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epilepsy surgery for tuberous sclerosis complex： a case report and literature review

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Chinese Medical Journal 2008年第10期121卷 959-960页

作者： ZHAO Guo-guang SHAN Yong-zhi DU Jian-xin LING Feng Department of Neurosurgery Xuanwu Hospital Capital Medical University Beijing 100053 China

Tuberous sclerosis complex （TSC） is a multisystem genetic disorder with variable phenotypic *** is the most common neurological complication and up to 80%-90% of the individuals with TSC suffer from epilepsy at some point in their lifetime. Developmental delay, intellectual impairment, autism, behavioral problems, and neuropsychiatric disorders occur commonly in individuals with TSC and may be associated with poorly controlled epilepsy.~ In this paper we reported a case report of TSC, focusing on the patient＇s clinical symptom, surgical aspects and neuropathology through a comprehensive analysis.

关键词： tuberous sclerosis complex intractable epilepsy epilepsy surgery histopathology

Posterior quadrant epilepsy surgery: case series of a South American hospital

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Acta Epileptologica 2022年第4期5卷 227-232页

作者： Mario Velasco Andrés Felipe Cárdenas-Cruz María Paula Aguilera-Pena Alejandro Vargas-Moreno Daniel Nariño Juan Carlos Pérez Oscar Zorro Pontificia Universidad Javeriana Cr16#75-32 apt 203BogotaColombia110221 Neuroscience Department Hospital Universitario San IgnacioCr16#75-32 apt 203BogotaColombia110221

Background Posterior quadrant epilepsy(PCE)is a type of focal epilepsy that originates in the parietal lobe,occipital lobe,and the parietal-occipital border of the temporal lobe,or in any combination of these *** has a low incidence,but it can cause a great burden in disability-adjusted life *** this retrospective cohort,patients of all ages with a diagnosis of PCE between 2006 and 2019 were evaluated in a referral center in Bogotá,Colombia.A descriptive analysis of demographic data,clinical history,imaging findings,type of surgery,histopathological diagnosis,outcome,and follow-up was performed using the Engel *** This study included refractory PCE patients of all ages who were evaluated by the epilepsy surgery group of the Hospital Universitario San Ignacio from 2006 to ***,imaging and surgical variables were obtained from the medical records and *** Thirteen patients were included in the study,including 8 males and 5 *** mean age of diagnosis was 8.8 years,while the mean age of surgery was 25 *** most frequent clinical finding was intellectual *** most common findings on magnetic resonance imaging were encephalomalacia and *** 61.5%of the patients,the lateralization of video-EEG matched with brain magnetic resonance imaging *** most frequent types of surgery performed were lobectomies,lesionectomies and cortical ***-freedom was achieved in approximately one third of the patients;however,more than half of the patients were free of disabling seizures or had significant improvement after *** PCE surgery is scarcely performed worldwide,therefore the effectiveness and outcomes are quite variable in the reported *** this study,we show that patients with PCE can obtain great benefits in terms of reduction of seizures with a low risk of surgical complications,encouraging the use of this type of procedure in carefully selected patients.

关键词： Posterior cortex epilepsy surgery Posterior quadrant epilepsy

Consensus on pediatric epilepsy Che up surgery for young children:an investigation by the China Association Against epilepsy task force on epilepsy surgery

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Acta Epileptologica 2023年第3期6卷 127-138页

作者： Lixin Cai Kai Zhang Wenjing Zhou Xiaoqiu Shao Yuguang Guan Tao Yu Ye Wu Shuhua Chen Rui Zhao Shuli Liang Xun Wu Guoming Luan Yuwu Jiang Jianguo Zhang Xiaoyan Liu Pediatric epilepsy Center Peking University First HospitalBejing 100000China Department of Neurosurgery Bejing Tiantan HospitalCapital Medical UniversityBeijing100000China Department of epilepsy Center Tsinghua University Yuquan HospitalBejing 100000China Department of Neurology Beijing Tiantan HospitalCapital Medical UniversityBeijing 100000China Department of Neurosurgery Sanbo Brain HospitalCapital Medical UniversityBejing100000China Department of Functional Neurosurgery Xuanwu HospitalCapital Medical UniversityBejing 100000China Department of Pediatrics Peking University First HospitalBeijing100000China Department of Neurology Bejing Children's HospitalCapital Medical University100000 BeijingChina Department of Neurosurgery Children's Hospital of Fudan University.Shanghai.200000China io Department of Functional Neurosurgery Bejing Children's HospitalCapital Medical UniversityBejing 100000China Department of Neurology Peking University First HospitalBejing 100000China

Researchers have widely acknowledged the therapeutic value of epilepsy surgery for drug-resistant ***-theless,there is a substantial gap in the surgical treatment for appropriate candidates owing to several factors,particularly in the population of young *** standardize the protocols of preoperative evaluation and sur-gery of young children for epilepsy surgery,the China Association Against epilepsy has appointed an expert task force to standardize the protocols of preoperative evaluation and surgery in pediatric epilepsy *** adopted the modifed Delphi method and performed two rounds of surveys through an anonymous inquiry among 75 experts from four subgroups including pediatric neurologists,epileptologists,pediatric epilepsy surgeons,and functional *** survey contents contained:(1)the participants,comprising children aged≤6 years;(2)adopted DRE definition proposed by the International League Against epilepsy in 2010;and(3)investigated epilepsy surgery,principally referring to curative epilepsy *** neuromodulation therapies were excluded because of the differences in treatment mechanisms from the above-mentioned *** to the Delphi process,a con-sensus was achieved for most aspects by incorporating two rounds of surveys including preoperative assessment,sur-gical strategies and techniques,and perioperative and long-term postoperative management,despite controversial opinions on certain *** hope the results of this consensus will improve the level of surgical treatment and man-agement of intractable epilepsy in young children.

关键词： epilepsy surgery Young children Consensus

Neuroendoscopy in epilepsy surgery

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World Journal of Neuroscience 2016年第2期6卷 114-118页

作者： Oscar Humberto Jimenez-Vazquez Norma Nagore Department of Neurosurgery State General Hospital Morelia México Nagore Norma Facultad de QFB UMSNH Morelia México

epilepsy surgery has constantly evolved in various fields of knowledge. Surgical criteria have shifted from standard procedures to individualized forms of treatment, depending on physiological tests and specific imagenology findings in an individual patient. New instruments and applications based upon older instruments have been described in the treatment of epilepsy surgery, including the use of endoscopes. Frequent indications of neuroendoscopy in epilepsy surgery have been mostly to assist in open procedures, particularly when fluid-filled spaces are present within the surgical field, such as cystic parasites, tumors, arachnoid, or other types of cysts. Other indications certainly include cases of temporal lobe epilepsy, where ventricular exploration precedes intraventricular electrode placing as a tool to localize epileptogenic zones. Although described several years ago, there has been a recent trend in performing endoscopy-assisted section of the corpus-callosum in patients with generalized seizures. As neurosurgical instruments and techniques continue their progress, endoscopy will be included more frequently as part of the armamentarium in epilepsy surgery.

关键词： Neuroendoscopy epilepsy surgery Intracranial Cysts

The Utility of Further EEG and surgery to Treat Intractable epilepsy after Anterior Corpus Callosotomy

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The Utility of Further EEG and Surgery to Treat Intractable ...

The utility of further EEG and surgery to treat intractable epilepsy after anterior corpus callosotomy

2011年浙江省神经外科学学术年会

作者： Ashwini D Sharan Ryan Hays Michael Sperling Department of Neurosurgery Thomas Jefferson University HospitalPhiladelphiaPAUSA Department of Neurology Jefferson Comprehensive Epilepsy CenterThomas Jefferson University HospitalPhiladelphiaPAUSA

Purpose To investigate if seizure outcomes in anterior corpus callosotomy patients(ACC) can be improved by placement of subdural electrodes,video-EEG monitoring and additional focal resection. Methods The study involved 120 patients,of whom 61 had anterior corpus callosotomy alone(ACCA),18 received ACC plus resection in the same surgery(ACCSR),19 had ACC followed by subdural electrodes/ VEEG monitoring leading to the identification of a seizure focus amenable to resection in a separate surgery (ACCMR),and 22 patients had ACC and further EEG evaluation with or without electrode placement but no further resection(ACCNR).Seizure outcome was analyzed at follow-up,ranging from 7-12 months after ACC and *** The class 1 outcome of the ACCMR and ACCSR groups was 42.10%and 38.88%, *** surgical outcomes for the ACCMR and ACCSR groups were relatively better than the ACCA and ACCNR *** outcomes showed that ACCMR was the most effective *** In some patients,ACC may allow for the discovery of a resectable epileptogenic *** patients in whom an epileptogenic focus is identified after ACC have an overall better outcome than those that undergo ACC alone without further ***,the patients in whom a resectable focus is not identified after ACC with additional intracranial monitoring tend to have a similar outcome as those ACC patients that never underwent any further ***,there may be value in monitoring all patients for a resectable seizure focus after ACC.

关键词： Anterior corpus callosotomy epilepsy surgery Intractable epilepsy

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The utility of further EEG and surgery to treat intractable ...

DIAGNOSTIC VALUE OF INTERICTAL DIFFUSION-WEIGHTED IMAGING IN EVALUATION OF INTRACTABLE TEMPORAL LOBE epilepsy

2011中华医学会神经外科学学术会议

作者： Ryan Hays Michael Sperling Ashwini D Sharan Department of Neurosurgery Thomas Jefferson University Hospital Philadelphia PA USA Department of Neurology Jefferson Comprehensive Epilepsy Center Thomas Jefferson University Hospital Philadelphia PA USA

关键词： anterior corpus callosotomy epilepsy surgery intractable epilepsy

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Chinese Medical Sciences Journal 2008年第2期23卷 68-72页

作者： Rui Wang Sa-ying Li Min Chen Cheng Zhou Department of Radiology Beijing Hospital Beijing 100730

Objective To explore the ability of interictal diffusion-weighted imaging(DWI)to localize the temporal lobe of seizure origin and to predict postoperative seizure control in patients with temporal lobe epilepsy(TLE).Methods Twenty-seven patients with intractable TLE considered for surgery and 19 healthy volunteers were studied with conventional magnetic resonance imaging(MRI)and *** diffusion coefficients(ADCs)of bilateral hippocampi in both TLE patients and control subjects were *** to either temporal lobe with hippocampal ADC was based on the threshold values derived from ±1SD of right/left ratios in normal *** the postoperative pathology was *** Hippocampal ADCs were higher on the side of surgery compared with those on the contralateral side as well as the ipsilateral side in control subjects [resected side(109.8±7.3)×10-5 cm2/s,contralateral side(91.7±4.7)×10-5 cm2/s,control subjects(81.6±5.2)×10-5 cm2/s,all P0.05).Conclusions Conventional MRI is a sensitive method to detect hippocampal *** of the right/left hippocampal ADC ratio for lateralizing to the side of surgery is very high,but it isn't a better predictor of surgical outcome.

关键词： magnetic resonance imaging temporal lobe epilepsy epilepsy surgery

Vagus Nerve Stimulation for Pediatric and Adult Patients with Pharmaco-resistant epilepsy

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Chinese Medical Journal 2015年第19期128卷 2599-2604页

作者： Fan-Gang Meng Fu-Min Jia Xiao-Hui Ren Yan Ge Kai-Liang Wang Yan-Shan Ma Ming Ge Kai Zhang Wen-Han HU Xin Zhang Wei Hu Jian-Guo Zhang Department of Functional Neurosurgery Beijing Neurosurgical InstituteCapital Medical UniversityBeijing 100050China Beijing Key Laboratory of Neuromodulation Beijing Municipal Science and Technology CommissionBeijing 100050China National Engineering Laboratory for Neuromodulation School of Aerospace EngineeringTsinghua UniversityBeijing 100084China Department of Neurosurgery Beijing Tiantan HospitalCapital Medical UniversityBeijing 100050China Department of Neurosurgery Beijing Fengtai HospitalBeijing 100071China Beijing Key Laboratory of NeuromodulationBeijing Municipal Science and Technology CommissionBeijing 100050China Department of Neurology University of Florida Gainesvilie FL 32607 USA

Background：Over past two decades,vagus nerve stimulation （VNS） has been widely used and reported to alleviate seizure frequency worldwide,however,so far,only hundreds of patients with pharmaco-resistant epilepsy （PRE） have been treated with VNS in China's *** study aimed to evaluate the effectiveness of VNS for Chinese patients with PRE and compare its relationship with age cohort and ***：We retrospectively assessed the clinical outcome of 94 patients with PRE,who were treated with VNS at Beijing Fengtai Hospital and Beij ing Tiantan Hospital between November 2008 and April 2014 from our database of 106 consecutive *** clinical data analysis was retrospectively ***：Seizure frequency significantly decreased with VNS therapy after intermittent stimulation of the vagus *** last follow-up,we found McHugh classifications of Class Ⅰ in 33 patients （35.1％）,Class Ⅱ in 27 patients （28.7％）,Class Ⅲ in 20 patients （21.3％）,Class Ⅳ in 3 patients （3.2％）,and Class Ⅴ in 11 patients （l 1.7％）.Notably,8 （8.5％） patients were seizure-free while ≥50％ seizure frequency reduction occurred in as many as 60 patients （63.8％）.Furthermore,with regard to the modified Engel classification,12 patients （12.8％） were classified as Class Ⅰ,l l patients （11.7％） were classified as Class Ⅱ,37 patients （39.4％） were classified as Class Ⅲ,34 patients （36.2％） were classified as Class Ⅳ.We also found that the factors of gender or age are not associated with clinical ***：This comparative study confirmed that VNS is a safe,well-tolerated,and effective treatment for Chinese PRE *** reduced the seizure frequency regardless of age or gender of studied patients.

关键词： epilepsy surgery Pharmaco-resistant epilepsy Vagus Nerve Stimulation

Predictors of outcome in the surgical treatment for epilepsy

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Chinese Medical Journal 2011年第24期124卷 4166-4171页

作者： YANG Xiao-lan LU Qin-chi XU Ji-wen WANG Gui-song LIU Qiang Department of Neurology Renji Hospital Shanghai Jiao Tong University School of Medicine Shanghai 200127 China Department of Neurosurgery Renji Hospital Shanghai Jiao Tong University School of Medicine Shanghai 200127 China Department of Pathology Renji Hospital Shanghai Jiao Tong University School of Medicine Shanghai 200127 China

Background Knowledge about factors influencing the prognosis of resective epilepsy surgery can be used to identify which patients are most suitable for surgical treatment. The aim of this study was to identify preoperative prognostic factors associated with the chance of achieving long-term seizure freedom. Methods We retrospectively reviewed seizure outcomes and clinical, electroencephalography （EEG）, magnetic resonance imaging （MRI）, histopathology, and surgical variables from 99 epilepsy surgery patients with at least one year of postoperative follow-up. Seizure outcomes were categorized based on the modified classification by the International League Against epilepsy. Results We found that the seizure-free rate was 27.9% after one year, and that it stabilized at about 20.0% between two and six years after surgery. Univariate analysis showed that medial temporal lobe epilepsy with hippocampal sclerosis, MRI with visible focal lesions concordant with EEG, and regional ictal EEG and electrocorticography patterns were associated with a favorable surgical outcome. On the other hand, seizure recurrence within six months, incomplete focus resection, and surgical complications were associated with a poor outcome. Multivariate analysis showed that medial temporal lobe epilepsy with hippocampal sclerosis and MRI with visible focal lesions were independent presurgical predictors of a favorable outcome （P 〈0.01）. Seizure recurrence within six months was the only significant independent predictor associated with a poor outcome （P〈0.01）. Conclusion Hippocampal sclerosis and abnormal MRI findings are strongly associated with a favorable surgical outcome, whereas seizure recurrence within six months is associated with a poor outcome.

关键词： epilepsy surgery seizure outcome focal cortical dysplasia magnetic resonance imaging electroencephalography