No abstract available.
Anterior Temporal Lobectomy* ; Seizures*

We report a rare case of meningioangiomatosis in a 22 year-old man who has refractory partial seizures. Seven of 11 seizures had ictal onset zone at the perilesional medial and orbitofrontal areas of frontal lobe and 4 seizures arose from the mesial temporal area. After having lesion resection and an anterior temporal lobectomy with amygdalohippocam-pectomy, the patient no longer suffered from seizures. The epileptogenic foci were found not only in the intra-/peri-lesional area but also in remote area.
Anterior Temporal Lobectomy ; Epilepsy* ; Frontal Lobe ; Humans ; Seizures ; Young Adult

In terms of seizure control for the patients with medically intractable temporal lobe epilepsy(TLE), extensive medial resection, especially of the hippocampus, has been advocated in anterior temporal lobectomy. The relationship between the outcome of anterior temporal lobectomy for epilepsy and the size of the hippocampectomy tailored to intraoperative electrocorticographic findings was evaluated in 100 patients, with at least 12 months of follow-up. In 28 patients with small hippocampal resection(temporal lobe surgery underwent less resection of lateral temporal and hippocampus(p<0.001) compared to the patients with non-dominant temporal lobectomy. Intraoperative acute recording over the hippocampus and surrounding area can be useful in tailoring the extent of hippocampal resection to the individual pathophysiology.
Anterior Temporal Lobectomy* ; Classification ; Epilepsy ; Epilepsy, Temporal Lobe* ; Follow-Up Studies ; Hippocampus ; Humans ; Seizures ; Temporal Lobe*

Ictal vomiting is a rare clinical manifestation of temporal lobe epilepsy. This manifestation is considered a clinical lateralizing sign pointing toward seizure activity within the nondominant temporal lobe. However, we have experienced a case of ictal vomiting associated with temporal lobe epilepsy within the dominant hemisphere. The ictal vomiting occurred early in the course of the seizure when rhythmic discharges predominantly involved the left temporal lobe. This patient underwent a left anterior temporal lobectomy and experienced markedly reduced seizure frequency for more than 2 years.
Anterior Temporal Lobectomy ; Epilepsy ; Epilepsy, Temporal Lobe* ; Humans ; Seizures ; Temporal Lobe* ; Vomiting*

PURPOSE: To investigate the relationship of the resection extent of hippocampus and temporal neocortex with the postsurgical outcome in patients with mesial temporal lobe epilepsy (TLE). METHODS: Sixty-eight patients with TLE underwent brain MRI pre- and post-operatively. They were divided into two groups by seizure outcomes:seizure free group (SF, N=54) and non-seizure free group (NSF, N=14). Patients were classified further according to the post-surgical memory changes:MD group (with postsurgical memory decline, N=15) and NMD group (without postsurgical memory decline, N=16). The hippocampal resection was estimated by subtracting the length of post-surgical hippocampus from the pre-surgical length. The resection of temporal neocortex was measured by comparing the resection lengths on superior, middle, inferior and basal temporal gyri shown on three dimensional brain MRI. RESULTS: The mean extent of hippocampal resection was significantly larger in SF than in NSF (33.2+/-7.5 mm vs. 24.8+/-7.4 mm p=0.001) while that between MD and NMD was not significantly different. The resection extent of temporal neocortex was not significantly different between SF and NSF as well as between MD and NMD, but the resection extent of basal temporal gyrus of left TLE was significantly larger in MD than in NMD. CONCLUSIONS: The hippocampal resection was significantly greater in SF. The overall resection extent of the temporal neocortex did not correlate to the surgical outcomes of seizures or memory although that of the basal temporal gyrus of the left TLE was larger in MD.
Anterior Temporal Lobectomy* ; Brain ; Epilepsy, Temporal Lobe ; Hippocampus ; Humans ; Magnetic Resonance Imaging ; Memory* ; Neocortex ; Seizures*

BACKGROUND: Patients with temporal lobe epilepsy (TLE) originating from different seizure onset zones had distinct electrophysiological characteristics and surgical outcomes. In this study, we aimed to investigate the relationship between the origin and prognosis of TLE, and the stereoelectroencephalography (SEEG) features. METHODS: Thirty patients with TLE, who underwent surgical treatment in our functional neurosurgery department from January 2016 to December 2017, were enrolled in this study. All patients underwent anterior temporal lobectomy after an invasive pre-operative evaluation with SEEG. Depending on the epileptic focus location, patients were divided into those with medial temporal lobe seizures (MTLS) and those with lateral temporal lobe seizures (LTLS). The Engel classification was used to evaluate operation effectiveness, and the Kaplan-Meier analysis was used to detect seizure-free duration. RESULTS: The mean follow-up time was 25.7 ± 4.8 months. Effectiveness was 63.3% for Engel I (n = 19), 13.3% for Engel II, 3.3% for Engel III, and 20.0% for Engel IV. According to the SEEG, 60.0% (n = 18) had MTLS, and 40.0% (n = 12) had LTLS. Compared with the MTLS group, the operation age of those with LTLS was significantly greater (26.9 ± 6.9 vs. 29.9 ± 12.5 years, t = -0.840, P = 0.009) with longer epilepsy duration (11.9 ± 6.0 vs. 17.9 ± 12.1 years, t = -1.801, P = 0.038). Patients with MTLS had a longer time interval between ictal onset to seizure (67.3 ± 59.1 s vs. 29.3 ± 24.4 s, t = 2.017, P = 0.008). The most common SEEG ictal pattern was a sharp/spike-wave rhythm in the MTLS group (55.6%) and low-voltage fast activity in the LTLS group (58.3%). Compared with the LTLS group, patients with MTLS had a more favorable prognosis (41.7% vs. 77.8%, P = 0.049). Post-operative recurrence was more likely to occur within three months after the operation for both groups, and there appeared to be a stable long-term outcome. CONCLUSION Patients with MTLS, who accounted for three-fifths of patients with TLE, showed a more favorable surgical outcome.
Anterior Temporal Lobectomy ; Electroencephalography ; Epilepsy, Temporal Lobe/surgery* ; Humans ; Stereotaxic Techniques ; Treatment Outcome

BACKGROUND: The typical MRI features of hippocampal sclerosis (HS) are volume loss and increased T2 weighted signal intensity. Hippocampal volumetry and T2 relaxometry are useful quantitative methods for presurgical diagnosis of HS, especially in the cases of mild, bilateral or focal hippocampal atrophies. We investigated the value of a new quantitative method using FLAIR (Fluid Attenuated Inversion Recovery) MR images compared to those of visual inter-pretation and MR volumetry. METHODS: Forty-five patients with mesial temporal lobe epilepsy (TLE) and 21 under-went volumetric MRI (T1-weighted, SPGR, T2 weighted, and FLAIR images). All patients underwent anterior temporal lobectomy with amygdalohippocampectomy., where visual analysis and hippocampal volumetry were performed. The absolute and normalized values of hippocampal FLAIR signal intensity [hippocampal FLAIR intensity/superior frontal FLAIR intensity=Hippocampal-Frontal Signal Intensity Ratio (HFSR)] were obtained from both normal subjects and patients with TLE. RESULTS: The pathology of resected hippocampus showed HS in all patients. Visual interpretation of presurgical MRI failed to lateralize HS in 10 patients (22.2%). Among these 10 patients, the HS was lateralized by HFSR method in seven patients (70%) [Five (50%) by right-to-left difference of HFSR and the other two (20%) by analysis of a longitudinal regional curve of HFSR] while it was further lateralized by hippocampal volumetry in only three. CONCLUSIONS: In presurgical evaluation of patients with TLE, the hippocampal FLAIR signal analysis appeared to be complementary to visual interpretation and MR volumetry.
Anterior Temporal Lobectomy ; Atrophy ; Diagnosis ; Epilepsy, Temporal Lobe* ; Hippocampus ; Humans ; Magnetic Resonance Imaging ; Pathology ; Sclerosis ; Temporal Lobe*

OBJECTIVES: Regarding the relationship between the laterality of seizure focus and depression in temporal lobe epilepsy (TLE), previous studies reported inconsistent results. The role of frontal function as moderating variable between laterality and depression had been proposed. We attempted to replicate functional involvement of frontal lobe (FIFL) and, as an effort to extend previous findings, to test the functional involvement of parietal lobe (FIPL) to prove the hypothesis derived from Heller's valencearousal theory of emotion. METHODS: In study 1, patients with TLE (right 19, left 17) performed MMPI-D as a depression measure, Wisconsin Card Sorting Test (WCST) as a frontal function measure, and block design (BD) as a parietal function measure in the course of pre-operation assessment. Multiple regression model of depression which includes the interaction terms both between laterality and WCST and between laterality and BD were tested. In study 2, patients underwent anterior temporal lobectomy (ATL;right 20, left 25) were assessed and analyzed in the same way as study 1. RESULTS: In study 1, contrary to the FIFL and FIPL prediction, interaction of laterality with WCST or BD were not significant. In study 2, the interaction with frontal function was significant. Consistent with FIFL prediction, depression came to be evident when seizure focus was lateralized to the left side and simultaneously frontal function declined. But the interaction with BD remained insignificant, which suggests the invalidity of FIPL hypothesis. CONCLUSION: We replicated the FIFL hypothesis in the depression of ATL patients. The relation of depression with frontal function was more evident in post rather than pre operation sample. This pattern may be due to the inter-hemispheric interference of frontal functions in pre-operation sample and to the release-of-function phenomenon in post-operation sample. On the other hand, we did not succeed in confirming the role of parietal function in depression. Intactness of the parietal function in TLE was considered as the main cause of the negative finding.
Anterior Temporal Lobectomy ; Depression* ; Epilepsy, Temporal Lobe* ; Frontal Lobe ; Hand ; Humans ; Parietal Lobe* ; Rabeprazole* ; Seizures ; Temporal Lobe* ; Wisconsin

BACKGROUND: Memory changes and its predictors after anterior temporal lobectomy (ATL) were investigated. A standardized regression-based (SRB) outcome methodology was used, accounting for the effects of practice and preoperative memory functions. METHODS: Consecutive 45 ATL patients (male 22) with mesial temporal sclerosis (dominant 21) who became seizure-free for at least 1 year postoperatively were included in the study. Wechsler Memory Scale-Revised(WMS-R) was performed pre- and postoperatively. Memory changes were estimated using SRB norms and then were correlated with age of onset, seizure duration, chronological age, seizure risk factors, and preoperative memory function. RESULTS: 1) The majority of cases (76~84%) showed no significant memory changes. Significant declines in verbal memory were noted for 8 (18%) out of 45 ATL patients whereas significant declines in visual memory were found in only 2 (4%). There were no differences in memory changes according to lesion laterality. 2) Later age at onset, shorter duration of epilepsy, absence of history of infection or febrile convulsion were significantly related to verbal memory decrease after ATL. 3) Using SRB methodology, adequacy of preoperative memory performance was correlated with decrease in visual memory but not in verbal memory, even if absolute change scores between pre-and postoperative values were associated with preoperative performances in both verbal and visual memory. CONCLUSIONS: Although group variability of memory outcome after ATL using WMS-R was not found to be significant, considerable individual variability of memory outcome after ATL was found along with significant predictors of postoperative verbal memory decrease. (J Korean Neurol Assoc 19(3):219~225, 2001)
Age of Onset ; Anterior Temporal Lobectomy ; Epilepsy, Absence ; Epilepsy, Temporal Lobe* ; Humans ; Memory ; Risk Factors ; Sclerosis ; Seizures ; Seizures, Febrile ; Temporal Lobe*

BACKGROUND: Various ictal manifestations of temporal lobe epilepsy have possibly the value of both lateralizing and localizing the epileptogenic zone. Some ictal manifestations such as hand automatism, dystonic limb posture, head turning, and speech phenomenon might distinguish patients with good surgical outcomes from patients with poor out-comes. METHODS: To determine ictal behavioral differences in patients from these groups, we analyzed 207 seizures from 75 patients (group A) who were seizure free after surgery and 172 seizures from 60 patients (group B) who experienced seizures after surgery. All patients had received an anterior temporal lobectomy with amigdalohippocampectomy, and were followed up for at least 1 year. RESULTS: The lateralizing value of ictal semiology was evaluated in group A. Head turning (HT) was shown in 42% of seizures and had a lateralizing significance. Forced HT indicated a contralateral epileptogenic region. Non-forced HT suggested an ipsilateral epileptogenic region. Unilateral dystonic limb posture with or without automatism of the other side occurred in 53% of seizures and had a lateralizing significance, localizing the seizure onset to the contralateral hemisphere. Abnormal speech and vocalization did not have any lateralizing significance. Contralateral dystonic limb posture without ipsilateral automatism was significantly more frequent in group B (p=0.003) as abnormal speech was more frequent in group A (p=0.001). Non-versive head turning had a higher tendency to occur in group A (p=0.0051). There were no statistically significant differences between the two groups in incidences of versive head turning, unilateral hand automatism without dystonic limb posture, vocalization, and normal speech. CONCLUSIONS: Some ictal manifestations might be helpful in predicting the surgical outcome of temporal lobe epilepsy(TLE) patients. The presence of unidentifiable ictal speech could reflect good surgical outcome in TLE patients. When presurgical video analysis reveal an ictal semiology of contralateral dystonic arm posture without ipsilateral hand automatism, careful presurgical evaluation of the epileptogenic region should be contemplated.
Anterior Temporal Lobectomy ; Arm ; Automatism ; Epilepsy, Temporal Lobe* ; Extremities ; Hand ; Head ; Humans ; Incidence ; Posture ; Seizures ; Temporal Lobe*