The Usefulness of 3D-Surface Rendering of the MRI in Surgical Treatment of Patients with Intractable Neocortical Epilepsy

BACKGROUND: This study is designed to indicate the role of 3D-surface rendering of the MRI in defining and resect-ing the epileptogenic zone. METHODS: 25 healthy volunteers and 55 patients were studied. Conventional MRI and 3D-surface rendering were performed. Sulcal and gyral patterns were assesed by a neuroradiologist and a neurologist with-out the clinical informations. Chronic video-EEG monitoring with surface and subdural grid electrodes, and PET were done. Resection was performed based on data of the EEG recordings and 3D-surface rendering. RESULTS: Conventional MRI identified structural abnormality ("MRI-identifiable lesion") in 20 patients. 20 of 35 patients without structural abnormality in conventional MRI revealed abnormal sulcal and gyral patterns in 3D-surface rendering of MRI ("3D-identifiable lesion"). Subdural grid EEGs recorded focal or diffuse ictal EEG onset from the region of "3D-identifiable lesion". Histopathologic findings revealed cortical dysplasia in 48 and neocortical gliosis in seven. Overall surgical out-come, at the average follow up period of 32.5 months, showed class I in 63.6%, class II in 25.5%, and class III in 10.9%. Among 20 patients with "MRI-identifiable lesion", 80% were in class I and 20% were in class II. Among 35 patients without "MRI-identifiable lesion", 54.3% were in class I, 28.6% were class II, and 17.1% were in class III. 80% of 20 patients with "3D-identifiable lesion" showed class I and 20% of 15 patients without "3D-identifiable lesion" showed class I. CONCLUSIONS: Identification of "MRI-identifiable lesion" or "3D-identifiable lesion" was of value in defining the epileptogenic zone. Resection of "MRI-identifiable lesion" or "3D-identifiable lesion", which were epilep-togenic in EEGs, promised a good surgical outcome.

A Case of Cutaneous Ossification in Pseudohypoparathyroidism / 대한피부과학회지

A 6-month-old female infant pre~sented with multiple, slightly depressed pea-sized erythematous macules on. the abdomen and the chest since birth, which together with obese, short stature, short neck, and round face suggested Albrights hereditary osteodystrophy(AHO). Some of the lesions were palpable as hard nodules or plaques in deep dermis. After 3 months follow up, the erythem- atous hue faded out, subcutaneous nodules and plaques enlarged. Skin biopsy specirnen demonstrated a bone formation in deep dermis. Serum calcium and phosphorus levels were lower and upper normal ranges, respectively and serum parathyroid hormone was increased in 69.1 pg/ml (normal, 9-55pg/ml). As pseudohypoparathyroidism including this case mostly exhibit characteristic morphologic features of AHO, the subcutaneous ossification may be a presenting feature.