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Lu S, Chu M, Wang X, Wu Y, Hou Y, Liu A. Anterior temporal lobectomy improved mood status and quality of life in Chinese patients with mesial temporal lobe epilepsy: a single-arm cohort study. Chin Med J (Engl) 2023; 136:407-414. [PMID: 36867545 PMCID: PMC10106264 DOI: 10.1097/cm9.0000000000002094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Indexed: 03/04/2023] Open
Abstract
BACKGROUND Many studies have emphasized that selective resection of epileptic lesions in temoral lobe is associated with better preservation of cognition function; whether this applies to patients with refractory mesial temporal lobe epilepsy (MTLE) remains unknown. The objective of this study was to evaluate changes in cognitive functions, mood status, and quality of life after anterior temporal lobectomy in patients with refractory MTLE. METHODS This single-arm cohort study assessed cognitive function, mood status, and quality of life, as well as electroencephalography findings, in patients with refractory MTLE who underwent anterior temporal lobectomy at Xuanwu Hospital from January 2018 to March 2019. Pre- and post-operative characteristics were compared to evaluate the effects of surgery. RESULTS Anterior temporal lobectomy significantly reduced the frequencies of epileptiform discharges. The overall success rate of surgery was acceptable. Anterior temporal lobectomy did not result in significant changes in overall cognitive functions (P > 0.05), although changes in certain domains, including visuospatial ability, executive ability, and abstract thinking, were detected. Anterior temporal lobectomy resulted in improvements in anxiety and depression symptoms and quality of life. CONCLUSIONS Anterior temporal lobectomy reduced epileptiform discharges and incidence of post-operative seizures as well as resulted in improved mood status and quality of life without causing significant changes in cognitive function.
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Affiliation(s)
- Song Lu
- Department of Neurology, Xuanwu Hospital Capital Medical University, Beijing 100053, China
- Fuxing Hospital, Capital Medical University, Beijing 100069, China
| | - Min Chu
- Department of Neurology, Xuanwu Hospital Capital Medical University, Beijing 100053, China
| | - Xian Wang
- Department of Neurology, Xuanwu Hospital Capital Medical University, Beijing 100053, China
| | - Yating Wu
- Department of Neurology, Xuanwu Hospital Capital Medical University, Beijing 100053, China
| | - Yue Hou
- Department of Neurology, Xuanwu Hospital Capital Medical University, Beijing 100053, China
| | - Aihua Liu
- Department of Neurology, Xuanwu Hospital Capital Medical University, Beijing 100053, China
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Costa E, Joris V, Vaz G, Santos SF, El-Tahry R, Duprez T, Raftopoulos C. The trans superior temporal gyrus approach for selective amygdalohippocamptectomy. World Neurosurg 2021; 159:e244-e251. [PMID: 34923179 DOI: 10.1016/j.wneu.2021.12.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Revised: 12/09/2021] [Accepted: 12/10/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND OBJECTIVE Different surgical approaches have been described for selective amygdalohippocampectomy (SeAH) in patients with pharmacoresistant temporal lobe epilepsy (TLE). We report the results of the innovative trans-superior temporal gyrus (trans-STG) approach in a monocentric patients' series. METHODS We reviewed the patients' characteristics, post-operative outcomes, and complications in a series of 8 consecutive TLE patients operated on using the trans-STG approach and recruited between November 2015 and April 2017. RESULTS Over a mean 2,5-year follow-up period, 7/8 patients (87,5%) remained seizure-free (Engel 1). Only one (12,5%) was not cured (Engel 3) without clear explanation for treatment failure. Mean operative time was 237 minutes, representing a shortage of 80 minutes when compared to our historic trans-sylvian approach. No peri-operative death was recorded nor visual field defect/visual acuity impairment due to the approach. One patient suffered from a left posterior thalamo-capsular stroke. CONCLUSION Trans-STG approach is feasible, fast, and safefor SeAH in drug refractory TLE patients. This approach allows preservation of the optic radiation but cuts part of the uncinate fasciculus and potentially the anterior aspect of the anterior bundle of the midlle longitudinal fasciculus.
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Affiliation(s)
- Emmanuel Costa
- Department of Neurosurgery, Saint-Luc academic Hospital, Université catholique de Louvain, Brussels, Belgium
| | - Vincent Joris
- Department of Neurosurgery, Saint-Luc academic Hospital, Université catholique de Louvain, Brussels, Belgium
| | - Geraldo Vaz
- Department of Neurosurgery, Saint-Luc academic Hospital, Université catholique de Louvain, Brussels, Belgium
| | - Susana Ferrao Santos
- Department of Neurology, Saint-Luc academic Hospital, Université catholique de Louvain, Brussels, Belgium
| | - Riëm El-Tahry
- Department of Neurology, Saint-Luc academic Hospital, Université catholique de Louvain, Brussels, Belgium
| | - Thierry Duprez
- Department of Radiology and Medical Imaging, Saint-Luc academic Hospital, Université catholique de Louvain, Brussels, Belgium
| | - Christian Raftopoulos
- Department of Neurosurgery, Saint-Luc academic Hospital, Université catholique de Louvain, Brussels, Belgium.
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Sugano H, Iimura Y, Suzuki H, Tamrakar S, Mitsuhashi T, Higo T, Ueda T, Nishioka K, Karagiozov K, Nakajima M. Can intraoperative electrocorticography be used to minimize the extent of resection in patients with temporal lobe epilepsy associated with hippocampal sclerosis? J Neurosurg 2021; 137:1-8. [PMID: 34861650 DOI: 10.3171/2021.9.jns211925] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 09/21/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Tailored surgery to extensively resect epileptogenic lesions using intraoperative electrocorticography (ioECoG) may improve seizure outcomes. However, resection of large areas is associated with decreased memory function postoperatively. The authors assessed whether ioECoG could provide useful information on how to minimize the focus resection and obtain better seizure outcomes without memory deterioration. They examined the postoperative seizure-free period and memory alteration in a retrospective cohort of patients with mesial temporal lobe epilepsy (TLE) due to hippocampal sclerosis (HS) in whom the extent of removal was determined using ioECoG findings. METHODS The authors enrolled 82 patients with TLE associated with HS who were treated surgically. Transsylvian amygdalohippocampectomy was indicated as the first step. When visual inspection identified interictal epileptic discharges from the lateral temporal lobe on ioECoG, anterior temporal lobectomy (ATL) was eventually performed. The patients were divided into the selective amygdalohippocampectomy (SA, n = 40) and ATL (n = 42) groups. Postoperative seizure outcomes were assessed at 1, 2, 3, 5, and 7 years postoperatively using the International League Against Epilepsy classification. The Kaplan-Meier survival analysis was applied to evaluate the period of seizure recurrence between the SA and ATL groups. Factors attributed to seizure recurrence were analyzed using the Cox proportional hazards model, and they were as follows: epileptic focal laterality; age at seizure onset (< 10 or ≥ 10 years old); seizure frequency (more than weekly or less than weekly seizures); history of focal to bilateral tonic-clonic seizure; infectious etiology; and surgical procedure. The Wechsler Memory Scale-Revised was used to evaluate memory function pre- and postoperatively. RESULTS Seizure outcomes were significantly worse in the SA group than in the ATL group at 2 years postoperatively (p = 0.045). The International League Against Epilepsy class 1 outcomes at 7 years postoperatively in the SA and ATL groups were 63% and 81%, respectively. Kaplan-Meier analysis showed that seizure recurred significantly earlier in the SA group than in the ATL group (p = 0.031). The 2-way ANOVA analysis was used to compare the SA and ATL groups in each memory category, and revealed that there was no significant difference regardless of the side of surgery. CONCLUSIONS Visual assessment of ioECoG cannot be used as an indicator to minimize epileptic focus resection in patients with TLE associated with HS. ATL is more effective in obtaining seizure-free outcomes; however, both ATL and SA can preserve memory function.
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DE Benedictis A, Marras CE, Petit L, Sarubbo S. The inferior fronto-occipital fascicle: a century of controversies from anatomy theaters to operative neurosurgery. J Neurosurg Sci 2021; 65:605-615. [PMID: 33940782 DOI: 10.23736/s0390-5616.21.05360-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Since its first description in the early 19th century, the inferior frontooccipital fascicle (IFOF) and its anatomo-functional features were neglected in the neuroscientific literature for the last century. In the last decade, the rapid development of in vivo imaging for the reconstruction of white matter (WM) connectivity (i.e., tractography) and the consequent interest in more traditional ex vivo methods (postmortem dissection) have allowed a renewed debate about course, termination territories, anatomical relationships, and functional roles of this fascicle. EVIDENCE ACQUISITION We reviewed the main current knowledge concerning the structural and functional anatomy of the IFOF and possible implications in neurosurgical practice. EVIDENCE SYNTHESIS The IFOF connects the occipital cortex, the temporo-basal areas, the superior parietal lobule, and the pre-cuneus to the frontal lobe, passing through the ventral third of subinsular WM of the external capsule. This wide distribution of cortical terminations provides multimodal integration between several functional networks, including language, non-verbal semantic processing, object identification, visuo-spatial processing and planning, reading, facial expression recognition, memory and conceptualization, emotional and neuropsychological behavior. This anatomo-functional organization has important implication also in neurosurgical practice, especially when approaching the frontal, insular, temporo-parieto-occipital regions and the ventricular system. CONCLUSIONS The IFOF is the most extensive associative bundle of the human connectome. Its multi-layer organization reflects important implications in many aspects of brain functional processing. Accurate awareness of IFOF functional anatomy and integration between multimodal datasets coming from different sources has crucial implications for both neuroscientific knowledge and quality of neurosurgical treatments.
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Affiliation(s)
- Alessandro DE Benedictis
- Neurosurgery Unit, Department of Neurosciences, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy -
| | - Carlo E Marras
- Neurosurgery Unit, Department of Neurosciences, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Laurent Petit
- Groupe d'Imagerie Neurofonctionnelle, Institut Des Maladies Neurodégénératives, UMR 5293, CNRS, CEA University of Bordeaux, Bordeaux, France
| | - Silvio Sarubbo
- Division of Neurosurgery, Structural and Functional Connectivity Lab, S. Chiara Hospital, Trento, Italy
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Abstract
PURPOSE OF REVIEW Access to epilepsy surgery is rapidly growing throughout the world. While it is an established and effective treatment for seizures, epilepsy surgery has the potential to exacerbate cognitive comorbidities of the condition. RECENT FINDINGS Not all surgical patients experience a postoperative decline in cognitive function. Postoperative cognitive function depends upon the functional integrity of the tissue to be removed and the functional reserve of the structures that remain in situ. While developments in surgical technique can reduce the cognitive morbidity of epilepsy surgery, the same procedure may result in different cognitive outcomes for different candidates, depending on their preoperative characteristics and postoperative trajectories. Multivariate models can be used to identify those most at risk of cognitive decline. There remains a significant lack of research into clinical interventions aimed at reducing the impact of surgically induced cognitive deficits on the lives of the patients who experience them. SUMMARY Accurate identification of the cognitive risks associated with surgery, based on an individual's personal risk profile rather than the generic risks associated with the procedure, is now recognized as a mandatory part of the preoperative evaluation and is one of the pillars of informed consent for the procedure.
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Al-Ezzi A, Kamel N, Faye I, Gunaseli E. Review of EEG, ERP, and Brain Connectivity Estimators as Predictive Biomarkers of Social Anxiety Disorder. Front Psychol 2020; 11:730. [PMID: 32508695 PMCID: PMC7248208 DOI: 10.3389/fpsyg.2020.00730] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Accepted: 03/25/2020] [Indexed: 12/13/2022] Open
Abstract
Social anxiety disorder (SAD) is characterized by a fear of negative evaluation, negative self-belief and extreme avoidance of social situations. These recurrent symptoms are thought to maintain the severity and substantial impairment in social and cognitive thoughts. SAD is associated with a disruption in neuronal networks implicated in emotional regulation, perceptual stimulus functions, and emotion processing, suggesting a network system to delineate the electrocortical endophenotypes of SAD. This paper seeks to provide a comprehensive review of the most frequently studied electroencephalographic (EEG) spectral coupling, event-related potential (ERP), visual-event potential (VEP), and other connectivity estimators in social anxiety during rest, anticipation, stimulus processing, and recovery states. A search on Web of Science provided 97 studies that document electrocortical biomarkers and relevant constructs pertaining to individuals with SAD. This study aims to identify SAD neuronal biomarkers and provide insight into the differences in these biomarkers based on EEG, ERPs, VEP, and brain connectivity networks in SAD patients and healthy controls (HC). Furthermore, we proposed recommendations to improve methods of delineating the electrocortical endophenotypes of SAD, e.g., a fusion of EEG with other modalities such as functional magnetic resonance imaging (fMRI) and magnetoencephalograms (MEG), to realize better effectiveness than EEG alone, in order to ultimately evolve the treatment selection process, and to review the possibility of using electrocortical measures in the early diagnosis and endophenotype examination of SAD.
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Affiliation(s)
- Abdulhakim Al-Ezzi
- Centre for Intelligent Signal and Imaging Research, Department of Electrical and Electronic Engineering, Universiti Teknologi PETRONAS, Seri Iskandar, Malaysia
| | - Nidal Kamel
- Centre for Intelligent Signal and Imaging Research, Department of Electrical and Electronic Engineering, Universiti Teknologi PETRONAS, Seri Iskandar, Malaysia
| | - Ibrahima Faye
- Centre for Intelligent Signal and Imaging Research, Department of Electrical and Electronic Engineering, Universiti Teknologi PETRONAS, Seri Iskandar, Malaysia
| | - Esther Gunaseli
- Psychiatry Discipline Sub Unit, Universiti Kuala Lumpur, Ipoh, Malaysia
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