” “psychological,” “psychiatric,” “quadranopia,” “quadranopsia,” “resective,” “side effect,” “surgery,” “temporal,” “temporal lobe,” and “visual field.” Results. There were six pediatric, three mixed-population, and eleven adult surgical series examining the incidence rates of procedure-related complications. The reported mortality rates varied between 0% and 3.5%, although the vast majority of the published series reported no mortality. The cumulative morbidity rates ranged between 3.2% and 88%. Conclusions. Temporal resective surgery for epilepsy is a safe treatment modality. The reported morbidity rates demonstrate a wide variation. Accurate detection and frank reporting of any surgical, neurological, cognitive, and/or psychological complications are of paramount importance for maximizing the safety and improving the patients' overall outcome.
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Cerebral vasospasm after temporal lobe epilepsy surgery: clinically important? Epilepsy Curr 2013; 13:69-70. [PMID: 23646006 DOI: 10.5698/1535-7597-13.2.69] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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