Preoperative MRI predicts outcome of temporal lobectomy

Berkovic, Samuel F.; McIntosh, Anne M.; Kalnins, Renate M; Jackson, Graeme D.; Fabinyi, Gavin; Brazenor, Graham; Bladin, Peter F.; Hopper, John L.

doi:10.1212/wnl.45.7.1358

Cited by 470 publications

(348 citation statements)

References 0 publications

Supporting

Mentioning

308

Contrasting

Unclassified

Order By: Relevance

“…It was previously suggested that if there is hippocampal neuronal damage, it will cause ipsilateral fornix and mammilary body atrophy as a result of transneuronal degeneration 7 . Adjacent parahippocampal gyrus white matter (PHGWM) reduction 1,5,8,9 can be another associated finding (Figs 6 and 10) and is thought to be the cause of recurrent seizures after the first surgery (10-20%) 10 , as reported in previous studies. These patients were submitted to a new surgical intervention for extension of mesial ressected areas, with good results in most of the cases 11,12 .…”

supporting

confidence: 62%

Analysis of parahippocampal gyrus in 115 patients with hippocampal sclerosis

Ferreira

Oliveira

Amaral

et al. 2003

Arq. Neuro-Psiquiatr.

View full text Add to dashboard Cite

-Purpose: Analysis of the parahippocampal gyrus (PHG) involvement in 115 patients with hippocampal sclerosis (HS) by MR imaging. The simultaneous occurrence of ipsilateral fornix (F) and mamillary body (MB) volume loss was checked also. These findings were correlated with the side of hippocampal involvement, the sex, patient´s age, and the symptoms onset. Method: The MR images of 115 patients with HS were studied retrospectively. All the examinations were performed on 1.5 T units (SIGNA, GE, Milwaukee, WI) and included high resolution coronal T2-weighted images (3 mm thickness, 0.6 mm gap). Results: The patient's age ranged between 3.5 and 80 years (mean 34.1); 62 (53.9%) were female and 53 (46.1%) were male. There were HS on the left side in 53 (46.0%), on the right side in 51 (44.3%), and bilateral in 11 (9.7%). In 43 (37.3%) cases there were ipsilateral PHG volume loss and signal hyper intensity on T2-weighted imaging. In 29 (25.2%) cases there were ipsilateral fornix volume loss and in 10 (34.5%) of this there were also ipsilateral MB changes. In abnormal PHG, 23 (53.4%) were on the left side, 17 (39.5%) were on the right side, and 3 (7.1%) were bilateral. There were fornix changes in 15 (34.8%) cases and MB volume loss in 5 (11.6%) cases. Pertinent clinical data were obtained in only 18 (41.8%) of the PHG lesion cases and 11 (61.1%) of these patients had epileptic attacks for more than 20 years before the examination. Conclusion: PHG involvement must be investigated in patients with HS and we suggest that the term mesial temporal sclerosis should be used only if there are also changes at this anatomical site.KEY WORDS: hippocampal sclerosis, epilepsy, MRI, parahippocampal gyrus.Análise do giro para-hipocampal em pacientes com esclerose hipocampal: estudo de 115 casos Análise do giro para-hipocampal em pacientes com esclerose hipocampal: estudo de 115 casos Análise do giro para-hipocampal em pacientes com esclerose hipocampal: estudo de 115 casos Análise do giro para-hipocampal em pacientes com esclerose hipocampal: estudo de 115 casos Análise do giro para-hipocampal em pacientes com esclerose hipocampal: estudo de 115 casos RESUMO -Objetivo: Analisar o envolvimento do giro para-hipocampal (GPH) em 115 pacientes com esclerose hipocampal (EH) à RM. Estudou-se a porcentagem dos casos com redução volumétrica do fórnix (F) e corpo mamilar (CM) ipsilaterais, lado acometido, sexo, idade e tempo de convulsão. Método: Estudo retrospectivo de 115 casos retirados do nosso arquivo. Foram realizados cortes coronais STIR (3mm de espessura com 0,6mm de espaçamento) em aparelhos GE, Signa Horizon, LX e CVI, 1,5T. Resultados: Nos 115 casos estudados, a idade dos pacientes variava entre 3,5 e 80 anos (média 34,1 anos); 62(53,9%) eram mulheres e 53(46,1%) eram homens; 53(46,0%) à esquerda, 51(44,3%) à direita e 11(9,7%) bilaterais; 43(37,3%) apresentavam GPH com dimensões reduzidas e hipersinal ipsilateral, 29(25,2%) fornix reduzido ipsilateralmente e destes, 10(34,5%) tinham CM alterado ipsilateral. Dos GPH alterado...

show abstract

supporting

confidence: 62%

Analysis of parahippocampal gyrus in 115 patients with hippocampal sclerosis

Ferreira

Oliveira

Amaral

et al. 2003

Arq. Neuro-Psiquiatr.

View full text Add to dashboard Cite

show abstract

“…However, up to 40% of patients with mTLE and HS will continue to experience persistent postoperative seizures 9. There has therefore been an attempt in some studies to identify brain alterations, most typically increased atrophy from T1‐weighted MRI, in patients with continued seizures relative to those rendered seizure free.…”

mentioning

confidence: 99%

Thalamotemporal alteration and postoperative seizures in temporal lobe epilepsy

Keller

Richardson

Schoene-Bake

et al. 2015

Annals of Neurology

110

127

View full text Add to dashboard Cite

ObjectiveThere are competing explanations for persistent postoperative seizures after temporal lobe surgery. One is that 1 or more particular subtypes of mesial temporal lobe epilepsy (mTLE) exist that are particularly resistant to surgery. We sought to identify a common brain structural and connectivity alteration in patients with persistent postoperative seizures using preoperative quantitative magnetic resonance imaging and diffusion tensor imaging (DTI).MethodsWe performed a series of studies in 87 patients with mTLE (47 subsequently rendered seizure free, 40 who continued to experience postoperative seizures) and 80 healthy controls. We investigated the relationship between imaging variables and postoperative seizure outcome. All patients had unilateral temporal lobe seizure onset, had ipsilateral hippocampal sclerosis as the only brain lesion, and underwent amygdalohippocampectomy.ResultsQuantitative imaging factors found not to be significantly associated with persistent seizures were volumes of ipsilateral and contralateral mesial temporal lobe structures, generalized brain atrophy, and extent of resection. There were nonsignificant trends for larger amygdala and entorhinal resections to be associated with improved outcome. However, patients with persistent seizures had significant atrophy of bilateral dorsomedial and pulvinar thalamic regions, and significant alterations of DTI‐derived thalamotemporal probabilistic paths bilaterally relative to those patients rendered seizure free and controls, even when corrected for extent of mesial temporal lobe resection.InterpretationPatients with bihemispheric alterations of thalamotemporal structural networks may represent a subtype of mTLE that is resistant to temporal lobe surgery. Increasingly sensitive multimodal imaging techniques should endeavor to transform these group‐based findings to individualize prediction of patient outcomes. Ann Neurol 2015;77:760–774

show abstract

“…Consistent with a lack of consensus concerning the optimal anatomic target, the reported seizure-free outcomes are variable, although some etiologic associations seem to exist. Higher success rates appear to be achieved when mesial temporal sclerosis or focal lesions are present, whereas lower cure rates accompany normal preoperative brain imaging studies or unremarkable histopathology (3,8,9).…”

mentioning

confidence: 99%

“…Potential reasons for failures include nonfocal or bitemporal lobe epilepsy, unresected lesion, perilesional or postsurgical gliosis, extratemporal lesions, or diffuse cerebral disease, as may be present after meningitis or encephalitis (8).…”

mentioning

confidence: 99%

See 1 more Smart Citation

Optimizing Epilepsy Surgery with Intraoperative MR Imaging

Kaibara¹,

Myles²,

Lee

et al. 2002

Epilepsia

View full text Add to dashboard Cite

Summary: Purpose:The surgical treatment of medically intractable temporal lobe epilepsy includes the resection of temporal lobe structures. Although the reported seizure-free outcomes are highly variable, there is growing evidence that the extent of resection of the mesiotemporal lobe directly correlates with seizure control.Methods: A moveable, high-field intraoperative magnetic resonance (MR) system was used to monitor and optimize the resection of the amygdala and hippocampus in 14 epilepsy patients. Fourteen patients with intractable seizures of temporal lobe origin underwent standard preoperative investigations including MR imaging, EEG telemetry, single-photon emission computed tomography, and neuropsychologic and sodium amytal testing. Anterior temporal lobectomy was performed on 10 patients, whereas four were treated with selective amygdalohippocampectomy. Intraoperative electrocorticography was applied as required. For all procedures, the objective was to resect the amygdala completely, and hippocampus to the posterior margin of the brainstem.Results: Interdissection intraoperative MR imaging taken when optimal resection was thought to have been achieved revealed residual unresected amygdala or hippocampus in seven of 14 patients. An unexpected acute hematoma was found in one patient. At 17 months' follow-up, 13 (93%) of 14 patients are seizure free or have significantly improved seizure control.Conclusions: The mobile high-field intraoperative MR system provides high-resolution images without restriction on surgical instruments or techniques. The ability to identify and resect residual mesial temporal lobe targets before craniotomy closure is of potentially tremendous value in optimizing seizure control.

show abstract

Preoperative MRI predicts outcome of temporal lobectomy

Cited by 470 publications

References 0 publications

Analysis of parahippocampal gyrus in 115 patients with hippocampal sclerosis

Analysis of parahippocampal gyrus in 115 patients with hippocampal sclerosis

Thalamotemporal alteration and postoperative seizures in temporal lobe epilepsy

Optimizing Epilepsy Surgery with Intraoperative MR Imaging

Contact Info

Product

Resources

About