No abstract available.
Moyamoya Disease*

Authors report on the general features of postoperative central nervous system infection in patients undergoing neurosurgical procedures. The postoperative central nervous system infection was defined was defined as 1) emergence of purulent material from any site that had been exposed to surgical field, and/or 2) development of meningitis during postoperative recovery period. The materials were obtained from 50 cases of postoperative central nervous system infection out of 1,232 cases of operations that had been performed in neurosurgical department of Seoul National University Hospital during the last three years. Various predisposing factors, associated problems, and therapeutic aspects are discussed. General features of hospital infection are also considered.
Anti-Bacterial Agents ; Causality ; Central Nervous System Infections* ; Central Nervous System* ; Cross Infection ; Humans ; Meningitis ; Neurosurgical Procedures ; Seoul ; Wound Infection

Moyamoya disease is a rare idiopathic cerebrovascular disease which is known to cause ischemic or hemorrhagic strokes in association with progressive stenosis of intracranial major arteries and subsequent formation of fragile collateral vessels. In this review, we have provided an update on the epidemiology, pathophysiology, clinical presentation, diagnosis, treatment and prognosis of moyamoya disease.
Arteries ; Constriction, Pathologic ; Moyamoya Disease ; Prognosis ; Stroke

We report 2 cases of pediatric DNTs which presented with intractable seizures and no other associated neurologic abnormalities. They showed typical appearance of DNTs on neuroimaging and histopathology. Most patients with DNT can be cured by surgical treatment with exellent outcome and do not need ratio- or chemotheraphy. This study indicates that it is quite important to consider DNTs as one of differential diagnoses in patients with intractable seizures especially when they present only with seizures without other neurologic symptoms.
Child* ; Diagnosis, Differential ; Humans ; Neoplasms, Neuroepithelial* ; Neuroimaging ; Neurologic Manifestations ; Seizures*

Epilepsy surgery can be a safe, effective treatment for individuals with intractable partial epilepsy. There is increasing evidence that brain abnormalities in focal epilepsy are not restricted to a single area. The longstanding debate around the relationship between structural lesions and the epileptic zone remains unresolved. Patients with DNT (dysembryoplastic neuroepithelial tumor), which is an essentially benign tumor, can be cured by epilepsy surgery-oriented approach. Cortical dysplasia is frequently associated with DNT and seems to contribute to epileptogenic activity of DNT. Surgical treatment should be aimed at removal of the associated cortical dysplasia as well as DNT itself for ideal treatment of the disease. Simple lesionectomy of cavernous angioma would relieve seizures significantly, but not always. The concept of epilepsy surgery needs to be recruited in the treatment of cavernous angioma with seizures because diffusion of hemosiderin into the surrounding brain tissue and formation of cortical scars can make epileptogenic areas. Cortical dysplasia is a highly epileptogenic lesion constituting an important cause of medically intractable epilepsy and surgery is a treatment of choice in a selected group of patients. Identification and complete resection of the lesion and ictal onset zone are necessary to achieve a good surgical results. Intractable epilepsy accompanied by benign brain lesions can be treated surgically using the entire armamentarium of presurgical investigations. Deliberate resective procedures aimed at complete removal of dysplastic tissue and epiletogenically active areas on and around the lesion ensure excellent seizure control without permanent neurologic deficit.
Brain* ; Cicatrix ; Diffusion ; Epilepsies, Partial ; Epilepsy* ; Hemangioma, Cavernous ; Hemosiderin ; Humans ; Malformations of Cortical Development ; Neurologic Manifestations ; Seizures

Three patients with complex partial seizures had dysembryoplastic neuroepithelial tumor (DNET) in temporal lobe. In all cases, longterm video-EEG monitoring showed epileptogenic focus in left temporal lobe where small mass lesion was located. For further seizure localization and functional mapping, subdural grids were placed on left temporal lobe including lesions. Lateral temporal lobectomy with lesionectomy was performed in two cases. Lateral temporal lobe resection and amygdalohippocampectomy was done in one case. The pathological findings of all lesions were characterized by intracortical location, multiple nodular architecture, foci of dysplastic cortical disorganization and the presence of a specific glioneuronal element. All patients have been seizure free.
Epilepsy, Temporal Lobe* ; Humans ; Neoplasms, Neuroepithelial* ; Seizures ; Temporal Lobe*

Cavernous angiomas (CAs) presenting with seizures have been regarded as a rather benign condition, because anti-epileptic drugs can be used as primary measures. Because CAs are frequently associated with diffusion of hemosiderin pigment into the surrounding brain tissue, there needs to be a special consideration in the management of CAs with seizures. The development of epilepsy surgery and neuro-imaging techniques, as well as the realization about the side effects of drugs are changing the concept of treatment of CAs. If the lesion is associated with intractable seizures, surgical treatment should be considered. Simple lesionectomy would relieve seizures significantly, but not always completely. The concept of epilepsy surgery needs to be recruited in such intractable cases, especially the lesion is located in the seizure-prone temporal lobe. Lesions located at or close to the eloquent areas can nowadays be removed safely by invasive and non-invasive functional mapping. Even though the seizures are not intractable, surgical resection can cure the rare seizures if the lesions are accessible. Careful assessment using comprehensive investigations on seizure itself, location of the lesion, and functional evaluation can cure the large proportion of patients suffering from seizures with CAs.
Brain ; Diffusion ; Epilepsy* ; Hemangioma, Cavernous* ; Hemosiderin ; Humans ; Seizures ; Temporal Lobe

Ischemic brain injury is associated with a stress response that includes hyperglycemia. Hyperglycemia is believed to aggravate cerebral ischemia. To review animal and human studies on the relationship between transient hyperglycemia and brain ischemia that elucidate some of the mechanisms for the deleterious effect of hyperglycemia, we searched computerized data sources and articles for human studies and experimental models that evaluated the association between hyperglycemia and cerebrovascular disorders containing ischemic brain injury. Most studies have shown that hyperglycemia in patients with ischemic brain injury is associated with a worse clinical outcome. The mechanisms of damaging process of hyperglycemia include tissue lactic acidosis, accumulation of extracelluar glutamate, blood-brain barrier disruption and brain edema formation.
Acidosis, Lactic ; Animals ; Blood-Brain Barrier ; Brain Edema ; Brain Injuries ; Brain Ischemia ; Cerebrovascular Disorders ; Information Storage and Retrieval ; Glutamic Acid ; Humans ; Hyperglycemia* ; Models, Theoretical

PURPOSE: To develop a fast and robust seizure anticipation program and test its usefulness in seizure prediction and localization of epileptic focus. METHODS: The video-EEG monitoring was performed in 20 epilepsy patients. The NPISI (Nonlinear Periodicity of Inter-Spike Intervals) of each channel and averaged NPISI of all channels were calculated in pre-ictal and ictal periods of 21 epileptic seizures. Seizure prediction times of NPISI in each channel and all channels were determined. RESULTS: There were eight mesial TLE, twelve neocortical epilepsies. The significantly reduced NPISI prior to seizure onset was observed in 20 seizures (95.2%) by NPISI of single EEG channel and in 14 seizures (66.7%) by the averaged NPISI of all channels. Time of seizure anticipation was 17.3+/-7.3 min by single channel NPISI and 14.0+/-6.0 min by all channel NPISI prior to the seizure onset. The earliest NPISI reduction was detected at electrodes concordant to the seizure focus in 6/20 (30.0%) seizures, electrodes adjacent to the focus in 5/20 (25.5%), mirror electrodes contralateral to the seizure focus in 4/20 (20.0%), and irrelevant electrodes to the focus in 5/20 (25.5%). CONCLUSIONS: This study demonstrated that the reduction of NPISI could predict epileptic seizures long before clinical seizure onset. Although the earliest NPISI reduction was observed at or near to epileptic focus in most cases, pre-ictal changes of NPISI occurred far beyond the epileptic focus. These findings suggest that pre-ictal NPISI reduction may reflect a widespread facilitation of brain before the seizure onset.
Brain ; Electrodes ; Electroencephalography ; Epilepsy* ; Humans ; Periodicity* ; Seizures

PURPOSE: The detection of epileptogenic lesion plays an important role in the management of patients with partial epilepsy. Although the development of MRI improved the examination of cerebral hemispheres greatly, many patients with neocortical temporal lobe epilepsy (TLE) or extratemporal lobe epilepsy (extra-TLE) still show no lesion in conventional two-dimensional (2D) images. To increase the yield of MRI in those patients, we performed three-dimensional (3D) surface-projection rendering (SPR) of the cerebral hemispheres. METHODS: Conventional 2D MRI (T1, T2, FLAIR, thin slice SPGR) and 3D SPR were performed in 24 patients with neocortical TLE and extra-TLE, and 20 normal subjects. Sulcogyral patterns were evaluated blindly to clinical information. The locations of the epileptogenic zone, ictal onset zone (IOZ) and irritative zone (IRZ) were determined by intracranial EEG monitoring and epilepsy surgery. RESULTS: The 2D MRI identified epileptogenic lesions in five of the 10 neocortical TLE (50%) and five of the 14 extra-TLE (35.7%). 3D SPR revealed abnormal sulcogyral patterns in 9 of the 10 neocortical TLE (90%) and 9 of the 14 extra-TLE (64.3%). Cortical deformation zones with sulcogyral anomalies included the whole area of IOZ in 10 (55.5%) and IRZ in 6 (33.3%), overlapped with IOZ in 7 (38.9%) and IRZ in 11 (61.1%), were connected to IOZ in 1 (5.6%) and IRZ in 1 (5.6%). CONCLUSION: 3D SPR of volumetric MRI data can detect epileptogenic structural lesions of neocortical epilepsy that are not visible in the conventional 2D images.
Brain* ; Cerebrum ; Electroencephalography ; Epilepsies, Partial ; Epilepsy* ; Epilepsy, Temporal Lobe ; Humans ; Magnetic Resonance Imaging*