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Objective To explore the preoperative localization diagnosis and surgical techniques of intractable occipital lobe epilepsy.Methods Retrospectively studied 37 patients diagnosed as occipital lobe epilepsy and underwent focal occipital resections for epilepsy.The semiology,scalp electroencephalography,MRI,fluorodeoxyglucose-positron emission tomography(FDG-PET),and intracranial EEG monitoring were used to localize the epileptogenic zones.The long-term seizure outcomes were assessed according to the Engel classification scheme.Results Visual symptoms were present in 25 patients preoperatively in this series.MRI displayed occipital lobe lesions in 15 patients,and FDG-PET revealed hypometabolism in or adjacent to epileptogenic zones.And 30 patients' epileptogenic zones and functional areas were defined by intracranial EEG monitoring.Visual field deficits were present in 35.3% of patients preoperatively,and 61% had new or aggravated visual field deficits after surgery.After a mean follow-up of 41 months,81.1% of the patients were seizure free or rarely had seizures.Conclusion The curative effect of the surgery on the medically intractable occipital lobe epilepsy is good.Intracranial EEG monitoring with electrodes extensively covering the occipital lobe and adjacent areas can be useful to demarcate the epileptogenic zones and the visural cortex,and it may prevent aggravation of the visual field deficits as much as possible.
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Objective To analyze the correlative factors of hypopituitarism in patients with intracranial non-sellar tumors.Methods Eighty-three patients with intracranial non-sellar tumors,admitted to our hospital from May 2014 to April 2015,were included in our study;their clinical data were retrospectively analyzed.The status of pituitary function was assessed according to the level of preoperative serum hormone.Univariate and multivariate Logistic regression analyses were employed to analyze the correlations of preoperative hypopituitarism with age,gender,hypertension,epilepsy history,course of disease,mass effect of tumor,tumor location,intracranial pressure (ICP),and composition of cerebrospinal fluid.Results Before surgery,30 showed hypopituitarism,accounting for 36.14％:23 had deficiency in one pituitary axe and 7 had multi-axial deficiency.Univariate analysis showed that high ICP (ICP＞200 mmH2O),acute or sub-acute course (≤ 3 months) and presence of mass effect by non-sellar brain tumor were the risk factors of hypopituitarism (P＜0.05).Multivariate Logistic regression analysis revealed that intracranial mass effect in patients with non-sellar brain tumor was an independent risk factor (OR=3.197,95％CI=1.085-9.423,P=0.035).Conclusion Hypopituitarism has high morbidity in patients with non-sellar brain tumor;intracranial mass effect is an independent risk factor for hypopituitarism.
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Objective To investigate the value of neuronavigation in microsurgery for medically refractory epilepsy. Methods The clinical data of 137 patients with medically refractory epilepsy who underwent epilepsy surgery with neuronavigation in our hospital from September 2008 to September 2016 were analyzed retrospectively. In these patients, 17 accepted temporal parietal occipital dissection, 23 accepted corpus callosum subtotal dissection, 11 accepted functional cerebral hemispheric dissection, and 86 accepted epilepsy foci resection. The surgical efficacies were analyzed. Results All patients uneventfully underwent the operations as planned. The mean follow-up period was 52 months (12-108 months). Engel grade I was achieved in 71 patients, grade II in 32, grade III in 25, and grade IV in 9 patients. The total satisfaction rate reached to 75.18％ (103/137), including 100％ patients (11/11) accepted functional cerebral hemispheric dissection. There were no severe operative complications. Conclusion Neuronavigation helps to locate intracranial targets, accurately resect the epileptogenic foci or disconnect the epilepsy conduction pathway, preserve the neurologic function, and avoid the operative complications.
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Objective To investigate the different memory outcomes in temporal lobe epilepsy patients underwent different surgical approaches.Methods Two hundred forty-eight patients with temporal lobe epilepsy and hippocampal scle-rosis underwent standard anterior temporal lobectomy ( ATL, n=83 ) or selective amygdalohippocampectomy ( SAH, n=165) from 2009 to 2013.All the patients underwent clinical memory function assessment before surgery, 3 months and 2 years after surgery respectively.Results The memory quotient ( MQ) of patients who underwent brain surgery in the domi-nant hemisphere significantly decreased 3 months after surgery (74.5 ±16.2, 75.6 ±19.5) compared to presurgery MQ (82.9 ±15.8, 83.2 ±21.2) in both ATL and SAH groups (P<0.05).Although MQ was slightly recovered at 2 years af-ter surgery, MQ (75.1 ±14.1, 76.1 ±17.6) was still significantly lower compared with presurgery MQ (P<0.05).A-mong this, both the decrease extent of the MQ 3 months after surgery and 2 years after surgery were smaller in the SAH group than in the ATL group (7.6 vs.8.4;7.1 vs.7.8).The MQ of patients who underwent brain surgery in the non-dominant hemisphere (either ATL or SAH ) increased slightly 3 months after surgery (87.2 ±15.1, 88.1 ±16.9) com-pared to presurgery MQ (85.5 ±13.5, 85.3 ±19.7) although the difference was not statistically significant.The MQ of these two groups improved significantly 2 years after surgery (92.8 ±12.7, 93.7 ±17.1)(P<0.05).The improvement extent of the MQ was larger in the SAH group than in the ATL group (8.4 vs.7.3).Conclusions SAH may be better than ATL in the maintenance of memory function in patients with temporal lobe epilepsy and hippocampal sclerosis.