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Abramov I, Jubran JH, Houlihan LM, Park MT, Howshar JT, Farhadi DS, Loymak T, Cole TS, Pitskhelauri D, Preul MC. Multiple hippocampal transection for mesial temporal lobe epilepsy: A systematic review. Seizure 2022; 101:162-176. [PMID: 36041364 DOI: 10.1016/j.seizure.2022.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 08/02/2022] [Accepted: 08/19/2022] [Indexed: 11/28/2022] Open
Abstract
PURPOSE Multiple hippocampal transection (MHT) is a surgical technique that offers adequate seizure control with minimal perioperative morbidity. However, there is little evidence available to guide neurosurgeons in selecting this technique for use in appropriate patients. This systematic review analyzes patient-level data associated with MHT for intractable epilepsy, focusing on postoperative seizure control and memory outcomes. METHODS The systematic review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Relevant articles were identified from 3 databases (PubMed, Medline, Embase) up to August 1, 2021. Inclusion criteria were that the majority of patients had received a diagnosis of intractable epilepsy, the article was written in English, MHT was the primary procedure, and patient-level metadata were included. RESULTS Fifty-nine unique patients who underwent MHT were identified across 11 studies. Ten (17%) of 59 patients underwent MHT alone. Forty-three (75%) of 57 patients who had a follow-up 12 months or longer were seizure free at last follow-up. With respect to postoperative verbal memory retention, 9 of 38 (24%) patient test scores did not change, 14 (37%) decreased, and 16 (42%) increased. With respect to postoperative nonverbal memory retention, 12 of 38 (34%) patient test scores did not change, 13 (34%) decreased, and 13 (33%) increased. CONCLUSION There are few reported patients analyzed after MHT. Although the neurocognitive benefits of MHT are unproven, this relatively novel technique has shown promise in the management of seizures in patients with intractable epilepsy. However, structured trials assessing MHT in isolation are warranted.
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Affiliation(s)
- Irakliy Abramov
- The Loyal and Edith Davis Neurosurgical Research Laboratory, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ
| | - Jubran H Jubran
- The Loyal and Edith Davis Neurosurgical Research Laboratory, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ
| | - Lena Mary Houlihan
- The Loyal and Edith Davis Neurosurgical Research Laboratory, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ
| | - Marian T Park
- The Loyal and Edith Davis Neurosurgical Research Laboratory, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ
| | - Jacob T Howshar
- The Loyal and Edith Davis Neurosurgical Research Laboratory, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ
| | - Dara S Farhadi
- The Loyal and Edith Davis Neurosurgical Research Laboratory, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ
| | - Thanapong Loymak
- Department of Neurosurgery, Srisawan Hospital, Nakhonsawan, Thailand
| | - Tyler S Cole
- The Loyal and Edith Davis Neurosurgical Research Laboratory, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ
| | - David Pitskhelauri
- Department of Neuro-Oncology, Burdenko Neurosurgical Center, Moscow, Russia
| | - Mark C Preul
- The Loyal and Edith Davis Neurosurgical Research Laboratory, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ.
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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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Kartum TA, Korkmaz TS, Kemerdere R, Yeni SN, Tanriverdi T. Trigeminal neuralgia as a complication after anterior temporal lobectomy: A case report. Neurochirurgie 2022; 68:693-696. [DOI: 10.1016/j.neuchi.2022.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Revised: 04/12/2022] [Accepted: 05/15/2022] [Indexed: 10/18/2022]
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Baran O, Balak N, Baydin S, Aydin I, Kayhan A, Evran S, Kemerdere R, Tanriover N. Assessing the connectional anatomy of superior and lateral surgical approaches for medial temporal lobe epilepsy. J Clin Neurosci 2020; 81:378-389. [PMID: 33222947 DOI: 10.1016/j.jocn.2020.10.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 09/15/2020] [Accepted: 10/03/2020] [Indexed: 12/13/2022]
Abstract
The most common approaches in the treatment of epilepsy, the trans-sylvian selective amygdalohippocampectomy (SAH) and the anterior temporal lobe resection (ATLR) reach the medial temporal lobe through different surgical routes. Our aim was to delineate the white matter (WM) fiber tracts at risk in relation to trans-sylvian SAH and ATLR by defining each fascicle en route to medial temporal lobe during each approach. ATLR and trans-sylvian SAH were performedand related WM tracts en route to medial temporal region were presented in relation to the relevant approaches and surrounding neurovascular structures. The WM tracts most likely to be disrupted during trans-sylvian SAH along the roof of the temporal horn were the UF - and less commonly IFOF - at the layer of the external capsule, anterior commissure, anterior bend of optic radiations, and sublenticular internal capsule. Amygdaloid projections to the claustrum, putamen and globus pallidus, the tail of caudate and the peduncle of the lentiform nucleus were also in close proximity to the resection cavity. Fiber tracts most likely to be impaired during ATLR included the UF, ILF, IFOF, anterior commissure, optic radiations, and, less likely, the vertical ventral segment of the arcuate fascicle. Both ATLR and trans-sylvian SAH carry the risk of injury to WM pathways, which may result in unpredictable functional loss. A detailed 3-D knowledge of the related connectional anatomy will help subside neurocognitive, neuroophtalmologic, neurolinguistic complications of epilepsy surgery, providing an opportunity to tailor the surgery according to patient's unique connectional and functional anatomy.
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Affiliation(s)
- Oguz Baran
- Department of Neurosurgery, Koç University Hospital, Istanbul, Turkey; Istanbul University - Cerrahpasa, Cerrahpasa Medical Faculty, Department of Neurosurgery, Microsurgical Neuroanatomy Laboratory, Istanbul, Turkey
| | - Naci Balak
- Istanbul Medeniyet University, Goztepe Education and Research Hospital, Istanbul, Turkey
| | - Serhat Baydin
- Istanbul University - Cerrahpasa, Cerrahpasa Medical Faculty, Department of Neurosurgery, Microsurgical Neuroanatomy Laboratory, Istanbul, Turkey; Ondokuz Mayis University, Medical Faculty, Department of Neurosurgery, Samsun, Turkey
| | - Ilhan Aydin
- Istanbul University - Cerrahpasa, Cerrahpasa Medical Faculty, Department of Neurosurgery, Microsurgical Neuroanatomy Laboratory, Istanbul, Turkey; Medical Park Hospital, Neurosurgery Clinic, Istanbul, Turkey
| | - Ahmet Kayhan
- Istanbul University - Cerrahpasa, Cerrahpasa Medical Faculty, Department of Neurosurgery, Microsurgical Neuroanatomy Laboratory, Istanbul, Turkey; Haseki Research and Training Hospital, Neurosurgery Clinic, Istanbul, Turkey
| | - Sevket Evran
- Haseki Research and Training Hospital, Neurosurgery Clinic, Istanbul, Turkey
| | - Rahsan Kemerdere
- Istanbul University - Cerrahpasa, Cerrahpasa Medical Faculty, Department of Neurosurgery, Istanbul, Turkey
| | - Necmettin Tanriover
- Istanbul University - Cerrahpasa, Cerrahpasa Medical Faculty, Department of Neurosurgery, Microsurgical Neuroanatomy Laboratory, Istanbul, Turkey; Istanbul University - Cerrahpasa, Cerrahpasa Medical Faculty, Department of Neurosurgery, Istanbul, Turkey.
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Li B, Sursal T, Bowers C, Cole C, Gandhi C, Schmidt M, Mayer S, Al-Mufti F. Chameleons, red herrings, and false localizing signs in neurocritical care. Br J Neurosurg 2020; 36:298-306. [PMID: 32924623 DOI: 10.1080/02688697.2020.1820945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
False localizing signs (FLS) and other misleading neurological signs have long been an intractable aspect of neurocritical care. Because they suggest an incorrect location or etiology of the pathological lesion, they have often led to misdiagnosis and mismanagement of the patient. Here, we reviewed the existing literature to provide an updated, comprehensive descriptive review of these difficult to diagnose signs in neurocritical care. For each sign presented, we discuss the non-false localizing presentation of symptoms, the common FLS or misleading presentation, etiology/pathogenesis of the sign, and diagnosis, as well as any other clinically relevant considerations. Within cranial neuropathies, we cover cranial nerves III, IV, V, VI, VII, VIII, as well as multiple cranial nerve involvement of IX, X, and XII. FLS ophthalmologic symptoms indicate diagnostically challenging neurological deficits, and here we discuss downbeat nystagmus, ping-pong-gaze, one-and-a-half syndrome, and wall-eyed bilateral nuclear ophthalmoplegia (WEBINO). Cranial herniation syndromes are integral to any discussion of FLS and here we cover Kernohan's notch phenomenon, pseudo-Dandy Walker malformation, and uncal herniation. FLS in the spinal cord have also been relatively well documented, but in addition to compressive lesions, we also discuss newer findings in radiculopathy and disc herniation. Finally, pulmonary syndromes may sometimes be overlooked in discussions of neurological signs but are critically important to recognize and manage in neurocritical care, and here we discuss Cheyne-Stokes respiration, cluster breathing, central neurogenic hyperventilation, ataxic breathing, Ondine's curse, and hypercapnia. Though some of these signs may be rare, the framework for diagnosing and treating them must continue to evolve with our growing understanding of their etiology and varied presentations.
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Affiliation(s)
- Boyi Li
- School of Medicine, New York Medical College, Valhalla, NY, USA
| | - Tolga Sursal
- Department of Neurosurgery, Westchester Medical Center, Valhalla, NY, USA
| | - Christian Bowers
- Department of Neurosurgery, University of New Mexico, Albuquerque, NM, USA
| | - Chad Cole
- Department of Neurosurgery, University of New Mexico, Albuquerque, NM, USA
| | - Chirag Gandhi
- Department of Neurosurgery, Westchester Medical Center, Valhalla, NY, USA
| | - Meic Schmidt
- Department of Neurosurgery, University of New Mexico, Albuquerque, NM, USA
| | - Stephan Mayer
- Department of Neurosurgery, Westchester Medical Center, Valhalla, NY, USA
| | - Fawaz Al-Mufti
- Department of Neurosurgery, Westchester Medical Center, Valhalla, NY, USA
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Wu C, Jermakowicz WJ, Chakravorti S, Cajigas I, Sharan AD, Jagid JR, Matias CM, Sperling MR, Buckley R, Ko A, Ojemann JG, Miller JW, Youngerman B, Sheth SA, McKhann GM, Laxton AW, Couture DE, Popli GS, Smith A, Mehta AD, Ho AL, Halpern CH, Englot DJ, Neimat JS, Konrad PE, Neal E, Vale FL, Holloway KL, Air EL, Schwalb J, Dawant BM, D'Haese PF. Effects of surgical targeting in laser interstitial thermal therapy for mesial temporal lobe epilepsy: A multicenter study of 234 patients. Epilepsia 2019; 60:1171-1183. [PMID: 31112302 DOI: 10.1111/epi.15565] [Citation(s) in RCA: 62] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Revised: 04/23/2019] [Accepted: 04/23/2019] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Laser interstitial thermal therapy (LITT) for mesial temporal lobe epilepsy (mTLE) has reported seizure freedom rates between 36% and 78% with at least 1 year of follow-up. Unfortunately, the lack of robust methods capable of incorporating the inherent variability of patient anatomy, the variability of the ablated volumes, and clinical outcomes have limited three-dimensional quantitative analysis of surgical targeting and its impact on seizure outcomes. We therefore aimed to leverage a novel image-based methodology for normalizing surgical therapies across a large multicenter cohort to quantify the effects of surgical targeting on seizure outcomes in LITT for mTLE. METHODS This multicenter, retrospective cohort study included 234 patients from 11 centers who underwent LITT for mTLE. To investigate therapy location, all ablation cavities were manually traced on postoperative magnetic resonance imaging (MRI), which were subsequently nonlinearly normalized to a common atlas space. The association of clinical variables and ablation location to seizure outcome was calculated using multivariate regression and Bayesian models, respectively. RESULTS Ablations including more anterior, medial, and inferior temporal lobe structures, which involved greater amygdalar volume, were more likely to be associated with Engel class I outcomes. At both 1 and 2 years after LITT, 58.0% achieved Engel I outcomes. A history of bilateral tonic-clonic seizures decreased chances of Engel I outcome. Radiographic hippocampal sclerosis was not associated with seizure outcome. SIGNIFICANCE LITT is a viable treatment for mTLE in patients who have been properly evaluated at a comprehensive epilepsy center. Consideration of surgical factors is imperative to the complete assessment of LITT. Based on our model, ablations must prioritize the amygdala and also include the hippocampal head, parahippocampal gyrus, and rhinal cortices to maximize chances of seizure freedom. Extending the ablation posteriorly has diminishing returns. Further work is necessary to refine this analysis and define the minimal zone of ablation necessary for seizure control.
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Affiliation(s)
- Chengyuan Wu
- Department of Neurological Surgery, Vickie and Jack Farber Institute for Neuroscience, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Walter J Jermakowicz
- Department of Neurological Surgery, Jackson Memorial Hospital, University of Miami, Miami, Florida
| | - Srijata Chakravorti
- Department of Electrical Engineering and Computer Science, Vanderbilt University, Nashville, Tennessee
| | - Iahn Cajigas
- Department of Neurological Surgery, Jackson Memorial Hospital, University of Miami, Miami, Florida
| | - Ashwini D Sharan
- Department of Neurological Surgery, Vickie and Jack Farber Institute for Neuroscience, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Jonathan R Jagid
- Department of Neurological Surgery, Jackson Memorial Hospital, University of Miami, Miami, Florida
| | - Caio M Matias
- Department of Neurological Surgery, Vickie and Jack Farber Institute for Neuroscience, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Michael R Sperling
- Department of Neurology, Vickie and Jack Farber Institute for Neuroscience, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Robert Buckley
- Department of Neurological Surgery, Harborview Medical Center, University of Washington, Seattle, Washington
| | - Andrew Ko
- Department of Neurological Surgery, Harborview Medical Center, University of Washington, Seattle, Washington
| | - Jeffrey G Ojemann
- Department of Neurological Surgery, Harborview Medical Center, University of Washington, Seattle, Washington
| | - John W Miller
- Department of Neurology, Harborview Medical Center, University of Washington, Seattle, Washington
| | - Brett Youngerman
- Department of Neurological Surgery, Neurological Institute of New York, Columbia University Medical Center, New York, New York
| | - Sameer A Sheth
- Department of Neurological Surgery, Baylor College of Medicine, Houston, Texas
| | - Guy M McKhann
- Department of Neurological Surgery, Neurological Institute of New York, Columbia University Medical Center, New York, New York
| | - Adrian W Laxton
- Department of Neurological Surgery, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Daniel E Couture
- Department of Neurological Surgery, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Gautam S Popli
- Department of Neurology, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Alexander Smith
- Department of Neurological Surgery, Zucker School of Medicine at Hofstra Northwell, Hempstead, New York
| | - Ashesh D Mehta
- Department of Neurological Surgery, Zucker School of Medicine at Hofstra Northwell, Hempstead, New York
| | - Allen L Ho
- Department of Neurological Surgery, Stanford Neuroscience Health Center, Stanford, California
| | - Casey H Halpern
- Department of Neurological Surgery, Stanford Neuroscience Health Center, Stanford, California
| | - Dario J Englot
- Department of Neurological Surgery, Vanderbilt University, Nashville, Tennessee
| | - Joseph S Neimat
- Department of Neurological Surgery, University of Louisville, Louisville, Kentucky
| | - Peter E Konrad
- Department of Neurological Surgery, Vanderbilt University, Nashville, Tennessee
| | - Elliot Neal
- Department of Neurological Surgery, University of South Florida Health South Tampa Center, Tampa, Florida
| | - Fernando L Vale
- Department of Neurological Surgery, University of South Florida Health South Tampa Center, Tampa, Florida
| | - Kathryn L Holloway
- Department of Neurological Surgery, Virginia Commonwealth University, Richmond, Virginia
| | - Ellen L Air
- Department of Neurological Surgery, Henry Ford Health System, Detroit, Michigan
| | - Jason Schwalb
- Department of Neurological Surgery, Henry Ford Health System, Detroit, Michigan
| | - Benoit M Dawant
- Department of Electrical Engineering and Computer Science, Vanderbilt University, Nashville, Tennessee.,Department of Neurological Surgery, Vanderbilt University, Nashville, Tennessee
| | - Pierre-Francois D'Haese
- Department of Electrical Engineering and Computer Science, Vanderbilt University, Nashville, Tennessee.,Department of Neurological Surgery, Vanderbilt University, Nashville, Tennessee
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Mandel M, Figueiredo EG, Mandel SA, Tutihashi R, Teixeira MJ. Minimally Invasive Transpalpebral Endoscopic-Assisted Amygdalohippocampectomy. Oper Neurosurg (Hagerstown) 2015; 13:2-14. [DOI: 10.1227/neu.0000000000001179] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2015] [Accepted: 11/24/2015] [Indexed: 11/19/2022] Open
Abstract
Abstract
BACKGROUND: Although anterior temporal lobectomy may be a definitive surgical treatment for epileptic patients with mesial temporal sclerosis, it often results in verbal, visual, and cognitive dysfunction. Studies have consistently reported the advantages of selective procedures compared with a standard anterior temporal lobectomy, mainly in terms of neuropsychological outcomes.
OBJECTIVE: To describe a new technique to perform a selective amygdalohippocampectomy (SAH) through a transpalpebral approach with endoscopic assistance.
METHODS: A mini fronto-orbitozygomatic craniotomy through an eyelid incision was performed in 8 patients. Both a microscope and neuroendoscope were used in the surgeries. An anterior SAH was performed in 5 patients who had the diagnosis of temporal lobe epilepsy with mesial temporal sclerosis. One patient had a mesial temporal lesion suggesting a ganglioglioma. Two patients presented mesial temporal cavernomas with seizures originating from the temporal lobe.
RESULTS: The anterior approach allowed removal of the amygdala and hippocampus. The image-guided system and postoperative evaluation confirmed that the amygdala may be accessed and completely removed through this route. The hippocampus was partially resected. All patients have discontinued medication with no more epileptic seizures. The patients with cavernomas and ganglioglioma also had their lesions completely removed. One-year follow-up has shown no visible scars.
CONCLUSION: The anterior route for SAH is a rational and direct approach to the mesial temporal lobe. Anterior SAH is a safe, less invasive procedure that provides early identification of critical vascular and neural structures in the basal cisterns. The transpalpebral approach provides a satisfactory cosmetic outcome.
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Affiliation(s)
- Mauricio Mandel
- Department of Neurosurgery, Hospital das Clínicas of University of São Paulo Medical School, São Paulo, Brazil
- Hospital Sírio Libanês, São Paulo, Brazil
- Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Eberval Gadelha Figueiredo
- Department of Neurosurgery, Hospital das Clínicas of University of São Paulo Medical School, São Paulo, Brazil
- Hospital Sírio Libanês, São Paulo, Brazil
| | - Suzana Abramovicz Mandel
- Department of Neurosurgery, Hospital das Clínicas of University of São Paulo Medical School, São Paulo, Brazil
- Hospital Sírio Libanês, São Paulo, Brazil
- Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Rafael Tutihashi
- Hospital Sírio Libanês, São Paulo, Brazil
- Hospital Israelita Albert Einstein, São Paulo, Brazil
- Department of Plastic Surgery, Hospital das Clínicas of University of São Paulo Medical School, São Paulo, Brazil
| | - Manoel Jacobsen Teixeira
- Department of Neurosurgery, Hospital das Clínicas of University of São Paulo Medical School, São Paulo, Brazil
- Hospital Sírio Libanês, São Paulo, Brazil
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Gill I, Parrent AG, Steven DA. Trigeminal neuropathic pain as a complication of anterior temporal lobectomy: report of 2 cases. J Neurosurg 2015; 124:962-5. [PMID: 26517768 DOI: 10.3171/2015.5.jns15123] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Cranial nerve (CN) deficits following anterior temporal lobectomy (ATL) are an uncommon but well-recognized complication. The usual CNs implicated in post-ATL complications include the oculomotor, trochlear, and facial nerves. To the authors' knowledge, injury to the trigeminal nerve leading to neuropathic pain has not been previously described in the literature. This paper presents 2 cases of trigeminal neuropathic pain following temporal lobe resections for pharmacoresistant epilepsy. The possible pathophysiological mechanisms are discussed and the microsurgical anatomy of surgically relevant structures is reviewed.
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Affiliation(s)
- Impreet Gill
- Schulich School of Medicine and Dentistry and Faculty of Science; and
| | - Andrew G Parrent
- Division of Neurosurgery, Department of Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - David A Steven
- Division of Neurosurgery, Department of Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
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Chen HI, Bohman LE, Emery L, Martinez-Lage M, Richardson AG, Davis KA, Pollard JR, Litt B, Gausas RE, Lucas TH. Lateral Transorbital Endoscopic Access to the Hippocampus, Amygdala, and Entorhinal Cortex: Initial Clinical Experience. ORL J Otorhinolaryngol Relat Spec 2015; 77:321-32. [DOI: 10.1159/000438762] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Accepted: 07/14/2015] [Indexed: 11/19/2022]
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Chen HI, Bohman LE, Loevner LA, Lucas TH. Transorbital endoscopic amygdalohippocampectomy: a feasibility investigation. J Neurosurg 2014; 120:1428-36. [DOI: 10.3171/2014.2.jns131060] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object
Resection of the hippocampus is the standard of care for medically intractable epilepsy in patients with mesial temporal sclerosis. Although temporal craniotomy in this setting is highly successful, the procedure carries certain immutable risks and may be associated with cognitive deficits related to cortical and white matter disruption. Alternative surgical approaches may reduce some of these risks by preserving the lateral temporal lobe. This study examined the feasibility of transorbital endoscopic amygdalohippocampectomy (TEA) as an alternative to open craniotomy in cadaveric specimens.
Methods
TEA dissections were performed in 4 hemispheres from 2 injected cadaveric specimens fixed in alcohol. Quantitative predictions of the limits of exposure based on predissection imaging were compared with intradissection measurements. The extent of resection and angles of exposure during the dissection and on postdissection imaging were recorded. These measurements were validated with MRI studies from 10 epilepsy patients undergoing standard surgical evaluations.
Results
The transorbital approach permitted direct access to the mesial temporal structures through the lateral orbital wall. Up to 97% of the hippocampal formation was resected with no brain retraction and minimal (mean 6.0 ± 1.4 mm) globe displacement. Lateral temporal lobe white matter tracts were preserved.
Conclusions
TEA permits hippocampectomy comparable to standard surgical approaches without disrupting the lateral temporal cortex or white matter. This novel approach is feasible in cadaveric specimens and warrants clinical investigation in carefully selected cases.
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Affiliation(s)
| | | | - Laurie A. Loevner
- 1Department of Neurosurgery and
- 2Division of Neuroradiology, University of Pennsylvania, Philadelphia, Pennsylvania
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Massager N, Tugendhaft P, Depondt C, Coppens T, Drogba L, Benmebarek N, De Witte O, Van Bogaert P, Legros B. Long-term outcome of surgical disconnection of the epileptic zone as an alternative to resection for nonlesional mesial temporal epilepsy. J Neurol Neurosurg Psychiatry 2013; 84:1378-83. [PMID: 23599386 DOI: 10.1136/jnnp-2012-304083] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND Pharmacoresistant epilepsy can be treated by either resection of the epileptic focus or functional isolation of the epileptic focus through complete disconnection of the pathways of propagation of the epileptic activity. OBJECTIVE To evaluate long-term seizure outcome and complications of temporal lobe disconnection (TLD) without resection for mesial temporal lobe epilepsy (MTLE). METHODS Data of 45 patients operated on for intractable MTLE using a functional disconnection procedure have been studied. Indication of TLD surgery was retained after a standard preoperative evaluation of refractory epilepsy and using the same criteria as for standard temporal resection. RESULTS Mean follow-up duration was 3.7 years. At the last follow-up, 30 patients (67%) were completely seizure-free (Engel-Ia/International League Against Epilepsy class 1) and 39 patients (87%) remained significantly improved (Engel-I or -II) by surgery. Actuarial outcome displays a 77.7% probability of being seizure-free and an 85.4% probability of being significantly improved at 5 years. No patient died after surgery and no subdural haematoma or hygroma occurred. Permanent morbidity included hemiparesis, hemianopia and oculomotor paresis found in three, five and one patient, respectively, after TLD. CONCLUSIONS TLD is acceptable alternative surgical technique for patients with intractable MTLE. The results of TLD are in the range of morbidity and long-term seizure outcome rates after standard surgical resection. We observed a slightly higher rate of complications after TLD in comparison with usual rates of morbidity of resection procedures. TLD may be used as an alternative to resection and could reduce operating time and the risks of subdural collections.
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Affiliation(s)
- Nicolas Massager
- Department of Neurosurgery, Clinic of Stereotactic and Functional Neurosurgery, ULB-Hôpital Erasme, , Brussels, Belgium
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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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Junna MR, Buechler R, Cohen-Gadol AA, Mandrekar J, Christianson T, Marsh WR, Meyer FB, Cascino GD. Prognostic importance of risk factors for temporal lobe epilepsy in patients undergoing surgical treatment. Mayo Clin Proc 2013; 88:332-6. [PMID: 23541008 DOI: 10.1016/j.mayocp.2013.01.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2012] [Revised: 12/19/2012] [Accepted: 01/14/2013] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To investigate the prognostic importance of an identified putative underlying risk factor in patients undergoing surgery for intractable temporal lobe epilepsy (TLE). PATIENTS AND METHODS A retrospective study of 400 consecutive patients who underwent TLE surgery between December 21, 1987, and September 11, 1996, was performed. Demographic characteristics, history of remote symptomatic neurologic disease, preoperative evaluation, and postoperative outcome data were extracted. Individuals without any risk factors were considered controls. Magnetic resonance imaging findings were used to identify mesial temporal sclerosis (MTS) before surgery. Seizure outcome was classified by a modified Engel classification. RESULTS Two hundred eighty-one patients had a potential underlying etiology, and 143 patients had more than 1 risk factor. One hundred nineteen patients had no evidence of a putative symptomatic neurologic illness. There was a statistically significant association (P<.05) between the presence of MTS and a favorable operative outcome (odds ratio, 4.28; 95% CI, 2.67-6.87). A history of remote symptomatic neurologic disease was not of prognostic importance unless associated with the development of MTS. CONCLUSION These results indicate that the preoperative identification of MTS by neuroimaging is the most important predictor of a favorable operative outcome in patients with TLE. These findings may be useful in the identification and counseling of potential candidates for epilepsy surgery.
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Affiliation(s)
- Mithri R Junna
- Division of Epilepsy, Department of Neurology, Mayo Clinic, Rochester, MN 55905, USA
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Ortler M, Fiegele T, Walser G, Trinka E, Eisner W. Cranial nerve monitoring during subpial dissection in temporomesial surgery. Acta Neurochir (Wien) 2011; 153:1181-9. [PMID: 21424600 DOI: 10.1007/s00701-011-0987-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2009] [Accepted: 02/22/2011] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Cranial nerves (CNs) crossing between the brainstem and skull base at the level of the tentorial hiatus may be at risk in temporomesial surgery involving subpial dissection and/or tumorous growth leading to distorted anatomy. We aimed to identify the surgical steps most likely to result in CN damage in this type of surgery. METHODS Electromyographic responses obtained with standard neuromonitoring techniques and a continuous free-running EMG were graded as either contact activity or pathological spontaneous activity (PSA) during subpial resection of temporomesial structures in 16 selective amygdalohippocampectomy cases. Integrity of peripheral motor axons was tested by transpial/transarachnoidal electrical stimulation while recording compound muscle action potentials from distal muscle(s). RESULTS Continuous EMG showed pathological activity in five (31.2%) patients. Nine events with PSA (slight activity, n = 8; strong temporary activity, n = 1) were recorded. The oculomotor nerve was involved three times, the trochlear nerve twice, the facial nerve once, and all monitored nerves on three occasions. Surgical maneuvers associated with PSA were the resection of deep parts of the hippocampus and parahippocampal gyrus (CN IV, twice; CN III, once), lining with or removing cotton patties from the resection cavity (III, twice; all channels, once) and indirect exertion of tension on the intact pia/arachnoid of the uncal region while mobilizing the hippocampus and parahippocampal gyrus en bloc (all channels, once; III, once). CMAPs were observed at 0.3 mA in two patients and at 0.6 mA in one patient, and without registering the exact amount of intensity in three patients. CONCLUSION The most dangerous steps leading to cranial nerve damage during mesial temporal lobe surgery are the final stages of the intervention while the resection is being completed in the deep posterior part and the resection cavity is being lined with patties. Distant traction may act on nerves crossing the tentorial hiatus via the intact arachnoid.
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Affiliation(s)
- Martin Ortler
- Clinical Department of Neurosurgery, Innsbruck Medical University, Anichstrasse 35, 6020, Innsbruck, Austria.
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Figueiredo EG, Deshmukh P, Nakaji P, Crusius MU, Teixeira MJ, Spetzler RF, Preul MC. Anterior Selective Amygdalohippocampectomy: Technical Description and Microsurgical Anatomy. Oper Neurosurg (Hagerstown) 2010; 66:45-53. [DOI: 10.1227/01.neu.0000350981.36623.8b] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
Objective:
We introduce a technique for performing a selective amygdalohippocampectomy (AH) through a minisupraorbital approach.
Methods:
A minisupraorbital craniotomy and an anterior selective AH were performed in 8 cadaver heads (16 sides). The anatomic specimens were analyzed, and the extent of resection of the hippocampus and amygdala was evaluated. Surgically relevant measurements were performed using anatomic specimens. An image-guided system was used to document the extent of the anterior AH. Laboratory data were used to support the clinical application of the technique.
Results:
The anterior route allowed removal of the amygdala and hippocampus, as confirmed by anatomic assessment. The image-guided system and anatomic evaluation confirmed that the amygdala and hippocampus can be accessed and removed through this route. The mean distance between the anterior aspect of the uncus and the tip of the temporal horn was 17.0 ± 4.6 mm; the mean distance from the head of the hippocampus to the posterior border of the cerebral peduncles was 26.0 ± 3.2 mm. Clinical application resulted in satisfactory removal of the amygdala and hippocampus.
Conclusion:
The anterior route for selective AH is a logical and straightforward approach to the mesial temporal lobe. Compared with other variations, it is less invasive and destructive, especially in terms of the fibers of the optic pathway, temporal stem, and lateral temporal neocortex.
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Affiliation(s)
- Eberval Gadelha Figueiredo
- Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph’s Hospital and Medical Center, Phoenix, Arizona
| | - Pushpa Deshmukh
- Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph’s Hospital and Medical Center, Phoenix, Arizona
| | - Peter Nakaji
- Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph’s Hospital and Medical Center, Phoenix, Arizona
| | | | - Manoel J. Teixeira
- Division of Neurological Surgery, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Robert F. Spetzler
- Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph’s Hospital and Medical Center, Phoenix, Arizona
| | - Mark C. Preul
- Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph’s Hospital and Medical Center, Phoenix, Arizona
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