The Wada test might predict postoperative fine finger motor deficit after hemispherotomy

Fujimoto, Ayataka; Okanishi, Tohru; Nishimura, Mitsuyo; Kanai, Sotaro; Sato, Keishiro; Enoki, Hideo

doi:10.1016/j.jocn.2017.08.011

Cited by 8 publications

(7 citation statements)

References 16 publications

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“…Hemispherectomy has been used successfully for hemispherical drug-resistant epilepsy. A few studies have focused on predicting postoperative motor function with invasive [13] or non-invasive methods without direct morphologic change evidence [2,14,15]. Here, we presented a report on the evaluation of residual motor function by direct morphological reconstruction of PTs, which had higher sensitivity and specificity than TMS.…”

Section: Discussionmentioning

confidence: 97%

Assessing structural integrity of the pyramidal tracts with diffusion spectrum imaging to predict postoperative motor function in pediatric epilepsy patients with hemispherectomy

Zhang

Wei

Lü

et al. 2023

Acta Epileptologica

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Background Hemispherectomy is an effective treatment option for patients with drug-resistant epilepsy caused by hemispheric lesions. However, patients often have deterioration of their motor functions postoperatively. Diffusion spectrum imaging (DSI) was reliable in presenting the natural shape of the white matter fibers. At the same time, the natural sprawl pyramid tract (PT) might be more intuitive for predicting postoperative motor functions. Therefore, we assessed the motor functions by the natural shape revealed by DSI tractography. Methods Ten children with drug-resistant epilepsy who were candidates for hemispherectomy performed DSI PTs tractography and transcranial magnetic stimulation (TMS) for motor mapping. The motor function was evaluated with muscle strength and hand grasping capability. Pyramidal tract (PT) structural integrity and TMS mapping results were compared between patients who remained stable and those with deteriorated motor functions. Receiver operating characteristic (ROC) curves with PTs asymmetric ratio were analyzed to evaluate DSI tractography diagnostic value. Results All patients underwent DSI acquisition, while four patients successfully performed TMS. One patient had no response to TMS until the maximal machine output was reached. Four patients failed to perform TMS due to lacking cooperation. One patient was contraindicated to TMS. DSI successfully reconstructed the sharp angle fan-shaped PTs within the hemisphere. The accurate fiber distribution with fiber termination and thickness within the lesioned hemisphere was replicated with DSI tractography. No significance was found in patients’ age, sex, seizure frequency, or medication between patients with stable or deteriorated postoperative motor functions. DSI effectively predicted postoperative motor function as stable with damaged PTs, mild deterioration with atrophied PTs, and intact PTs with contralateral innervation confirmed by intracranial stimulation. The area under the curve (AUC) of DSI tractography was 0.84. According to ROC, the cut-off value of PTs asymmetric ratio was 11.5% with 100% sensitivity and 75% specificity. The sensitivity and specificity of TMS were 2/3 and 1/2, respectively. Conclusions The anatomic integrity of PTs with DSI tractography could effectively predict postoperative motor function after hemispherectomy. This enables neurosurgeons to inform patients and relatives about postoperative motor functions with direct morphological evidence of PTs to help them with their surgical decisions.

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Section: Discussionmentioning

confidence: 97%

Assessing structural integrity of the pyramidal tracts with diffusion spectrum imaging to predict postoperative motor function in pediatric epilepsy patients with hemispherectomy

Zhang

Wei

Lü

et al. 2023

Acta Epileptologica

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“…We manually injected diluted propofol (10 mg per 10 mL solution of saline) through the catheter. Scalp EEG was performed simultaneously to observe the diffuse slowing produced by the propofol in the injected hemisphere [ 13 ]. The Wada test showed left-hemisphere language dominance.…”

Section: Case Presentationmentioning

confidence: 99%

Non-Ruptured Temporal Lobe Dermoid Cyst Concomitant with Focal Cortical Dysplasia Causing Temporal Lobe Epilepsy—A Case Report and Literature Review

et al. 2021

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Background: Intracranial dermoid cyst is a rare, benign, nonneoplastic tumor-like lesion that could cause seizures, headache, and hydrocephalus. We hypothesized that the temporal lobe dermoid cyst in combination with other factors were causing the epileptic seizure. Methods: We encountered a 17-year-old girl with anti-seizure medication-resistant epilepsy secondary to dermoid cyst located in the temporal region depicted on magnetic resonance imaging (MRI). She showed neither symptoms of meningitis nor rupture of the cyst according to serial MRI. We hypothesized that temporal lobe dermoid cyst in combination with other factors, such as focal cortical dysplasia (FCD), etc., was causing epileptic seizures in this case. She underwent dermoid cyst removal surgery with resection of the tip of the antero-inferior temporal lobe. Results: Histopathological study showed multiple small intramedullary dermoid cysts in the left antero-inferior temporal lobe in addition to MRI lesions and FCD. Conclusion: A patient with medically intractable epilepsy secondary to left temporal lobe dermoid cyst showed multiple intramedullary dermoid cysts and focal cortical dysplasia that might have interacted to create epileptogenicity. To our knowledge, this is the first case report of dermoid cyst concomitant with FCD.

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“…A peri-insula hemispherotomy was performed [13,14]. This procedure disconnected association and commissural fibers in one hemisphere and interrupted radiation fibers such as pyramidal tracts.…”

Section: Hemispherotomymentioning

confidence: 99%

“…Post-operative hydrocephalus [10], hemiparesis [11], and hemianopsia [12] are major complications. However, as this procedure is regarded as a lastchoice, invasive treatment option [11], subtle but important deficits such as decreased dexterity of the hands [13] tend to be ignored. Therefore, little has been reported about minor, post-hemispherotomy complications including strabismus.…”

Section: Introductionmentioning

confidence: 99%

Hemispherotomy can cause post-operative strabismus

Fujimoto

Okanishi

Sato

et al. 2020

Brain and Development

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The Wada test might predict postoperative fine finger motor deficit after hemispherotomy

Cited by 8 publications

References 16 publications

Assessing structural integrity of the pyramidal tracts with diffusion spectrum imaging to predict postoperative motor function in pediatric epilepsy patients with hemispherectomy

Assessing structural integrity of the pyramidal tracts with diffusion spectrum imaging to predict postoperative motor function in pediatric epilepsy patients with hemispherectomy

Non-Ruptured Temporal Lobe Dermoid Cyst Concomitant with Focal Cortical Dysplasia Causing Temporal Lobe Epilepsy—A Case Report and Literature Review

Hemispherotomy can cause post-operative strabismus

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