Summary: Purpose:We report on the efficacy and safety of extended one-stage callosal section performed in a large and homogeneous series of patients.Methods: Seventy-six patients with Lennox-Gastaut (n = 28) and Lennox-like (n = 48) syndrome were studied (42 male patients; mean age, 11.2 years). All patients had multiple seizure types per day, including atonic, tonic-clonic, atypical absence, myoclonic, and tonic seizures. All of them were developmentally impaired. The EEG showed intense secondary bilateral synchrony in all of them. All patients were submitted to an extended, one-stage, callosal section, leaving only the splenium intact. Mean follow-up time was 4.7 years.Results: Worthwhile improvement (>50%) was noted in 69 of 76 patients; 52 patients had a ≥90% reduction in seizure frequency. Seven patients were seizure free after surgery. The seizure patterns most responsive to surgery were atonic (92%), atypical absence (82%), and tonic-clonic (57%) seizures. All patients had some degree of a transient acute postoperative disconnection syndrome. A consistent increase in attention level was observed postoperatively.Conclusions: We report one of the larger homogeneous series of patients submitted to callosotomy and are the first to report on the effectiveness and safety of performing extended callosal section in a single stage in this patient group. Extended callosal section should be considered a good palliative surgical option for suitable candidates. The increase in attention level was as useful as seizure control in improving quality of life of these patients.

aneurIsma Intraselar da carótIda Interna coexIstIndo com adenoma secretor de gh em pacIente acromegálIco

No abstract

-I n t roduction: Several pre-operative work-up protocols have been used while selecting epileptic patients for surg e ry among diff e rent centers. The relative value of the diff e rent available pre -o p e r ative tests is still under discussion. Objective: We re p o rt on the surgical outcome obtained in patients with re f r a c t o ry temporal lobe epilepsy associated to mesial temporal sclerosis (MTS) and who were evaluated p re-operatively by interictal EEG and MRI alone. Method: F o rty one patients with re f r a c t o ry unilateral temporal lobe epilepsy were evaluated using interictal EEG and MRI. MRI disclosed unilateral MTS in all patients. All patients had at least 4 interictal EEG re c o rdings. All patients were submitted to cort i c o -a m y gdalo-hippocampectomy at the side determined by MRI. Results: Interictal EEG showed unilateral epilept i f o rm discharges compatible with MRI findings in 37 patients; in four out of the 41 patients, bilateral discharges were found. Mean follow-up time was 4.3±1.1 years. Thirty-nine patients (95.1%) were classified as Engel's Class I (70.6% Engel I-A). Two patients (4.9%) were rated as Engel's Class II. All patients in whom bilateral discharges were found were in Engel's Class I. Pathological examination showed MTS in all patients. Conclusion: It is possible to adequately select good surgical candidates for temporal lobe resection using MRI and interictal EEG alone. In patients with MRI-defined MTS we should expect a postoperative remission rate higher then 90%. The finding of MTS on MRI is the most important good prognostic factor after temporal lobe resection.KEY WORDS: re f r a c t o ry temporal lobe epilepsy, hippocampal sclerosis, surg e ry, electro e n c e p h a l o g r a p h y, magnetic resonance image.Resultados cirúrgicos em pacientes com epilepsia refratária associada a esclerose mesial temporal unilateral definida por ressonância magnética RESUMO -I n t rodução: P rotocolos diferentes têm sido utilizados para a investigação pré-operatória de pacientes epilépticos nos diferentes centros. No entanto, o valor relativo de cada teste disponível ainda é c o n t roverso na literatura. Objetivo: Relatamos os resultados cirúrgicos de pacientes com epilepsia re f r a t á r i a do lobo temporal associada a esclerose hipocampal (EH), cuja investigação pré-operatória consistiu exclusivamente de estudo de eletrencefalograma (EEG) inter-crítico e ressonância magnética (RM). M é t o d o :Foram estudados 41 pacientes com epilepsia refratária do lobo temporal, avaliados pré-operatoriamente somente por meio de EEG interictal e RM encefálica. Foram incluídos somente pacientes em quem a RM mostrava apenas EH unilateral. Todos pacientes possuíam ao menos quatro EEG inter-ictais. Todos os pacientes foram submetidos a córtico-amígdalo-hipocampectomia no lado demonstrado pela RM. Resultados: A análise do EEG interictal revelou atividade epileptiforme unilateral, compatível com os achados da RM em 37 pacientes. Nos outros quatro pacientes, o EEG evidenciou compromet...