Abstract:
OBJECT:The authors provide a systematic analysis of electroclinical characteristics in patients with persistent seizures following temporal lobe epilepsy (TLE) surgery and identify ideal candidates for reoperation. METHODS:The authors retrospectively reviewed the records of 68 adult patients (mean follow-up 8.7 years) who underwent a video electroencephalography evaluation and high-resolution imaging after failed TLE surgery performed between 1990 and 2004 at The Cleveland Clinic. Multivariate logistic regression analyses were performed to identify predictors of the yield of a repeat evaluation, location of the recurrence focus, and outcome following reoperation. RESULTS:Although a focus of recurrence was identified in 44 patients, only 15 underwent reoperation, and only 6 of these became seizure free. Localized foci of recurrence were successfully identified in patients with early (within 1 postoperative year) and frequent (≥4 per month) recurrent seizures (yield of 100% if both conditions were fulfilled). Predictors of contiguity of the focus of recurrence to the initial surgical bed were variable depending on the type of the initial surgery: patients with baseline contralateral temporal spiking were 6 times (OR 6.34, p<0.05) more likely to experience seizure recurrence from the contralateral temporal lobe after a "standard" temporal lobectomy, while the need to use subdural electrodes and the timing of recurrence were more significant following limited temporal resections. The focus of recurrence was distant to the original surgical bed when subdural electrodes were used prior to first surgery (OR 28.0, p=0.01) or when seizures recurred early (within <6 postoperative months; OR 12.5, p=0.04). With reoperation, only patients with mesial and basal extension of the temporal resections became seizure free. Interestingly, seizure freedom was achieved with medical therapy alone in 42% of patients with a nonidentifiable recurrence focus as opposed to 4% of those with an unoperated identifiable focus. CONCLUSIONS:The timing and frequency of recurrent seizures following unsuccessful TLE surgery provide useful guidelines for the yield of a surgical reevaluation, and potentially for the mechanisms of surgical failure.
journal_name
J Neurosurgjournal_title
Journal of neurosurgeryauthors
Jehi LE,Silveira DC,Bingaman W,Najm Idoi
10.3171/2010.8.JNS10180subject
Has Abstractpub_date
2010-12-01 00:00:00pages
1186-94issue
6eissn
0022-3085issn
1933-0693journal_volume
113pub_type
杂志文章abstract::A 54-year-old female presented with multiple episodes of emesis, intractable headaches, worsening balance, and slowly progressive right facial weakness. Imaging demonstrated a 3-cm mass in the left internal capsule and corona radiata region with associated edema, mass effect, and midline shift concerning for high-grad...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/2016.7.JNS1690
更新日期:2017-08-01 00:00:00
abstract::The surgical treatment of cerebrovascular malformations intrigued early neurosurgeons. Cushing defined vascular malformations as tumors arising from cerebral blood vessels. He successfully resected the first arteriovenous malformation 3 years after it had been irradiated. In the absence of angiography, the pathoanatom...
journal_title:Journal of neurosurgery
pub_type: 传,历史文章,杂志文章
doi:10.3171/jns.2004.101.3.0553
更新日期:2004-09-01 00:00:00
abstract:OBJECT:The risk of surgical site infection (SSI) after craniotomies or craniectomies in patients in whom contaminated bone flaps have been reimplanted has not been determined. The objectives of this study were to identify the prevalence of bone flaps with positive cultures--especially those contaminated with Propioniba...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/2011.1.JNS10782
更新日期:2011-06-01 00:00:00
abstract::This series of 228 patients with infantile non-neoplastic hydrocephalus who received either a ventriculoatrial (VA) or a ventriculoperitoneal (VP) shunt before 2 years of age was followed for an average of 7 years, and the results with the two types of shunt were compared. Mortality and infection rates were similar fo...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/jns.1979.50.2.0179
更新日期:1979-02-01 00:00:00
abstract:OBJECT:Assessing academic productivity through simple quantification may overlook key information, and the use of statistical enumeration of academic output is growing. The h index, which incorporates both the total number of publications and the citations of those publications, has been recently proposed as an objecti...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/2008.10.JNS08978
更新日期:2009-08-01 00:00:00
abstract:OBJECTIVE:The authors sought to determine the predictors of late neurological and hospital-acquired medical complications (HACs) in patients with low-grade aneurysmal subarachnoid hemorrhage (aSAH). METHODS:The authors conducted a retrospective study of 424 patients with low-grade aSAH admitted to their institution fr...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/2019.1.JNS182394
更新日期:2019-05-03 00:00:00
abstract::OBJECT Current recommendations stress the need for cognitive parameters to be integrated in the evaluation of outcomes for intracranial meningioma surgery. The aim of this prospective study was to examine neurocognitive function in meningioma patients pre- and postoperatively. METHODS Patients with skull base (anterio...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/2015.6.JNS1549
更新日期:2016-06-01 00:00:00
abstract:OBJECT:This prospective study is based on a consecutive series of 20 patients with pineal region tumors who underwent minimally invasive preferential management. The purpose of this report is to discuss the role of neuroendoscopic procedures in the management of pineal region tumors. METHODS:If the tumor markers alpha...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/jns.2000.93.2.0245
更新日期:2000-08-01 00:00:00
abstract::The authors report a case of cerebral aspergillosis. This is only the fifth case following intracranial surgery noted in the literature. Pathogenesis, angiographic findings, and results of cerebrospinal fluid culture are discussed. ...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/jns.1978.49.2.0308
更新日期:1978-08-01 00:00:00
abstract::A 24-hour intensive intravenous dosing regimen with the glucocorticoid steroid methylprednisolone has recently been shown to be effective in enhancing neurological recovery in spinal cord-injured patients when initiated within 8 hours after injury. The state of knowledge concerning the neuroprotective pharmacology of ...
journal_title:Journal of neurosurgery
pub_type: 杂志文章,评审
doi:10.3171/jns.1992.76.1.0013
更新日期:1992-01-01 00:00:00
abstract::The management of ventriculoperitoneal (VP) shunt failure is a common problem in neurosurgical practice. On occasion, extraperitoneal sites for CSF diversion are required when shunting to the peritoneal cavity has failed after multiple attempts. The authors report a novel minimally invasive procedure allowing cannulat...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/2016.8.JNS16342.test
更新日期:2017-03-17 00:00:00
abstract::The criteria by which acromegalic patients are considered "cured" after surgical therapy are still controversial. Since the abnormal growth hormone (GH) increase after the administration of some agents has been demonstrated to be characteristic of the tumoral somatotrophs, its disappearance after surgery may be taken ...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/jns.1983.59.3.0402
更新日期:1983-09-01 00:00:00
abstract::A case of chronic diploic hematoma of the parietal bone is reported. This lesion is considered to have developed over several years following minor head trauma. Clinical, radiological, and pathological findings of this rare lesion are described. To the authors' knowledge, this is the first reported case of such an unc...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/jns.1994.80.6.1112
更新日期:1994-06-01 00:00:00
abstract:OBJECT:In this paper the authors introduce a novel use of magnetoencephalography (MEG) for noninvasive mapping of language-specific cortex in individual patients and in healthy volunteers. METHODS:The authors describe a series of six experiments in which normative MEG data were collected and the reliability, validity,...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/jns.1999.90.1.0085
更新日期:1999-01-01 00:00:00
abstract::The authors report their experience in successfully treating a 15-week-old child who became comatose following a spontaneous intracerebral hemorrhage. It was initially believed that a tumor in the right frontal lobe caused the hemorrhage. Coagulation studies revealed abnormal results on presentation, and the problem w...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/ped.2006.104.3.202
更新日期:2006-03-01 00:00:00
abstract::A new technique is presented in which expandable compressed Ivalon sponge emboli were used to obliterate an intramedullary arteriovenous malformation of the spinal cord by intraparenchymal embolization. A case is described in which this method was used. ...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/jns.1977.47.1.0119
更新日期:1977-07-01 00:00:00
abstract:OBJECT:Angiogenesis occurs after intracerebral hemorrhage (ICH). Thrombin mediates mitogenesis and survival in endothelial cells and induces angiogenesis. The present study aimed to clarify whether thrombin is involved in triggering ICH-related angiogenesis. METHODS:In the first part of the experiment, autologous bloo...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/2012.8.JNS112152
更新日期:2012-11-01 00:00:00
abstract:OBJECT:The concept of the flow-diverter stent (FDS) is to induce aneurysmal thrombosis while preserving the patency of the parent vessel and any covered branches. In some circumstances, it is impossible to avoid dangerously covering small branches, such as the anterior choroidal artery (AChA), with the stent. In this p...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/2014.11.JNS141603
更新日期:2015-12-01 00:00:00
abstract::Experimental cerebral vasospasm was produced in the canine basilar artery by an intracisternal injection of fresh autogenous arterial blood, and prostaglandins generated in spastic and nonspastic arteries were assessed by thin-layer chromatography. Prostaglandins synthesized in normal arteries were 6-keto-prostaglandi...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/jns.1981.55.5.0779
更新日期:1981-11-01 00:00:00
abstract:OBJECT:Until now there has been no reliable stimulation protocol for inducing transient language disruptions while mapping Broca's area. Despite the promising data of only a few studies in which speech arrest and language disturbances have been induced, certain concerns have been raised. The purpose of this study was t...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/2013.11.JNS13952
更新日期:2014-05-01 00:00:00
abstract::Sixteen patients referred for atlantoaxial fixation failures were treated surgically with revision procedures during the past decade. Of these 16 patients, atlantoaxial instability occurred because of rheumatoid arthritis in five, as odontoideum in seven, transverse ligament disruption in two, and odontoid fracture no...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/jns.1995.83.2.0248
更新日期:1995-08-01 00:00:00
abstract:OBJECT:The aim of this study was to describe the application of a novel transarterial approach to curative embolization of complex intracranial dural arteriovenous fistulas (DAVFs). This technique is particularly useful in patients harboring high-grade DAVFs with direct cortical venous drainage or for whom transvenous ...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/jns.2003.98.3.0498
更新日期:2003-03-01 00:00:00
abstract::The case of a 30-year-old man with a spinal extradural meningeal cyst in the thoracolumbar region is reported. Operative findings revealed a dural defect that allowed communication between the extradural cyst cavity and the subarachnoid space. Application of the Valsalva maneuver made the cerebrospinal fluid flow into...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/jns.1996.85.2.0354
更新日期:1996-08-01 00:00:00
abstract::Five full-term neonates with a posterior fossa subdural hematoma caused by birth injury are reported. All of the patients were successfully treated with surgery. They all presented with biphasic ventricular dilatation as demonstrated by serial computerized tomography (CT) scanning. The initial dilatation due to obstru...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/jns.1988.68.2.0211
更新日期:1988-02-01 00:00:00
abstract::A 42-year-old man suffered a head injury in a road traffic accident and subsequently developed anosmia and isolated adrenocorticotropic hormone (ACTH) deficiency. There was no other evidence of pituitary dysfunction. No previous case of isolated ACTH deficiency following head injury has been reported. ...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/jns.1990.73.3.0453
更新日期:1990-09-01 00:00:00
abstract::The authors report the successful staged stenting and coil embolization of a large vertebral artery-posterior inferior cerebellar artery (VA-PICA) aneurysm using the contralateral VA for access. A 67-year-old woman presented with a large ruptured VA-PICA aneurysm. Initial attempts to stent the wide-necked aneurysm fro...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/JNS-07/12/1214
更新日期:2007-12-01 00:00:00
abstract::Proximal shunt obstruction or obstruction of the ventricular catheter may present with signs and symptoms of shunt failure with either no cerebrospinal fluid flow or a falsely low intracranial pressure (ICP) upon shunt tap. The author reports a technique for lowering the ICP and for measuring the pressure in patients ...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/jns.1988.68.5.0817
更新日期:1988-05-01 00:00:00
abstract:OBJECTIVE:Transsphenoidal surgery is advocated as the first-line management of growth hormone (GH)-secreting adenomas. Although disease control is defined by strict criteria for biochemical remission, the length of follow-up needed is not well defined in literature. In this report, the authors present their long-term r...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/2019.6.JNS191187
更新日期:2019-10-11 00:00:00
abstract:OBJECT:The average 65-year-old patient with moderate dementia can look forward to only 1.4 quality-adjusted life years (QALYs), that is, longevity times quality of life. Some of these patients suffer from normal-pressure hydrocephalus (NPH) and respond dramatically to shunt insertion. Currently, however, NPH cannot be ...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/jns.2006.105.6.815
更新日期:2006-12-01 00:00:00
abstract::Forty-five studies of regional cerebral blood volume (rCBV), regional cerebral blood flow (rCBF), and regional cerebral oxygen utilization (rCMRO2) were performed in 30 patients undergoing diagnostic cerebral angiography for evaluation of a subarachnoid hemorrhage due to a ruptured intracranial aneurysm. Tracer method...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/jns.1977.46.4.0446
更新日期:1977-04-01 00:00:00