The Results of One stage Total Callosotomy in Pediatric Epilepsy / 대한간질학회지

PURPOSE: In the pediatric patients who have medically intractable epilepsy the callosotomy is useful to prevent the propagation of seizure from one hemisphere to the other. The indications of callosotomy are drop attack, life threatening primarily or secondarily generalized seizure, medically refractory mixed seizure types such as Lennox-Gastaut syndrome. In addition, the retarded children are not contraindicated. The anterior callosotomy is used to perform to control medically intractable epilepsy which is believed to have some advantages to total callosotomy. But, we propose that the anterior callosotomy does not seem to be superior to total callosotomy for the prevention of the propagation of seizure or complication. We describe a series of 21 patients with medically intractable epilepsy who underwent total callosotomy in one stage. METHODS: The diagnoses in these patients included Lennox-Gastaut syndrome, atonic seizure, infantile hemiplegia, and no obvious solitary seizure focus on chronic video/EEG monitoring to characterize seizures, electrographic activity, and postictal behaviors. Preoperatively 16 patients suffered from disabling drop attacks or intense head drop seizures which caused frequent physical injuries. Other types of seizures are 12 generalized tonic-clonic seizures, 7 complex partial seizures, 1 absence seizure, and 7 myoclonic seizures. Male:Female=14:7, Age: 2-22 years (Mean: 9.4 years). The follow-up period ranged from 0.8 to 3.8 years (median 2.4 years). Seizure outcome, parental assessment of daily function, and parental satisfaction with outcome were assessed postoperatively. RESULTS: Drop attacks disappeared completely during the entire follow-up period in 13 patients and decreased to less than 10% of baseline in five. The corpus callosum of the one patient were not completely sectioned in Diffusion Tensor Image, tractography. Other types of seizures resolved completely in 14 patients and decreased in 7. 2 patients experienced a transient disconnection syndrome, but completely resolved within four weeks. Overall daily function improved and parents were satisfied with the surgical outcome in all patients except three who experienced recurrent of drop attacks after operation. There was no sign of significant and persistent neurological deficits in any case. CONCLUSION: Results of total callosotomy in patients with medically intractable epilepsy with diffuse epileptic foci were favorable in most cases. The procedure was particularly effective against drop attacks causing physical injuries and impaired quality of life in these patients.

Stent-Assisted Angioplasty for Symptomatic Middle Cerebral Artery Stenosis: Short-term Arteriographic and Clinical Outcome

OBJECTIVE: Stent-assisted angioplasty is an effective treatment modality in the coronary and peripheral arterial disease, however, its efficacy for intracranial atherosclerotic disease has not been verified. We assess the treatment outcome of stent-assisted angioplasty for symptomatic middle cerebral artery (MCA) stenosis. METHODS: We performed stent-assisted angioplasty in 12 patients with symptomatic high-grade stenosis(>60%) on the proximal portion of the MCA, who had either recurrent transient ischemic attacks (TIAs) resistant to medical therapy or perfusion problems. Patient records were analyzed for angiographic characteristic, degree of stenosis, preprocedural regimen of antiplatelet and/or anticoagulation agents, used devices, procedure-related complications, and clinical and radiographic outcomes. RESULTS: Stent-assisted angioplasty was successfully performed in 8 patients without any serious complications. Two patients had arterial rupture. One of two patients was rescued by an additional stenting and balloon tamponade, and the other patient was dead. Another complications among the 2 patients included thrombotic occlusion and distal thrombosis. Residual stenosis was less than 50% in diameter in all the patients. During follow-up period (mean, 11 months), stroke attacks including TIAs did not recur in 9 of 11 patients who had experienced intractable TIAs or strokes. All of 8 patients who underwent follow-up cerebral angiography had no restenosis. CONCLUSION: Stent-assisted angioplasty for refractory and symptomatic MCA stenosis is a relatively safe and effective procedure. It can be used to prevent recurrent TIAs or strokes in selected patients.

Endovascular Treatment for a Penetrating Vertebral Artery Injury: Case Report

The vertebral artery injuries are rare in frequency and penetrating injuries are most likely to damage the vertebral artery as a sort of a collateral damage from striking the bony cervical spine. A 49-year-old man was struck in the face with a metal bar. The plain skull X-ray showed a long nail penetrating from the maxilla to the suboccipital area. Digital subtraction angiography revealed an injury of the left vertebral artery with a strong retrograde flow down the rostral segment and a filling with thrombus within the distal portion from injured segment. The patient underwent Guglielmi detachable coils embolization for complete isolation of the injured segment. The manual removal of the foreign body was attempted and was successfully completed.