RESUMEN
INTRODUCTION: Abnormal MRI findings localizing to the mesial temporal lobe predict a favorable outcome in temporal lobe epilepsy surgery. The purpose of this study is to summarize the surgical outcome of patients who underwent a tailored antero-temporal lobectomy (ATL) with normal 1.5 T MRI. Specifically, factors that may be associated with favorable post-surgical seizure outcome are evaluated. METHODS: A retrospective analysis of the Rush University Medical Center surgical epilepsy database between 1992 and 2003 was performed. Patients who underwent an ATL and had a normal MRI study documented with normal volumetric measurements of hippocampal formations and the absence of any other MRI abnormality were selected for this study. Demographic information was collected on all patients. Seizure outcomes were evaluated using Engel's classification. A two-sided Fisher exact test with Bonferroni correction was performed in statistical analyses. RESULTS: Twenty-one (21) patients met the inclusion criteria of normal 1.5 T MRI and underwent a tailored temporal lobectomy. Mean age at time of surgery was 28 years (SD=8.1, range 11-44) and mean duration of the seizure disorder was 13.4 years (range 2-36). Risk factors for epilepsy included head injury (n=4), encephalitis (n=3), febrile seizures (n=2), and 12 patients had no risk factors. Pathological evaluation of resected tissue revealed no abnormal pathology in 12/21 patients (57%). After a mean 4.8 years follow-up post-surgical period, 15/21 (71%) patients were free of disabling seizures (Engel I outcome). At 8.3 years follow-up, 13/21 (62%) patients had similar results. Absence of prior epilepsy risk factors was the only statistically significant predictor of an Engel class I outcome (p<0.0022). CONCLUSION: Patients with medically intractable epilepsy and normal MRI appear to benefit from epilepsy surgery. Absence of prior epilepsy risk factors may be a positive prognostic factor.
Asunto(s)
Epilepsia del Lóbulo Temporal/cirugía , Cefalea/etiología , Hipocampo/patología , Adulto , Edad de Inicio , Anticonvulsivantes/uso terapéutico , Estudios Transversales , Escolaridad , Electroencefalografía , Epilepsia del Lóbulo Temporal/complicaciones , Epilepsia del Lóbulo Temporal/patología , Epilepsia del Lóbulo Temporal/fisiopatología , Femenino , Lateralidad Funcional , Cefalea/fisiopatología , Hipocampo/fisiopatología , Humanos , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Esclerosis , Factores Socioeconómicos , Resultado del Tratamiento , Ácido Valproico/uso terapéuticoRESUMEN
The history of neurosurgery at Rush University is tightly linked to the emergence of neurological surgery in the city of Chicago. Rush Medical College (RMC) was chartered in 1837 and in 1898 began an affiliation with the newly founded University of Chicago (UC), which proceeded to full union in 1923 as the Rush Medical College of the University of Chicago (RMC/UC). Percival Bailey founded neurosurgery at the RMC/UC and started a neurosurgery training program at the South Side campus in 1928. In 1935, Adrien Ver Brugghen started the first neurosurgical training program at the West Side campus at the Presbyterian Hospital/RMC. The major alliances with RMC have involved the Cook County Hospital, the Presbyterian Hospital, the UC, the University of Illinois, and St. Luke's Hospital. Those affiliations significantly shaped Rush neurosurgery. The RMC/UC union was dissolved in 1941, and an affiliation was formed with the University of Illinois in Chicago (UI). In 1959, Eric Oldberg, the founder and Chairman of Neurosurgery at the UI, became the next chairman of neurosurgery at Presbyterian-St. Luke's Hospital, incorporating it into the UI program. He was succeeded in 1970 by Walter Whisler, who founded the first independent and board-approved neurosurgery residency program in 1972 at the newly reactivated Rush Medical College. Whisler was chairman until 1999, when Leonard Cerullo, founder of the Chicago Institute of Neurosurgery and Neuroresearch, became chairman at Rush. Richard Byrne, appointed in 2007, is the current chairman of the Rush University neurosurgery department.
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Centros Médicos Académicos/historia , Encefalopatías/cirugía , Neurocirugia/historia , Chicago , Historia del Siglo XIX , Historia del Siglo XX , Historia del Siglo XXI , HumanosRESUMEN
OBJECT: The authors undertook a study to review the clinical features and outcome in patients who underwent surgery for intractable chronic epilepsy caused by temporal lobe tumors. METHODS: The Rush Surgical Epilepsy Database was queried to identify patients with chronic intractable epilepsy who underwent resection of temporal lobe tumors between 1981 and 2005 at Rush University Medical Center. Medical records were reviewed for age of the patient at seizure onset, delay to referral for surgery, seizure frequency and characteristics, preoperative MR imaging results, extent of resection, pathological diagnosis, complications, duration of follow-up period, and seizure improvement. RESULTS: Thirty-eight patients were identified, all with low-grade tumors. Gangliogliomas were the most common (36.8%), followed in descending order by dysembryoplastic neuroepithelial tumors (26.3%) and low-grade diffuse astrocytoma (10.5%). The mean duration between seizure onset and surgery was 15.4 years. Complex partial seizures were the most common presenting symptom. Detailed operative data were available for 28 patients; of these, 89.3% underwent complete resection of the amygdala, and 82.1% underwent partial or complete resection of hippocampus, in addition to lesionectomy. The mean follow-up duration was 7.7 years (range 1.0-23.1 years), with 78.9% of patients having seizure status that improved to Engel Class I, 15.8% to Engel Class II, and 5.3% to Engel Class III. Permanent complications were noted in 2.6% of patients. CONCLUSIONS: The authors' examination of the long-term follow-up data in patients with temporal lobe tumors causing chronic intractable epilepsy demonstrated excellent results in seizure improvement after surgery.
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Neoplasias Encefálicas/complicaciones , Neoplasias Encefálicas/cirugía , Epilepsia/etiología , Epilepsia/cirugía , Adolescente , Adulto , Amígdala del Cerebelo/patología , Amígdala del Cerebelo/cirugía , Astrocitoma/patología , Astrocitoma/cirugía , Neoplasias Encefálicas/patología , Niño , Enfermedad Crónica , Epilepsia/patología , Femenino , Ganglioglioma/patología , Ganglioglioma/cirugía , Glioma/patología , Glioma/cirugía , Hipocampo/patología , Humanos , Estudios Longitudinales , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Procedimientos Neuroquirúrgicos , Cuidados Preoperatorios , Resultado del TratamientoRESUMEN
BACKGROUND: This is a technical report describing a different technique for the insertion of epidural electrodes in the preoperative evaluation of epilepsy surgery. Our experience in 67 cases using this technique is analyzed. METHODS: Cylinder electrodes with multiple recording nodes spaced 1 cm apart along a Silastic core are placed into the epidural space under general anesthesia through single or multiple burr holes. We reviewed the data on 67 cases of medically intractable epilepsy requiring intracranial monitoring that had epidural cylinder electrodes placed. The electrodes were placed bilaterally or contralateral to subdural grids in 64 of the 67 cases. Continuous monitoring was performed from 1 to 3 weeks. RESULTS: This method was most useful when used bilaterally or contralateral to subdural grids. Definitive surgery was rendered in 48 of 67 cases. After monitoring, all electrodes were removed at bedside or upon return to the operating room for definitive surgery. There were no mortalities, infections, cerebrospinal fluid leaks, neurologic deficits, or electrode malfunctions. Two patients (2/67, 3%) did develop subdural hematomas early in our series after dural injury near the pterion; however, these patients did not sustain permanent deficit. CONCLUSIONS: Epidural cylinders are another option for preoperative monitoring, useful for determining lobe or laterality of seizure genesis. They offer an alternate method to EPEs in cases where epidural recording is desirable. The cylinder electrodes are easy to place and can be removed without a return to the operating theater. The electrodes' minimal mass effect allows them to be safely placed bilaterally or contralateral to subdural grids. The epidural cylinders can monitor cortex with a greater density of nodes and can access regions not amenable to EPEs.
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Electrodiagnóstico/instrumentación , Espacio Epidural/fisiología , Epilepsia/diagnóstico , Epilepsia/cirugía , Monitoreo Fisiológico/instrumentación , Cuidados Preoperatorios/instrumentación , Adolescente , Adulto , Corteza Cerebral/anatomía & histología , Corteza Cerebral/fisiología , Corteza Cerebral/cirugía , Niño , Preescolar , Craneotomía , Electrodos/normas , Electrodiagnóstico/métodos , Espacio Epidural/anatomía & histología , Espacio Epidural/cirugía , Epilepsia/fisiopatología , Femenino , Humanos , Complicaciones Intraoperatorias/prevención & control , Masculino , Persona de Mediana Edad , Monitoreo Fisiológico/métodos , Procedimientos Neuroquirúrgicos/instrumentación , Procedimientos Neuroquirúrgicos/métodos , Cuidados Preoperatorios/métodosRESUMEN
Pain words used to communicate suffering were analyzed to identify specific dimensions of back pain. The words were obtained from a group of 131 patients suffering from back pain who described their discomfort on a standardized 87-item pain questionnaire. The results indicate that words descriptive of back pain are not associated in completely random ways. When patients complain of back pain, their report falls into 7 distinguishable patterns. The major pattern accounts for 38% of the variance and refers almost entirely to emotional discomfort. The second pattern accounts for 9% of the variance and is a mixed emotional and sensory factor. The remaining 5 patterns account for 29% of the variance and constitute an entirely sensory class of factors.