No abstract available.
Hemispherectomy*

The extratemporal operative approaches for intractable epilepsy are reviewed. Intracranial recordings are often necessary for extratemporal epilepsy to define the lateratization as well as the localization of epileptogenic regions and tailor the resection. The operative procedures include cortical resections, corpus callosotomy, and functional hemispherectomy. The author presents an overview of indications for surgery, oprative methods, and risks in the medically intractable epileptic patient with extratemporal focus.
Epilepsy* ; Hemispherectomy ; Humans ; Surgical Procedures, Operative

Infantile hemiplegia is the end state of various pathological conditions affecting the cerebral hemisphere before or during birth, or in first few years of life. In 1950, Krynauw first reported that total hemispherectomy could be carried out with beneficial results for infantile hemiplegia with uncontrollable convulsion, temper tantrum and mental deficiency. Hemispherectomy is not suitable for all cases of infantile hemiplegia, but is seems clear that it should be undertaken in any case of established infantile hemiplegia with fits which cannot be controlled by drugs, or in which there is backwardness or deterioration in the patient's intellectual or emotional state. We have recently experienced a 8-year-old boy who was suffering left hemiplegia with intractable epilepsy. Both carotid angiogram and pneumoencephalogram showed right cerebral hemiatrophy. After right hemispherectomy intractable seizure was controlled and personality disorder disappeared completely. But left hemiplegia wasn't definitely improved.
Cerebrum ; Child ; Epilepsy* ; Hemiplegia* ; Hemispherectomy* ; Humans ; Intellectual Disability ; Male ; Parturition ; Personality Disorders ; Seizures

OBJECTIVE: This study was designed to analyze seizure outcome and to investigate the prognostic factors for predicting seizure outcome according to the preoperative evaluations, surgical procedures, topectomy sites and histopathological findings in patients with extratemporal lobe epilepsy (ETLE). METHODS: This study comprised 63 patients with ETLE who underwent surgery. Preoperative evaluations included semiologic analysis, chronic video-EEG monitoring, and neuroimaging studies. Surgical procedures consisted of topectomy in 51 patients, corpus callosotomy in 9, functional hemispherectomy in 2, and vagus nerve stimulation (VNS) in 1. Histopathological findings were reviewed. Postoperative seizure outcomes were assessed by Engel's classification at the average follow up period of 66.8 months. Chi-square test was used for statistics. RESULTS: Total postoperative seizure outcomes were class I in 51 (80%) patients, class II in 6 (10%), class III in 6 (10%). Patients with structural abnormalities on neuroimaging study showed class I in 49 (88%) patients (p<0.05). Patients with focal and regional ictal EEG onset revealed class I in 47 (90%) patients (p<0.05). Semiologic findings, surgical procedures, topectomy sites and histopathological findings did not show statistical correlation with seizure outcome (p>0.05). CONCLUSION: A good seizure outcome was obtained in patients with ETLE. The factors for favorable seizure outcome are related to the presence of structural abnormalities on neuroimaging study, and focal and regional ictal EEG onset.
Classification ; Electroencephalography ; Epilepsy* ; Follow-Up Studies ; Hemispherectomy ; Humans ; Neuroimaging ; Psychosurgery ; Seizures* ; Vagus Nerve Stimulation

Child ; Child, Preschool ; Encephalitis ; diagnosis ; pathology ; surgery ; Follow-Up Studies ; Hemispherectomy ; methods ; Humans ; Male

PURPOSE: For certain forms of childhood epilepsy that remain uncontrolled despite adequate treatment with standard antiepileptic medication, surgical therapy should be considered as a potential treatment. The prognosis for seizure control after early surgery is favorable and is at least comparable with that of adults. With the exception of the obvious benefit conferred by alleviating seizures at a younger age, early surgery also later improves psychosocial status and adaptive function. This study was performed to evaluate the efficacy of epilepsy surgery. METHODS: We analyzed the results of 28 cases of intractable childhood epilepsy who underwent epilepsy surgery at the epilepsy center of Dongsan Medical Center between February, 1993 and January, 1996. They followed up for at least 15 months after surgery. Seizures began at 14 days to 15 years (mean 6.3 years) after birth and had been refractory to antiepileptic medications. Presurgical evaluations of epilepsy included detailed clinical history, scalp/sphenoidal EEG, Video-EEG monitoring, neuroimaging, neuropsychological test, Wada test and invasive study with subdural electrodes. RESULTS: Temporal lobectomy (with or without corticectomy) was performed in 13 cases, extratemporal lobectomy in 11 cases (frontal lobe n=7, parietal lobe n=2, frontoparietal n=1, parietooccipital n=1), functional hemispherectomy in two cases and corpus callosotomy in two cases. The surgical outcome was better in temporal lobe epilepsy compared with that of extratemporal lobe epilepsy. In temporal lobe epilepsy, seven of 13 cases had class I outcome grade, four cases had class II and the rest had class III and class IV. In extratemporal lobe epilepsy, five of 11 cases had class I outcome and the remainders had class III, IV. CONCLUSION: Our results agree with previous reports that epilepsy surgery can provide relief from intractable seizure in pediatric patients, but more extensive study for the patients' cognitive and behavior status will be necessary.
Adult ; Electrodes ; Electroencephalography ; Epilepsy* ; Epilepsy, Temporal Lobe ; Hemispherectomy ; Humans ; Neuroimaging ; Neuropsychological Tests ; Parietal Lobe ; Parturition ; Prognosis ; Seizures

PURPOSE: Recent advances in neurophysiology and neuroimaging provided surgical application in intractable childhood epilepsy with improved outcome. The aim of this study is to reveal benefit and safety of epileptic surgery in childhood by reviewing our experiences. METHOD: Thirty patients who underwent epilepsy surgery from February, 1997 to June, 2002 at epilepsy center, Inje University Sang-gye Paik Hospital, were included. We reviewed clinical features and outcomes according to temporal/extratemporal epilepsies including generalized or undertermined epileptic syndromes. RESULTS: In 8 patients of temporal lobe epilepsy, surgical procedures were as follows, anterior temporal lobectomy (ATL) was in 6 patients, ATL and extended temporal resection in 1, ATL and multiple subpial transection (MST) in 1. Pathologic findings showed cortical dysplasia, hippocampal sclerosis, tumor and old infarction. Engel class I was in 6 (75%) patients and class II was in 2 (25%) patients. Six patients (75%) showed developmental progress. In 22 patients of extratemporal lobe epilepsy, various surgical methods such as partial or total lobectomy, functional lobectomy, corticectomy, functional hemispherectomy, peri-insular hemispherotomy, multiple subpial transection, lesionectomy and palliative corpus callosotomy were done according to the location of epileptic focus and epileptic syndromes. Engel class I was in 16 (72.7%) patients, class II in 4 (18.2%) and class III in 2 (9.1%) patients. Eight patients (66.6%) among 12 patients could have been followed for more than 12 months showed developmental progress. Most of neuroimaging studies were highly concordant to ictal EEG's. CONCLUSIONS: Epilepsy surgery is effective in most of localization related intractable childhood epilepsy and developmental acceleration can be expected in successfully treated patients.
Acceleration ; Anterior Temporal Lobectomy ; Epilepsy* ; Epilepsy, Temporal Lobe ; Hemispherectomy ; Humans ; Infarction ; Malformations of Cortical Development ; Neuroimaging ; Neurophysiology ; Sclerosis

This paper deals with cerebral paragonimiasis and cerebral hemispherectomy conducted as a treatment of cerebral paragonimiasis by Bo Sung Sim in Korea in 1950s-1960s. He demonstrated that cerebral hemispherectomy could be used for unilateral diffuse cerebral paragonimiasis. Sim learned cerebral hemispherectomy from Dr. L. A. French. at the University of Minnesota from 1955 to 1957 in America. The authors argues that Bo Sung Sim's introduction of cerebral hemispherectomy to Korea was not a simple application of an advanced medical technology, but a complicated and active process in that Sim used the technique to intervene intractable complications from cerebral paragonimiasis such as generalized convulsions, spastic hemiplegia and mental deterioration. Bo Sung Sim, one of the neurosurgeons of the first generation in Korea, was trained in neurology, neuropathology, neuroradiology and animal experiments as well as in neurosurgery at the University of Minnesota. After returning to Korea, Sim faced parasitic diseases, one of the most serious public health problems at that time, which were far different from what he learned in America. As a neurosurgeon, Sim tackled with parasitic diseases of the central nervous system with various diagnostics and therapeutics. In 1950s, more than one million populations suffered from pulmonary paragonimiasis acquired by eating raw crabs or by feeding juice of crushed crayfish for the treatment of measles in Korea. About 26.6 percent of people with paragonimiasis had cerebral paragonimiasis. Before bithionol therapy was introduced in 1962, neurosurgery was the only available treatment to control increased intracranial pressures, intractable epilepsy, paralysis and mental deterioration. Between 1958 to 1962, Bo Sung Sim operated on 24 patients of cerebral paragonimiasis. In two of them, he performed cerebral hemispherectomy to control intractable convulsions when he found diffuse cerebral paragonimiasis and cerebral atrophy at the operating table. The two patients were recovered dramatically after the operation. The first patient became a part of medical campus for 20 years after hemispherectomy, doing chores at the hospital and helping Bo Sung Sim for his teaching neuroanatomy. The presence of the hemispherectomized patient in the classroom impressed the students deeply. Furthermore, the hemispherectomized patient stimulated Sim and his school to perform research upon the neuroanatomy and neurophysiology of the brain with hemispherectomized animals.
Animals ; Brain/parasitology ; Hemispherectomy/*history ; History, 20th Century ; Humans ; Paragonimiasis/*history/surgery ; Parasitic Diseases/history/therapy ; Trematoda

BACKGROUNDIn the years around 1990, in Beijing Tiantan Hospital Affiliated to Capital Medical University many children with infantile hemiplegia and intractable epilepsy were treated with further modified anatomical hemispherectomy. We report the follow up of the first six cases. To make good use of these precious clinical data and make clear their neuropsychological state, we performed neuropsychological and neurophysiological measurements in these patients, who were at a median of 17.8 years after hemispherectomy.

METHODSOddball task was given to the patients and to a normal control group to collect the peak latency (PL) and peak amplitude (PA) of event-related potentials (ERPs)-P300. The P300 data of the two groups were analyzed and the P300 patterns of the six patients are presented. The baseline characteristics and long-term follow-up of the six hemispherectomized patients, especially the long-term seizure control and cognitive function after surgery, are described.

RESULTSFive patients had no seizures and one was almost seizure-free during the years after surgery. Clear P300 was obtained from every electrode in the patients. Differences of P300 between patients and normal control group had no statistical significance. And the maximum PA was at the site of electrode Pz or Cz which was consistent with that of the control group and with previous findings.

CONCLUSIONSFurther modified anatomical hemispherectomy has preferable long-term antiepileptic effects. The P300 results of the patients mean that the basic cognitive function of the patients has no difference from the control group. This reflects the plasticity of the hemisphere to some extent and increases the affirmation of the long-term curative effects of further modified anatomical hemispherectomy from both neuropsychological and neurophysiological aspects.

Adult ; Disease-Free Survival ; Event-Related Potentials, P300 ; Female ; Follow-Up Studies ; Hemispherectomy ; Humans ; Male ; Seizures ; surgery ; Treatment Outcome

It is well known that after removal of one cerebral hemisphere all experimental animals, such as monkeys, dogs, cats and rabbits, circle in walking toward the side of the lesion with deviation of head and eyes to the same side for a while. However, the cause of circling gait following cerebral hemispherectomy is not clearly established. In this experiments physiological phenomena were observed in the dog and rabbit following unilateral or bilateral frontal or occipital lobectomies or partial ablations, parietal lobe lesions, section of unilateral optic nerve or optic tract. The results were as follows : 1) All experimental animals circled in walking toward the side of lesion with deviation of head and eyes to the same side for about one week following unilateral frontal lobectomy of partial ablation. There were transient motor weakness for a few days and pseudohemianopsia for about one week on the contralateral side. 2) Bilateral frontal lobectomies did not induce circling gait. But there was a lack of response to visual stimuli for a week. 3) Unilateral parietal lobe ablation did not induce circling gait nor pseudohemianopsia. 4) All experimental animals circled in walking toward the occipital lobectomized side for about 2 or 3 weeks, but deviation of head and eyes toward the side of lesion was not so evident as frontal lobectomized animals. The permanent neurological deficit was contralateral hemianopsia. 5) Bilateral occipital lobectomies was followed by a blindness in all experimental animals. They walked without a definite direction. 6) Section of unilateral optic nerve induced ipsilateral blindness. All experimental animals showed a tendency to walk toward the opposite side but did not circle in walking. 7) Section of unilateral optic tract induced permanent contralateral hemianopsia. All experimental animals circled in walking toward the side of the lesion of a while but deviation of the head was not evident. It is our conclusion that circling gait following cerebral hemispherectomy may be attributed by the permanent and transient hemianopsia and some neurological functional imbalance between the removed cerebral hemisphere, and the intact opposite cerebral hemisphere and brain stem.
Animals ; Blindness ; Brain Stem ; Cats ; Cerebrum ; Dogs ; Gait* ; Haplorhini ; Head ; Hemianopsia ; Hemispherectomy* ; Optic Nerve ; Parietal Lobe ; Physiological Phenomena ; Rabbits ; Visual Pathways ; Walking