AIM:To investigate the relationship between clinical features and prognosis of the hippocampal sclerosis (HS) cases and International League Against Epilepsy (ILAE) histopathology classification. MATERIAL and METHODS:A hundred patients with refractory epilepsy who were operated with the diagnosis of the Mesial Temporal Lobe Epilepsy were included in the study. Socio-demographic characteristics, clinical and family histories, post-operative ILAE and Engel epilepsy scores and diagnostic tests were recorded. At the same time, all of the pathological specimens were classified according to the new semi-quantitative ILAE classification. A significant statistical relationship was investigated between clinical data and HS-ILAE groups.RESULTS: There were 36 male 64 female patients. The mean follow-up period was 6.5 years. 75% of the cases were HS-ILAE type 1, 19% HS-ILAE type 2, 6% were unidentifiable. FCD3A was detected in 3 patients. The HS-ILAE Type 2 ratio was high on the rightsided cases. In addition, HS-ILAE Type 1 ratio was high in patients with early seizure onset and long duration of epilepsy. There was no significant relationship between long-term ILAE and Engel epilepsy outcome scores and HS-ILAE types. CONCLUSION:Resection of mesiotemporal structures in hippocampal sclerosis provides seizure control in at least two-thirds of cases. Histopathological findings may help us understand the epileptogenicity-prognosis of HS. The relationship between ILAE histopathology classification and clinical factors will become more obvious in the future. According to our study, there was a relationship between onset age of epilepsy, epilepsy duration, lesion side and HS-ILAE types. The reinforcement of these relationships with larger series will benefit clinicians.
AIM:To investigate the surgical value of MER recordings and improve surgical technique by demonstrating the consistency between preoperative radiological STN volume and intraoperative neurophysiological STN length. MATERIAL and METHODS:Sixty-one patients with PD were enrolled. The volumes of the STN were measured using magnetic resonance images 3-dimensional volume reconstructions of stereotactic magnetic resonance images. MER were performed in all patient and the maximal electrophysiologic length of the STN was recorded each patient. In the postoperative period, the permanent electrode was modeled and reconstructed in 3D, and the longest distance traveled in the STN was calculated. RESULTS:A total of 61 patients who underwent surgery between 2012-2022 were included in the study. Thirty-six (59%) of the patients were male, and 25 (41%) were female. A total of 122 STNs were performed with 166 electrodes. The most common end alignment used was center with 86. STN length averaged 4.9 mm (0-10.5 mm). The mean STN volume was 0.11 cm 3 . The STN Volume of men were significantly higher than women. The STN Length, Volume, and the target MER length showed a positive correlation significantly. CONCLUSION:With radiological advances, it is possible to better visualize the target points and define the boundaries better, and direct methods can be used more in making targeting plans. MER records obtained during surgery and STN dimensions in presurgical planning show compatibility, and it is seen that there may be differences between the right and left sides because of brain shifting. Although radiology is increasingly providing better support, electrophysiological recordings provides real-time information on the electrodes' locations and give the opportunity to surgical team choosing alternative target.
Immune checkpoint molecules (ICM) regulate the immune system's response to different antigens.
Objective: Cingulum bundle is a major fiber tract that extends into the cingulate gyrus and reaches to the temporal tip. It carries striatal, projection, association and commissural fibers. Therefore, it has an important role in the diagnosis and treatment of many psychiatric and neurological diseases. Our aim; to describe the structure of the cingulum fiber, to reveal its neighborhood and connections and to find an anatomical-functional classification that clinicians can use. Method: Ten human cadaver brains were prepared by using the Klingler method. In all brains, medial to lateral, inferior to superior, and superior to inferior dissection were performed. Dissection was performed under microscopic magnification. All dissection stages were visualized with the camera. Results: Singulum fiber is a long and major fiber of the brain that is approximately 9-10 cm. It starts from the orbitofrontal cortex and extends on the corpus callosum. It turns to the lateral and inferior on the splenium level. And it reaches the temporal pole. It divides into 5 segments. These are subgenual, anterior cingulate, mid-cingulate, retrosplenial and parahippocampal cingulum segments. Each segment has different projections. Conclusions: The functional and anatomical relationships and segments of the cingulum bundle will guide the diagnosis and treatment of some psychiatric and neurological diseases.
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