Surgical treatment of epilepsy: our experiences with 34 children.

Surgical treatment of medically intractable epileptic fits in children is highly specialized, owing to the specific etiology of epilepsies in this age group and the epileptogenic property of the brain in childhood. In our series of 340 patients operated on for medically intractable epileptic seizures, there were 34 (10%) patients up to 15 years of age (the youngest was 2 years old; mean age was 11 years). This group of patients comprises four subgroups: 9 patients with temporal foci, 6 patients with extratemporal foci, 16 patients with infantile hemiplegia and epilepsy, and 3 patients with epilepsia partialis continua (Kozhevnikov's disease). Preoperatively, detectable brain lesions were present in 30 (88%) cases, a much higher frequency than in adult surgical series. Postoperative follow-up so far is 1-14 years (mean, 4 years). Surgical outcome in this group of 34 patients is as follows: 21 (62%) are seizure-free, 8 (23%) have improved, and 5 (15%) have shown no improvement.

Why are so few patients operated on for epilepsy? A Yugoslavian perspective.

A detailed review of the literature is provided which documents the discrepancy between the number of potential candidates for epilepsy surgery and the number actually operated on. Against a historical background, the limitations of understanding and of diagnostic tests are evaluated together with a careful review of long term surgical results, including those of the author.

Experience with orbital electrodes in the patients operated on for epilepsy--results of temporofrontal resections.

We introduced the orbital electrodes (Fb-frontobasal) in clinical practice in 1983. Since then we have operated on 112 patients for medically intractable "temporal" epileptic fits. In this series there were 45 patients (40%) with independent focal interictal EEG epileptic abnormalities over frontobasal cortex (with or without independent spiking over interomedial temporal region). In these patients we performed a small temporal lobectomy (with amygdaloectomy and resection of pes hippocampi) (TL) and resection of frontoorbital cortex (FOCR). The surgical results are as follows: There are 75 patients with follow-up one to 5 years. TL and FOCR were performed in 27 patients (36%). In this group seizure-free are 25 (93%) and 2 patients (7%) are much better. In the series of 48 patients examined by sphenoidal electrodes and operated for "temporal" fits (TL) by the same author (R.I.) (follow-up 5-13 years), seizure-free are 38 (79%), much better are 8 (17%) and unchanged are 2 (4%) patients. The difference in proportion of seizure-free patients in these two series is statistically significant (t = 2.53;p less than 0.05). Our results suggest that in some patients suffering with "temporal" seizures a well defined EEG picture suggests a new clinical entity the "temporo-frontal" epilepsy, the surgical treatment of which gives excellent results.

The electrocorticographic status and the extent of the cortical resection in epileptic patients.

In three patients operated on for focal epilepsy small pathological lesions in the functionally important cortical regions were microsurgically extirpated. The neighbouring areas of cortex were preseved, although they showed epileptic activity on electrocorticography. The patients are seizure-free three years, two years, and nineteen months later, respectively. On the bases of these facts and experience with another 35 patients operated on for focal epilepsy the authors speculate on the relations between the pathological lesion, epileptogenic cortical area, and the relative dependence of the extent of cortical resection on the electrocorticographic status.

Surgical treatment of craniopharyngiomas in adults.

Thirty-eight patients over the age of 21 were found to be suffering from craniopharyngiomas. According to the clinical symptoms, 8 tumours were of the juvenile type and 24 of the adult type. Thirty-four patients underwent direct surgery of the tumour. Ten were operated on unilaterally and then contra-laterally, as we were unable to remove the tumour in one go. Fifteen of the 24 adult type tumours were operated on radically, and five subtotally. Four patients were given an A-V shunt implant. The best results were obtained with subtotal excisions of adult suprasellar craniopharyngiomas.

[Elements in the objective evaluation of the carotid arteriogram]. / Elementi za objektivnu procenu karotidnog arteriograma.

The carotid angiography is widely used in our country, and has great importance even in those medical, neurosurgical, and neurotraumatic centers which employ the most advanced methods such as computerized tomography of the brain. To asure correct interpretation of a carotid arteriogram (thus making maximal use of such a tool) the interpreneur must have a more detailed knowledge of cephalic angiography. In the A--P picture the main elements are the infra and supraclinoid parts of the carotid, as well as the anterior and middle cerebral arteries and their branches. The authors describe these arteries and their anatomic peculiarities and changes to be expected in certain pathologic processes as illustrated by a new pictures. Of particular importance is the lateral carotid arteriogram whose changes allow diagnosis of expansive intracranial processes such as tumors and trauma.