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1.
Nat Commun ; 11(1): 4686, 2020 09 17.
Artigo em Inglês | MEDLINE | ID: mdl-32943633

RESUMO

Electrophysiology provides a direct readout of neuronal activity at a temporal precision only limited by the sampling rate. However, interrogating deep brain structures, implanting multiple targets or aiming at unusual angles still poses significant challenges for operators, and errors are only discovered by post-hoc histological reconstruction. Here, we propose a method combining the high-resolution information about bone landmarks provided by micro-CT scanning with the soft tissue contrast of the MRI, which allowed us to precisely localize electrodes and optic fibers in mice in vivo. This enables arbitrating the success of implantation directly after surgery with a precision comparable to gold standard histology. Adjustment of the recording depth with micro-drives or early termination of unsuccessful experiments saves many working hours, and fast 3-dimensional feedback helps surgeons avoid systematic errors. Increased aiming precision enables more precise targeting of small or deep brain nuclei and multiple targeting of specific cortical or hippocampal layers.


Assuntos
Encéfalo/diagnóstico por imagem , Eletrodos Implantados , Processamento de Imagem Assistida por Computador/métodos , Fibras Ópticas , Microtomografia por Raio-X/métodos , Animais , Comportamento Animal , Encéfalo/patologia , Mapeamento Encefálico , Hipocampo/diagnóstico por imagem , Hipocampo/patologia , Hipocampo/cirurgia , Técnicas Histológicas/métodos , Imagem por Ressonância Magnética/métodos , Masculino , Camundongos , Camundongos Endogâmicos C57BL , Modelos Animais , Silício , Técnicas Estereotáxicas
2.
BMC Neurol ; 20(1): 160, 2020 Apr 29.
Artigo em Inglês | MEDLINE | ID: mdl-32349706

RESUMO

BACKGROUND: We report the first case of transcranial magnetic resonance-guided focused ultrasound (MRgFUS) for mesial temporal lobe epilepsy (MTLE). CASE PRESENTATION: The target was located 20 mm lateral from the midline and 15 mm above the skull base (left hippocampus). Despite the application of maximal energy, the ablation temperature did not exceed 50 °C, probably because of the low number of effective transducer elements with incident angles below 25 degrees. The skull density ratio was 0.56. Post-operative magnetic resonance imaging did not reveal any lesion and the patient remained almost seizure-free for up to 12 months. CONCLUSIONS: This preliminary case report suggests that MRgFUS may be effective for treating cases of MTLE. Therefore, the safety and feasibility of MRgFUS should be evaluated in future studies with larger numbers of participants and longer follow-up duration.


Assuntos
Técnicas de Ablação/métodos , Epilepsia do Lobo Temporal/cirurgia , Hipocampo/cirurgia , Imagem por Ressonância Magnética , Ultrassonografia de Intervenção/métodos , Adulto , Feminino , Humanos
3.
J Vis Exp ; (159)2020 05 07.
Artigo em Inglês | MEDLINE | ID: mdl-32449727

RESUMO

Epilepsy affects about 1% of the world population and leads to a severe decrease in quality of life due to ongoing seizures as well as high risk for sudden death. Despite an abundance of available treatment options, about 30% of patients are drug-resistant. Several novel therapeutics have been developed using animal models, though the rate of drug-resistant patients remains unaltered. One of probable reasons is the lack of translation between rodent models and humans, such as a weak representation of human pharmacoresistance in animal models. Resected human brain tissue as a preclinical evaluation tool has the advantage to bridge this translational gap. Described here is a method for high quality preparation of human hippocampal brain slices and subsequent stable induction of epileptiform activity. The protocol describes the induction of burst activity during application of 8 mM KCl and 4-aminopyridin. This activity is sensitive to established AED lacosamide or novel antiepileptic candidates, such as dimethylethanolamine (DMEA). In addition, the method describes induction of seizure-like events in CA1 of human hippocampal brain slices by reduction of extracellular Mg2+ and application of bicuculline, a GABAA receptor blocker. The experimental set-up can be used to screen potential antiepileptic substances for their effects on epileptiform activity. Furthermore, mechanisms of action postulated for specific compounds can be validated using this approach in human tissue (e.g., using patch-clamp recordings). To conclude, investigation of vital human brain tissue ex vivo (here, resected hippocampus from patients suffering from temporal lobe epilepsy) will improve the current knowledge of physiological and pathological mechanisms in the human brain.


Assuntos
Hipocampo/anatomia & histologia , Técnicas In Vitro/métodos , Hipocampo/cirurgia , Humanos
4.
Sci Rep ; 10(1): 2768, 2020 02 17.
Artigo em Inglês | MEDLINE | ID: mdl-32066806

RESUMO

Postoperative cognitive dysfunction (POCD) is a major complication affecting patients of any age undergoing surgery. This syndrome impacts everyday life up to months after hospital discharge, and its pathophysiology still remains unclear. Translational research focusing on POCD is based on a wide variety of rodent models, such as the murine tibial fracture, whose severity can limit mouse locomotion and proper behavioral assessment. Besides, influence of skeletal muscle injury, a lesion encountered in a wide range of surgeries, has not been explored in POCD occurrence. We propose a physical model of muscle injury in CX3CR1GFP/+ mice (displaying green fluorescent microglial cells) to study POCD, with morphological, behavioral and molecular approaches. We highlighted: alteration of short- and long-term memory after muscle regeneration, wide microglial reactivity in the brain, including hippocampus area, 24 hours after muscle injury, and an alteration of central brain derived neurotrophic factor (BDNF) and nerve growth factor (NGF) balance, 28 days after muscle injury. Our results suggest for the first time that muscle injury can have early as well as late impacts on the brain. Our CX3CR1GFP/+ model can also facilitate microglial investigation, more specifically their pivotal role in neuroinflammation and synaptic plasticity, in the pathophysiology of POCD.


Assuntos
Encéfalo/cirurgia , Músculo Esquelético/cirurgia , Complicações Cognitivas Pós-Operatórias/patologia , Complicações Pós-Operatórias/metabolismo , Envelhecimento/patologia , Animais , Encéfalo/patologia , Fator Neurotrófico Derivado do Encéfalo/metabolismo , Receptor 1 de Quimiocina CX3C/genética , Citocinas/metabolismo , Modelos Animais de Doenças , Hipocampo/lesões , Hipocampo/patologia , Hipocampo/cirurgia , Humanos , Masculino , Camundongos , Microglia/patologia , Músculo Esquelético/lesões , Músculo Esquelético/metabolismo , Músculo Esquelético/patologia , Fator de Crescimento Neural/metabolismo , Complicações Cognitivas Pós-Operatórias/etiologia , Complicações Cognitivas Pós-Operatórias/metabolismo , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/patologia
5.
Neurology ; 94(12): e1303-e1313, 2020 03 24.
Artigo em Inglês | MEDLINE | ID: mdl-32102974

RESUMO

OBJECTIVE: To qualify the incidence of and risk factors for visual field deficits (VFD) following laser interstitial thermal ablation (LITT) for mesial temporal lobe epilepsy (MTLE) and to relate this to anterior temporal lobectomy (ATL). METHODS: Fifty-seven patients underwent LITT of the amygdalo-hippocampal complex (AH) for MTLE. Masks of ablation volumes, laser probe trajectories, and visual radiations (VRs) from individual subject space were transformed into standardized space using nonlinear registration. Voxel-wise statistics were performed to model relationships between VFDs vs ablation volumes, laser trajectories, VRs, and AH asymmetry. A review of VFDs following ATLs was performed. RESULTS: The incidence of VFD after LITT is much lower than after ATLs. A total of 37.5% of patients developed a VFD, with the probability of this being much higher after left (50%) vs right hemisphere LITT (10%) (Fisher test, p = 0.05). This laterality effect on VFDs is mirrored but underappreciated in ATL series. The most consistent LITT-VFD occurred in the superior vertical octant. Ablation of Meyer loop as well as the summed probability of VRs within laser trajectories correlated with VFDs (p < 0.05). Left and right hippocampi have significantly distinct orientations in axial and coronal planes, which may be one reason for the variation in VFD probability. CONCLUSIONS: LITT results in lower rates of and smaller VFDs-typically an octantanopsia. VRs are at greater risk during surgery for left than right MTLE. Anatomical asymmetries in hippocampal anatomy may explain the hemispheric differences in deficits, and should factor into trajectory planning and also into preoperative patient counseling. Overall the incidence and extent of visual deficits following LITT for MTLE is lower than the reported data following anterior temporal lobectomy. VF tractography incorporated into LITT planning may reduce the occurrence of VFDs.


Assuntos
Hipocampo/cirurgia , Terapia a Laser/efeitos adversos , Complicações Pós-Operatórias/etiologia , Transtornos da Visão/etiologia , Campos Visuais , Epilepsia do Lobo Temporal/cirurgia , Humanos , Complicações Pós-Operatórias/epidemiologia
6.
PLoS One ; 15(1): e0227879, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31929603

RESUMO

Accumulating evidence suggests that Alzheimer's disease is associated with brain insulin resistance, as are some other types of dementia. Intranasal insulin administration has been suggested as a potential approach to overcoming brain insulin resistance and improving cognitive functions. Islet transplantation into the cranial subarachnoid cavity was used as an alternative route for insulin delivery into the brain. Recently, the authors showed the short-term beneficial cognitive effect of a small number of intracranially grafted islets in rats with cognitive dysfunction induced by intracerebroventricular administration of streptozotocin (icv-STZ). This was associated with continuous and safe insulin delivery to the rat brain. The current study investigated the long-term effect of intracranial grafting of islets on cognitive functioning in icv-STZ rats. Severe dementia, associated with obesity and cerebral amyloid-ß angiopathy, was induced in Lewis inbred rats by icv-STZ. Two months after icv-STZ, one hundred syngeneic islets were transplanted into the cranial subarachnoid space. Two and six months later, cognitive alterations were assessed by Morris water-maze tests. Islet graft survival was evaluated by immunohistochemical and biochemical assays. Improvement was found in spatial learning and memory of grafted rats as opposed to the sham-operated icv-STZ rats. The grafted islets showed intact morphology, intensive expression of insulin, glucagon and glucose transporter 2. Normoglycemic obesity and cerebral amyloid-ß angiopathy were found in both grafted and sham-operated icv-STZ rats. In conclusion, islet grafting into cranial subarachnoid space provides an efficient and safe approach for insulin delivery to the brain, leading to a long-term attenuation of icv-STZ-induced cognitive dysfunction.


Assuntos
Doença de Alzheimer/terapia , Transtornos Cognitivos/terapia , Insulina/biossíntese , Transplante das Ilhotas Pancreáticas/métodos , Doença de Alzheimer/metabolismo , Doença de Alzheimer/patologia , Animais , Encéfalo/metabolismo , Encéfalo/patologia , Encéfalo/cirurgia , Cognição/fisiologia , Transtornos Cognitivos/metabolismo , Transtornos Cognitivos/patologia , Modelos Animais de Doenças , Hipocampo/metabolismo , Hipocampo/patologia , Hipocampo/cirurgia , Humanos , Ilhotas Pancreáticas/metabolismo , Aprendizagem em Labirinto , Memória/fisiologia , Ratos
7.
J Clin Neurosci ; 72: 43-49, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31956086

RESUMO

AIM OF THE STUDY: Temporal lobe epilepsy (TLE) has been associated with the phenomenon of accelerated long-term forgetting (ALF). In this study, we aimed to demonstrate the effect of surgery on the ALF phenomena thus contributing to potential explanation of the causal mechanism. MATERIALS AND METHODS: We evaluated 51 patients with TLE related to hippocampal sclerosis who had amygdalohippocampectomy and had remained seizure-free after surgery. A control group consisted of 24 healthy individuals. All were given a verbal learning test assessing recall after 30 min, 1 week and 6 weeks. RESULTS: In our study, the Left-TLE (L-TLE) group showed a statistically significant reduction in the performance at all assessment intervals from 30 min to 1 week compared to the Right-TLE and control groups regarding verbal learning memory test (VLMT) as well as for logical memory. The forgetting rates in the VLMT from 30 min to 1 week were not statistically significantly different between all 3 groups. The logical memory test results equally showed no statistically significant difference in the forgetting rates for the 3 groups between 30 min and 1 week. CONCLUSIONS AND CLINICAL IMPLICATIONS: These results may support ongoing debates assuming the initial low performance in the memory of L-TLE patients to be directly related with left hippocampal-temporal tissue loss irrespective of epileptic activity. The discovery of the ALF phenomenon explains that standard memory tests are unable to detect memory loss in some patients who are experiencing a significant level of problems with forgetfulness in their daily lives.


Assuntos
Epilepsia do Lobo Temporal/cirurgia , Epilepsia/complicações , Transtornos da Memória/etiologia , Adulto , Amnésia , Feminino , Hipocampo/cirurgia , Humanos , Aprendizagem , Memória , Rememoração Mental , Pessoa de Meia-Idade , Testes Neuropsicológicos , Lobo Temporal , Adulto Jovem
8.
Acta Neurochir (Wien) ; 162(4): 795-801, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-31997072

RESUMO

BACKGROUND: Patients with a lesion within the amygdala and uncus may develop temporal lobe epilepsy despite having functional mesial structures. Resection of functional hippocampus and surrounding structures may lead to unacceptable iatrogenic deficits. To our knowledge, there is limited descriptions of surgical techniques for selectively resecting the amygdala and uncus lesions while preserving the hippocampus in patients with language-dominant temporal lobe pathology. METHODS: Thirteen patients with language-dominant temporal lobe epilepsy related to amygdala-centric lesions were identified. Patients with sclerosis of the mesial structures or evidence of pathology outside of the amygdala-uncus region were excluded. Neuropsychological evaluation confirmed normal function of the mesial structures ipsilateral to the lesion. All patients were worked up with video-EEG, high-resolution brain MRI, neuro-psychology evaluation, and either Wada or functional MRI testing. RESULTS: All patients underwent selective resection of the lesion including amygdala and uncus with preservation of the hippocampus via a transcortical inferior temporal gyrus approach to the mesial temporal lobe. Pathology was compatible with glioneuronal tumors. Post-operative MRI demonstrated complete resection in all patients. Eight of the thirteen patients underwent post-operative neuropsychology evaluations and did not demonstrate any significant decline in tasks of delayed verbal recall or visual memory based on the Rey Auditory Verbal Learning Test (RAVLT). One patient showed a slight decrease in confrontation naming using the Boston Naming Test (BNT). Seizure freedom (Engel class I) was achieved in 12 of 13 patients. CONCLUSION: Selective transcortical amygdala and uncus resection with hippocampus preservation may be a reasonable way to achieve seizure control while sparing functional mesial structures.


Assuntos
Tonsila do Cerebelo/cirurgia , Neoplasias Encefálicas/cirurgia , Epilepsia do Lobo Temporal/cirurgia , Ganglioglioma/cirurgia , Giro Para-Hipocampal/cirurgia , Adolescente , Adulto , Tonsila do Cerebelo/diagnóstico por imagem , Neoplasias Encefálicas/diagnóstico por imagem , Eletroencefalografia , Epilepsia do Lobo Temporal/diagnóstico por imagem , Epilepsia do Lobo Temporal/etiologia , Feminino , Ganglioglioma/diagnóstico por imagem , Hipocampo/cirurgia , Humanos , Idioma , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Testes Neuropsicológicos , Giro Para-Hipocampal/diagnóstico por imagem , Complicações Pós-Operatórias/psicologia , Esclerose , Lobo Temporal/diagnóstico por imagem , Lobo Temporal/cirurgia , Resultado do Tratamento , Adulto Jovem
9.
J Neurointerv Surg ; 12(2): 165-169, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31320550

RESUMO

BACKGROUND: The selective posterior cerebral artery (PCA) amobarbital test, or PCA Wada test, is used to predict memory impairment after epilepsy surgery in patients who have previously had a failed internal carotid artery (ICA) amobarbital test. METHODS: Medical records from 2012 to 2018 were retrospectively reviewed for all patients with seizures who underwent a selective PCA Wada test at our institution following a failed or inconclusive ICA Wada test. Standardized neuropsychological testing was performed before and during the Wada procedure and postoperatively in patients who underwent resection. RESULTS: Thirty-three patients underwent a selective PCA Wada test, with no complications. Twenty-six patients with medically refractory epilepsy had a seizure focus amenable to selective amygdalohippocampectomy (AHE). Six patients (23%, n=26) had a failed PCA Wada test and did not undergo selective AHE, seven (27%) declined surgical resection, leaving 13 patients who underwent subtemporal selective AHE. Hippocampal sclerosis was found in all 13 patients (100%). Twelve patients (92%) subsequently underwent formal neuropsychological testing and all were found to have stable memory. Ten patients (77%) were seizure-free (Engel Class I), with average follow-up of 13 months. CONCLUSION: The selective PCA Wada test is predictive of memory outcomes after subtemporal selective AHE in patients with a failed or inconclusive ICA Wada test. Furthermore, given the low risk of complications and potential benefit of seizure freedom, a selective PCA Wada test may be warranted in patients with medically intractable epilepsy who are candidates for a selective AHE and who have a prior failed or inconclusive ICA Wada test.


Assuntos
Amobarbital/farmacologia , Tonsila do Cerebelo/cirurgia , Hipocampo/cirurgia , Memória/efeitos dos fármacos , Testes Neuropsicológicos , Artéria Cerebral Posterior/efeitos dos fármacos , Adulto , Epilepsia Resistente a Medicamentos/diagnóstico , Epilepsia Resistente a Medicamentos/psicologia , Epilepsia Resistente a Medicamentos/cirurgia , Feminino , Humanos , Hipnóticos e Sedativos/farmacologia , Masculino , Memória/fisiologia , Transtornos da Memória/diagnóstico , Transtornos da Memória/etiologia , Transtornos da Memória/psicologia , Pessoa de Meia-Idade , Artéria Cerebral Posterior/fisiologia , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/psicologia , Valor Preditivo dos Testes , Estudos Retrospectivos
10.
World Neurosurg ; 135: e174-e180, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31785436

RESUMO

BACKGROUND: Brain metastases are a common occurrence, with literature supporting the treatment of a limited number of brain metastases with stereotactic radiosurgery (SRS), as opposed to whole brain radiotherapy (WBRT). Less well understood is the role of SRS in patients with ≥10 brain metastases. METHODS: Patients treated with SRS to ≥10 brain metastases without concurrent WBRT between March 1999 and December 2016 were reviewed. Analysis was performed for overall survival, treated lesion freedom from progression (FFP), freedom from new metastases (FFNMs), and adverse radiation effect. Hippocampal volumes were retrospectively generated in patients treated with up-front SRS for evaluation of dose volume metrics. RESULTS: A total of 143 patients were identified with 75 patients having up-front SRS and 68 patients being treated as salvage therapy after prior WBRT. The median number of lesions per patient was 13 (interquartile range [IQR], 11-17). Median total volume of treatment was 4.1 cm3 (IQR, 2.0-9.9 cm3). The median 12-month FFP for up-front and salvage treatment was 96.8% (95% confidence interval [CI], 95.5-98.1) and 83.6% (95% CI, 79.9-87.5), respectively (P < 0.001). Twelve-month FFNMs for up-front and salvage SRS was 18.8% (95% CI, 10.9-32.3) versus 19.2% (95% CI, 9.7-37.8), respectively (P = 0.90). The mean hippocampal dose was 150 cGy (IQR, 100-202 cGy). CONCLUSIONS: Excellent rates of local control can be achieved when treating patients with >10 intracranial metastases either in the up-front or salvage setting. Hippocampal sparing is readily achievable with expected high rates of new metastatic lesions in treated patients.


Assuntos
Neoplasias Encefálicas/cirurgia , Irradiação Craniana/mortalidade , Recidiva Local de Neoplasia/cirurgia , Radiocirurgia , Idoso , Neoplasias Encefálicas/secundário , Feminino , Hipocampo/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Radiocirurgia/métodos , Estudos Retrospectivos , Terapia de Salvação/métodos , Resultado do Tratamento
11.
World Neurosurg ; 134: 629-634.e1, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31790835

RESUMO

BACKGROUND: Awake craniotomy is becoming an essential technique, especially for intrinsic brain tumors which have no clear margins and where extent of resection (EOR) matters. However, intraoperative monitoring for awaken patients requires voice feedback in regular settings. Resection of hippocampal glioma is challenging because of its deep-seated location, its extension in an anterior-posterior axis, and being covered with eloquent cortex. We present a native deaf and mute patient, who has been diagnosed of a left pan-hippocampal glioma, who underwent an awake craniotomy using sign language during intraoperative monitoring. CASE DESCRIPTION: The patient was a 58-year-old, right-handed, native deaf and mute woman who was diagnosed with a left pan-hippocampal glioma. Magnetic resonance imaging (MRI) revealed an intrinsic, nonenhanced, expansile lesion involving the pan-hippocampus. Functional MRI preferred a right hemisphere-dominant pattern. Neuropsychologic testing was normal. An awake craniotomy was successfully performed using sign language to preserve her remaining sole method of communication. A standard sleep-awake-sleep protocol with a transmiddle temporal gyrus (2.5 × 1 cm gyrectomy) approach was performed after a negative mapping result. More than 90% EOR was achieved with only a 0.7 cm3 residual tumor at the hippocampal tail. The pathology was anaplastic ganglioglioma, Ki-67 70%, and World Health Organization grade III. Her postoperative neuropsychologic status was the same as preoperative condition. CONCLUSIONS: We demonstrated using sign language for intraoperative monitoring is feasible in a native deaf and mute patient. We also showed a navigation-assisted minimal transcortical approach to achieve >90% EOR for a pan-hippocampal glioma in a single-stage operation.


Assuntos
Neoplasias Encefálicas/cirurgia , Glioma/cirurgia , Línguas de Sinais , Vigília , Neoplasias Encefálicas/complicações , Neoplasias Encefálicas/diagnóstico , Craniotomia , Feminino , Glioma/complicações , Hipocampo/cirurgia , Humanos , Pessoa de Meia-Idade , Monitorização Intraoperatória/métodos
12.
Brain ; 143(1): 191-209, 2020 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-31834353

RESUMO

Temporal lobe epilepsy represents a major cause of drug-resistant epilepsy. Cognitive impairment is a frequent comorbidity, but the mechanisms are not fully elucidated. We hypothesized that the cognitive impairment in drug-resistant temporal lobe epilepsy could be due to perturbations of amyloid and tau signalling pathways related to activation of stress kinases, similar to those observed in Alzheimer's disease. We examined these pathways, as well as amyloid-ß and tau pathologies in the hippocampus and temporal lobe cortex of drug-resistant temporal lobe epilepsy patients who underwent temporal lobe resection (n = 19), in comparison with age- and region-matched samples from neurologically normal autopsy cases (n = 22). Post-mortem temporal cortex samples from Alzheimer's disease patients (n = 9) were used as positive controls to validate many of the neurodegeneration-related antibodies. Western blot and immunohistochemical analysis of tissue from temporal lobe epilepsy cases revealed increased phosphorylation of full-length amyloid precursor protein and its associated neurotoxic cleavage product amyloid-ß*56. Pathological phosphorylation of two distinct tau species was also increased in both regions, but increases in amyloid-ß1-42 peptide, the main component of amyloid plaques, were restricted to the hippocampus. Furthermore, several major stress kinases involved in the development of Alzheimer's disease pathology were significantly activated in temporal lobe epilepsy brain samples, including the c-Jun N-terminal kinase and the protein kinase R-like endoplasmic reticulum kinase. In temporal lobe epilepsy cases, hippocampal levels of phosphorylated amyloid precursor protein, its pro-amyloidogenic processing enzyme beta-site amyloid precursor protein cleaving enzyme 1, and both total and hyperphosphorylated tau expression, correlated with impaired preoperative executive function. Our study suggests that neurodegenerative and stress-related processes common to those observed in Alzheimer's disease may contribute to cognitive impairment in drug-resistant temporal lobe epilepsy. In particular, we identified several stress pathways that may represent potential novel therapeutic targets.


Assuntos
Peptídeos beta-Amiloides/metabolismo , Disfunção Cognitiva/patologia , Epilepsia do Lobo Temporal/patologia , Hipocampo/patologia , Fragmentos de Peptídeos/metabolismo , Placa Amiloide/patologia , Lobo Temporal/patologia , Proteínas tau/metabolismo , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Doença de Alzheimer/metabolismo , Doença de Alzheimer/patologia , Precursor de Proteína beta-Amiloide/metabolismo , Autopsia , Estudos de Casos e Controles , Criança , Pré-Escolar , Disfunção Cognitiva/complicações , Disfunção Cognitiva/metabolismo , Disfunção Cognitiva/fisiopatologia , Epilepsia Resistente a Medicamentos/complicações , Epilepsia Resistente a Medicamentos/metabolismo , Epilepsia Resistente a Medicamentos/patologia , Epilepsia Resistente a Medicamentos/cirurgia , Epilepsia do Lobo Temporal/complicações , Epilepsia do Lobo Temporal/metabolismo , Epilepsia do Lobo Temporal/cirurgia , Feminino , Hipocampo/metabolismo , Hipocampo/cirurgia , Humanos , Proteínas Quinases JNK Ativadas por Mitógeno/metabolismo , Masculino , Pessoa de Meia-Idade , Procedimentos Neurocirúrgicos , Placa Amiloide/metabolismo , Lobo Temporal/metabolismo , Lobo Temporal/cirurgia , Adulto Jovem , eIF-2 Quinase/metabolismo
13.
Acta Neurochir (Wien) ; 162(4): 881-891, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-31834499

RESUMO

BACKGROUND: Selective amygdalohippocampectomy (AH) is a surgical option for patients with medically intractable seizures from mesial temporal lobe pathology. The transcranial route is considered the best method to achieve this goal. However, the standard approach through the neocortex is still invasive. The risks can be minimized if the mesial temporal lobe is resected while preserving the lateral temporal lobe and the Meyer's loop. This study explores the feasibility of selective AH by endoscopic endonasal approach (EEA) in cadaveric specimens. METHODS: The endoscopic anatomy of the mesial temporal lobe and the feasibility of a successful selective AH were studied in six hemispheres from three injected human cadavers. Quantitative analyses on the extent of resection and angles of exposure were performed based on CT and MRI studies of pre- and post-selective AH and measurements taken during dissections. RESULTS: The EEA V1-V2 corridor provided a direct and logical line of access to the mesial temporal lobe, following its natural trajectory with no brain retraction and minimal exposure of the pterygopalatine fossa. The components of the mesial temporal lobe were resected just as selectively and easily as the transcranial route, but without compromising the structures of the lateral temporal lobe or the Meyer's loop. CONCLUSIONS: The EEA V1-V2 corridor demonstrated its selective resectability and accessibility of the mesial temporal lobe in cadaveric specimens. The clinical value of this approach should be explored responsibly by a surgeon with both competent microsurgical skills and experiences in EEA.


Assuntos
Tonsila do Cerebelo/cirurgia , Epilepsia do Lobo Temporal/cirurgia , Hipocampo/cirurgia , Neuroendoscopia/métodos , Lobo Temporal/cirurgia , Tonsila do Cerebelo/diagnóstico por imagem , Cadáver , Epilepsia do Lobo Temporal/diagnóstico por imagem , Hipocampo/diagnóstico por imagem , Humanos , Imagem por Ressonância Magnética , Nariz , Fossa Pterigopalatina , Lobo Temporal/diagnóstico por imagem
14.
Epilepsy Behav ; 102: 106643, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31805504

RESUMO

Hippocampal sclerosis (HS) is characterized by neuronal loss and gliosis. The intensity and distribution of these histopathological findings over the Cornu Ammonis (CA) subfields are important for the classification of HS and prognostication of patients with temporal lobe epilepsy (TLE). Several studies have associated the neuronal density reduction in the hippocampus with cognitive decline in patients with TLE. The current study aimed at investigating whether the expression of glial proteins in sclerotic hippocampi is associated with presurgical memory performance of patients with TLE. Before amygdalohippocampectomy, patients were submitted to memory tests. Immunohistochemical and morphometric analyses with glial fibrillary acidic protein (GFAP) for astrogliosis and human leucocyte antigen DR (HLA-DR) for microgliosis were performed in paraffin-embedded HS and control hippocampi. Sclerotic hippocampi exhibited increased gliosis in comparison with controls. In patients with TLE, the area and intensity of staining for HLA-DR were associated with worse performance in the memory tests. Glial fibrillary acidic protein was neither associated nor correlated with memory test performance. Our data suggest association between microgliosis, but not astrogliosis, with visual memory decline in patients with TLE.


Assuntos
Epilepsia do Lobo Temporal/psicologia , Gliose/psicologia , Hipocampo/patologia , Transtornos da Memória/psicologia , Adulto , Disfunção Cognitiva/etiologia , Disfunção Cognitiva/psicologia , Epilepsia do Lobo Temporal/complicações , Epilepsia do Lobo Temporal/cirurgia , Feminino , Proteína Glial Fibrilar Ácida/metabolismo , Gliose/complicações , Antígenos HLA-DR , Hipocampo/cirurgia , Humanos , Masculino , Transtornos da Memória/etiologia , Pessoa de Meia-Idade , Testes Neuropsicológicos , Procedimentos Neurocirúrgicos , Esclerose , Fatores Socioeconômicos , Adulto Jovem
15.
Nat Commun ; 10(1): 5721, 2019 12 16.
Artigo em Inglês | MEDLINE | ID: mdl-31844154

RESUMO

The hippocampal formation is considered essential for spatial navigation. In particular, subicular projections have been suggested to carry spatial information from the hippocampus to the ventral striatum. However, possible cross-structural communication between these two brain regions in memory formation has thus far been unknown. By selectively silencing the subiculum-ventral striatum pathway we found that its activity after learning is crucial for spatial memory consolidation and learning-induced plasticity. These results provide new insight into the neural circuits underlying memory consolidation and establish a critical role for off-line cross-regional communication between hippocampus and ventral striatum to promote the storage of complex information.


Assuntos
Hipocampo/fisiologia , Consolidação da Memória/fisiologia , Memória Espacial/fisiologia , Estriado Ventral/fisiologia , Animais , Técnicas de Observação do Comportamento , Comportamento Animal/fisiologia , Hipocampo/cirurgia , Masculino , Aprendizagem em Labirinto/fisiologia , Camundongos , Modelos Animais , Vias Neurais/fisiologia , Plasticidade Neuronal/fisiologia , Técnicas Estereotáxicas , Estriado Ventral/cirurgia
16.
Epilepsy Behav ; 100(Pt A): 106496, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31654940

RESUMO

OBJECT: Temporal lobectomy with amygdalohippocampectomy is the standard surgical treatment for appropriate candidates with medically-intractable temporal lobe epilepsy. More recently, because of the risk of postoperative language/memory decline in a subset of patients with intact memory, a multiple hippocampal transection (MHT) approach has been proposed to preserve function. METHODS: Studies of MHT reporting both Engel and verbal memory outcome measures were included in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for reporting of systematic reviews. Data were extracted on verbal memory function pre- and postoperatively, seizure outcome, and demographic factors. A random effects model was used to determine overall verbal memory function after MHT, and a meta-regression model was applied to identify factors associated with outcome. RESULTS: A total of 114 patients across five studies were included. Engel class I seizure outcome across all studies ranged from 64.7% to 94.7%, with 84 of the 114 patients achieving this outcome. Preoperative verbal memory score was most strongly associated with postoperative verbal memory preservation (p = 0.003). Of 59 patients with full verbal memory outcome scores, 86.8% (95% CI [confidence interval]: 77.6%-96%) had complete preservation of verbal memory relative to preoperative functional baseline. CONCLUSION: Multiple hippocampal transection is an evolving surgical technique. Although the present data are limited, the current systematic review suggests that this approach is effective at preserving verbal memory in patients with good baseline function. Although reasonable seizure outcomes have been reported with MHT, comparison to a well-established procedure such as temporal lobectomy and amydalohippocampectomy must be guided by further evidence.


Assuntos
Epilepsia do Lobo Temporal/cirurgia , Hipocampo/cirurgia , Transtornos da Memória/prevenção & controle , Procedimentos Neurocirúrgicos/métodos , Psicocirurgia/métodos , Hemisferectomia/efeitos adversos , Humanos , Transtornos da Memória/etiologia , Procedimentos Neurocirúrgicos/efeitos adversos , Complicações Pós-Operatórias/prevenção & controle , Psicocirurgia/efeitos adversos , Convulsões/cirurgia , Aprendizagem Verbal
17.
Stereotact Funct Neurosurg ; 97(4): 255-265, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31618749

RESUMO

Selective laser amygdalohippocampotomy (SLAH) is a minimally invasive surgical treatment for medial temporal lobe epilepsy. Visual field deficits (VFDs) are a significant potential complication. The objective of this study was to determine the relationship between VFDs and potential mechanisms of injury to the optic radiations and lateral geniculate nucleus. We performed a retrospective cross-sectional analysis of 3 patients (5.2%) who developed persistent VFDs after SLAH within our larger series (n = 58), 15 healthy individuals and 10 SLAH patients without visual complications. Diffusion tractography was used to evaluate laser catheter penetration of the optic radiations. Using a complementary approach, we evaluated evidence for focal microstructural tissue damage within the optic radiations and lateral geniculate nucleus. Overablation and potential heat radiation were assessed by quantifying ablation and choroidal fissure CSF volumes as well as energy deposited during SLAH.SLAH treatment parameters did not distinguish VFD patients. Atypically high overlap between the laser catheter and optic radiations was found in 1/3 VFD patients and was accompanied by focal reductions in fractional anisotropy where the catheter entered the lateral occipital white matter. Surprisingly, lateral geniculate tissue diffusivity was abnormal following, but also preceding, SLAH in patients who subsequently developed a VFD (all p = 0.005).In our series, vision-related complications following SLAH, which appear to occur less frequently than following open temporal lobe -surgery, were not directly explained by SLAH treatment parameters. Instead, our data suggest that variations in lateral geniculate structure may influence susceptibility to indirect heat injury from transoccipital SLAH.


Assuntos
Tonsila do Cerebelo/cirurgia , Hipocampo/cirurgia , Terapia a Laser/efeitos adversos , Complicações Pós-Operatórias/etiologia , Técnicas Estereotáxicas/efeitos adversos , Transtornos da Visão/etiologia , Adolescente , Adulto , Idoso , Tonsila do Cerebelo/diagnóstico por imagem , Estudos Transversais , Epilepsia do Lobo Temporal/diagnóstico por imagem , Epilepsia do Lobo Temporal/cirurgia , Feminino , Seguimentos , Hipocampo/diagnóstico por imagem , Humanos , Terapia a Laser/tendências , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/diagnóstico por imagem , Psicocirurgia/efeitos adversos , Psicocirurgia/tendências , Estudos Retrospectivos , Fatores de Risco , Técnicas Estereotáxicas/tendências , Transtornos da Visão/diagnóstico por imagem , Campos Visuais/fisiologia , Adulto Jovem
18.
World Neurosurg ; 132: 230-235, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31505290

RESUMO

BACKGROUND: Symptomatic cerebral vasospasm may occur in the setting of aneurysmal subarachnoid hemorrhage, traumatic brain injury, or after anterior skull base surgery, but its occurrence is extremely rare in the background of glioma surgical resection. CASE DESCRIPTION: We present a rare case of symptomatic diffuse vasospasm, which is the fourth reported case of symptomatic vasospasm after temporal lobectomy and the third in the setting of a glial tumor. This patient, a 10-year-old boy, developed bilateral, progressive cerebral infarcts because of diffuse vasospasm after anteromesial temporal lobectomy for a left temporal ganglioglioma leading to significant morbidity. CONCLUSIONS: The risk factors, likely pathogenesis and the importance of early diagnosis and timely institution of treatment, in such cases are discussed in the background of relevant literature. The current case represents the first report of symptomatic diffuse vasospasm occuring after surgical resection of intracranial ganglioglioma in the Western literature.


Assuntos
Neoplasias Encefálicas/cirurgia , Ganglioglioma/cirurgia , Complicações Pós-Operatórias/diagnóstico por imagem , Vasoespasmo Intracraniano/diagnóstico por imagem , Tonsila do Cerebelo/cirurgia , Criança , Angiografia por Tomografia Computadorizada , Hipocampo/cirurgia , Humanos , Masculino , Giro Para-Hipocampal/cirurgia , Complicações Pós-Operatórias/fisiopatologia , Lobo Temporal/cirurgia , Vasoespasmo Intracraniano/fisiopatologia
19.
Seizure ; 71: 304-311, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31521052

RESUMO

PURPOSE: Concerns about the impact of open surgery for drug-resistant mesial temporal lobe epilepsy with hippocampal sclerosis (MTLE-HS) have driven interest in minimally invasive techniques. Stereo-electro-encephalography guided radiofrequency thermocoagulation (SEEG guided RF-TC) offers an alternative choice but with currently limited efficacy. We developed a procedure for optimally extended thermocoagulative lesions and investigated the efficacy and safety for MTLE-HS in a preliminary observational study. METHODS: From June 2016 to August 2017, twenty-two patients were selected for the present study. They met the criteria of unilateral MTLE-HS after noninvasive evaluation and then underwent implantation of a combination of SEEG electrodes to form a high-density focal stereo-array, including one electrode along the long axis of amygdalohippocampal complex and three orthogonal electrodes to widely sample mesial temporal structures. A unilateral epileptogenic zone of mesial temporal structures was confirmed in these 21 patients. SEEG-guided bipolar coagulations were performed between two contiguous contacts of the same electrode, or between two adjacent contacts of different electrodes. RESULTS: Surgical procedures were well tolerated, with no related complications. At the follow-up of 12 months, 20 patients (95.2%) experienced a >90% decrease in seizure frequency and 16 patients (76.2%) were free of disabling seizures (Engel class I). Among them, eight (38.1%) were classified as Engel class Ia and the other eight (38.1%) as Engel class Ib. Four others (19%) had rare disabling seizures (Engel class II). Only one (4.8%) experienced an Engel class III outcome. CONCLUSION: Optimized SEEG-guided RF-TC is a promising complementary option for the treatment of MTLE-HS.


Assuntos
Epilepsia Resistente a Medicamentos/cirurgia , Eletrocoagulação , Eletrocorticografia , Epilepsia do Lobo Temporal/cirurgia , Hipocampo/cirurgia , Avaliação de Processos e Resultados em Cuidados de Saúde , Ablação por Radiofrequência , Técnicas Estereotáxicas , Adolescente , Adulto , Criança , Pré-Escolar , Epilepsia do Lobo Temporal/patologia , Feminino , Seguimentos , Hipocampo/patologia , Humanos , Lactente , Masculino , Procedimentos Cirúrgicos Robóticos , Esclerose/patologia , Adulto Jovem
20.
World Neurosurg ; 132: e759-e765, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31415886

RESUMO

OBJECTIVE: To determine postoperative long-term changes of hippocampal volume (HV) correlating with cognitive functions in patients who underwent surgery for hippocampal sclerosis with postoperative freedom from seizures. METHODS: We studied 1.5T magnetic resonance imaging before and after surgery in 24 patients (mean ± SD age, 36.9 ± 11.0 years) with hippocampal sclerosis. We performed serial magnetic resonance imaging at 6 months to 1 year, 1-2 years, 2-3 years, and 3-5 years postoperatively. We compared HVs of 24 patients with HVs of 14 age-matched control subjects. We analyzed correlations between consecutive HVs and seizure duration and age at surgery. We compared consecutive changes in HVs between dominant and nondominant hemispheres with concurrent cognitive functions. RESULTS: Preoperative HVs of unresected contralateral hippocampus were significantly smaller than HVs of control subjects (P < 0.01). Unresected contralateral HV changes compared with preoperative HVs were -3.6% ± 6.9%, -2.3% ± 8.5%, -3.6% ± 10.2% (P < 0.05), and -5.0% ± 9.5% (P < 0.05) at consecutive postoperative periods. Largest change in HVs at 3-5 years was significantly correlated with older age at surgery (P < 0.05). Unresected contralateral dominant 14 HVs remained consistently smaller than nondominant 10 HVs up to 5 years with statistical significance (P < 0.05). Verbal memory was preserved in 14 patients with unresected contralateral smaller dominant hippocampus. CONCLUSIONS: In seizure-free patients after hippocampal sclerosis resection , unresected contralateral HV significantly declined with older age at surgery. Visual memory was preserved regardless of side and volume loss. Despite significantly reduced HVs, verbal memory was preserved with the unresected contralateral dominant hippocampus. Earlier surgical intervention may have lower potential risk for memory decline secondary to postoperative HV loss.


Assuntos
Hipocampo/patologia , Hipocampo/cirurgia , Transtornos da Memória/prevenção & controle , Transtornos da Memória/psicologia , Procedimentos Neurocirúrgicos/métodos , Complicações Pós-Operatórias/prevenção & controle , Complicações Pós-Operatórias/psicologia , Adolescente , Adulto , Fatores Etários , Lobectomia Temporal Anterior , Criança , Dominância Cerebral , Feminino , Seguimentos , Hipocampo/diagnóstico por imagem , Humanos , Imagem por Ressonância Magnética , Masculino , Transtornos da Memória/etiologia , Pessoa de Meia-Idade , Testes Neuropsicológicos , Esclerose , Convulsões , Resultado do Tratamento , Adulto Jovem
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