Functional magnetic resonance imaging study of drug-resistant medial temporal lobe epilepsy / 中华神经科杂志

Objective:To explore the changes of brain activity in drug-resistant or drug-controlled medial temporal lobe epilepsy patients by the method of functional connectivity density (FCD), and to analyze their correlation with the course of the disease.Methods:According to the definition of drug-resistant epilepsy by the International League Against Epilepsy in 2010, 146 patients with medial temporal lobe epilepsy who were clearly diagnosed as unilateral hippocampal sclerosis in Jinling Hospital, Nanjing University School of Medicine from July 2009 to February 2019 were divided into drug control group ( n=73) and drug-resistant group ( n=73). The 3.0 T resting state functional magnetic resonance scan was performed on all subjects to compare the difference in FCD between the two groups, and calculate the correlation between the FCD value of the brain area and the course of the disease between the two groups of patients. Results:There was significant difference between the two groups in FCD. Compared with the drug control group, the drug-resistant group had significantly lower FCD values in the insula, lenticular nucleus, thalamus, hippocampus and precentral gyrus on the side of the epileptogenic focus. The FCD value of the precuneus on the side of the epileptogenic focus in the drug-resistant group was negatively correlated with the duration ( r=-0.30, P=0.01). Conclusions:The FCD of patients with drug-resistant medial temporal lobe epilepsy was lower than that of the drug control group. In addition, there may be progressive damage to the brain. The difference is helpful for exploring the pathophysiological mechanisms related to drug resistance in patients with medial temporal lobe epilepsy, and finding reliable neuroimaging markers related to drug resistance.

Application of simultaneous monitoring of cortical EEG and scalp EEG during anterior circulation aneurysm surgery / 国际脑血管病杂志

Objective To develop a simple and effective method for monitoring cortical ischemia after temporary occlusion of the parent arteries during anterior circulation intracranial aneurysm surgery. Methods Fifty-two patients with anterior circulation aneurysm (58 aneurysms) received craniotomy from April to November 2008, and at the same time,cortical electroencephalograpby (EEG) and scalp EEG were monitored during the surgery.According to the international 10/20 electrode placement system, scalp electrodes were placed on O1, O2, P3, P4, T5, and T6 for monitoring the changes in the depth of anesthesia. A cortical strip electrode was placed on the cortical surface supplied by the artery that was possibly blocked during the operation, which was used to monitor the possible cortical ischemia. For patients who had cortical EEG suppression after the temporary occlusion of the parent arteries Were compared with the changes of scalp EEG. Whether there were ischemic events in the corresponding supply territory after vascular occlusion were observed after surgery. Results Of the 58 aneurysms, 40 aneurysms and 41 major arteries were occluded temporarily. After being occluded temporarily in 19 arteries of 18 patients, cortical EEG changed significantly,while scalp EEG did not change significantly. Only 9 patients had ischemic events in the corresponding supply territories after the occlusion in the cortical EEG significant change group. The changes in the depth of anesthesia had the consistent impact on cortical and scalp EEG. Conelusions Simultaneous monitoring of cortical and scalp EEG is a simple and effective method for monitoring cortical ischemia during anterior circulation intracranial aneurysm surgery, and may effectively identify the effect of anesthesia on EEG.

Surgical treatment of gliomatosis cerebri / 医学研究生学报

Objective:To discuss the diagnosis, treatment and outcome of patients with gliomatosis cerebri (GC). Methods:Retrospectively reviewed the clinical manifestations and radiological appearances of 6 patients with GC, which were diagnosed in our hospital between 1993 and 2003. We employed surgical treatment in three patients, stereotactic biopsy in two, and the other one received both biopsy and surgery. Results: The lesions of GC infiltrated more than two lobes in brain. CT studies showed diffuse hypodensity changes and enhancement was absent in four patients. MRI examinations revealed isointense or hypointense regions on T1WI, and uniformly high signal on T2WI. MRI also disclosed structural enlargement. All patients received radiotherapy after surgery and three patients underwent chemotherapy additionally. Five patients died during follow up with average course of 16.4 months. Conclusion:MRI examination is valuable in the diagnosis and the prognosis of GC is poor.

Classification and surgical approach for tentorial meningiomas / 医学研究生学报

Objective:To explore the classification and the choice of surgical approach for tentorial meningiomas. Methods: 56 patients with tentorial meningiomas operated on between 1992 and 2002 were retrospectively analysed. According to Gkalp , there were 28 cases with medial tumor,17 cases with lateral tumor,11 cases with falcotentorial tumor. The tumors developing mainly supratentorial were approached from modified pteronal, subtemporal, temporooccipital or occipital craniotomy. For tumors developing mainly in the posterior cranial fossa, suboccipital craniectomy or combined occipital- suboccipital craniectomy was performed. The tumors developing both supratentorial and infratentorial the subtemporal-presigmoidal craniotomy were approached . Results: Total removal was achieved in 53 cases and partial removal in 3 cases. Two cases died of severe postoperative complications. The mortality rate was 3.6%. Five had additional neurological deficits postoperatively. Recurrences occurred in 6 cases. Conclusion: Surgical approach for tentorial meningiomas must be individualized for each case. The operators must master well about microanatomy of the tentorium and its specifically regional structures and expertly use microsurgical techniques for obtaining successful surgery and good outcome.

Surgery outcome of pediatric intractable temporal epilepsy / 医学研究生学报

Objective:To discuss the surgical outcome of pediatric intractable temporal epilepsy. Methods:This observation included 34 pediatric patients with intractable temporal epilepsy who were admitted to our hospital from 1990 to 2001.CT or MRI,EEG and neuropsychological examinations were taken to determine the situations of the patients.They all underwent improved anterior temporal lobectomy. Results:The patients have been followed up for 2-13 years.According to Engel's classification,the achieved outcomes were seizure-free in 22(65 %) patients,apparently improved in 3(9 %) patients,improved in 3(9 %) patients,no effect in 2(6 %) patients,and lost of follow-up in 4(12 %) patients,respectively. Conclusion:Surgical treatment to pediatric intractable temporal epilepsy is safe and effective.The most common pathological causes for pediatric epilepsy are tumor and hippocampus sclerosis.Early surgery of pediatric temporal epilepsy could improve the life qualities of patients.

Functional magnetic resonance imaging of ictal epilepsy / 医学研究生学报

Objective: To investigate the ictal epileptic activation using simultaneous electroencephalogram functional MRI(EEG-fMRI),and to study the neural mechanism and the roles of the cerebral cortex and subcortical structures in the generation and propagation of the epileptic activity.Methods: A patient with partial epilepsy was retrospectively found to have slight seizures during the simultaneous EEG-fMRI examination.Two sessions of the ictal functional MRI data were processed and analyzed using the general-linear model.Results: Consistent activation patterns were obtained from the two sessions of data.The positive activation was found over the bilateral parietal lobes,insula cortex,bilateral striatum,thalamus and some nuclei of the brain stem,as well as over the vermis and right cerebellar hemisphere.The maximum intensity point was in the left parietal lobe.Conclusion: The seizure activation is originated from the cerebral cortex,and then propagates through the reciprocal circuits made up of the cortex and the subcortical structures.The cerebral cortex and the brain stem reticular formation are the main structures that propagate the seizure to contralateral hemisphere.The subcortical structures play important roles in the seizure propagation and seizure manifestation.

Treatment of brain deep lesions by stereotaxy / 医学研究生学报

Objectives:To discuss the effects of stereotactic techniques in treating brain deep lesions. 　Methods: Eighty-two patients with deep brain lesions were treated by fisher stereotactic apparatus and ASA-601S. Among these, stereotactic biopsy was performed in 22, clearance of haematoma in 5 (2 located in brain stem), aspiration of brain abscess in 2 and placement of Ommaya tube into cystic craniopharyngioma in 53.　Results: All of the 22 biopsies were pathologically diagnosed, which included 10 cases of glioma, 4 cases of germ cell tumor, 3 cases of brain parasite, 4 cases of metastatic lung tumor and one case of hyperplasia of colloid cells at rear end of third ventricle, which turned to be glioma in follow-up period. Tumor resection was performed in 4 patients with glioma and radiation therapy for other tumors. After the treatment, 6 patients were fully recovered ( 4 with germ cell tumor and 2 with metastatec tumor). All brain parasite, brain abscess and brain haematoma were cured. Three patients with craniopharyngioma were cured after the placement of Ommaya tube (with radiation therapy inside the cyst), and others were improved. 　Conclusions:Stereotaxy has the advantages of precise location, less damage, easy manipulation and on the safe side. It is worth advocating.