ABSTRACT
BACKGROUND: Sleep-related complex motor seizures have long been considered pathognomonic features of Nocturnal Frontal Lobe Epilepsy (NFLE). In recent years, these manifestations have also been reported to have a temporal or insular origin. METHOD: We describe 40 drug-resistant epileptic patients with complex motor seizures during sleep, submitted to presurgical stereo-EEG (SEEG) evaluation and seizure-free after surgical resection of the epileptogenic zone. RESULTS: In a significant proportion (30%) of these patients, seizures arose from extra-frontal regions, including mainly the temporal lobe and the insular cortex, but also the parietal and occipital lobes. In patients with extra-frontal epilepsy, when complex motor behaviors appeared, SEEG revealed that the ictal discharge involved the cingulate and the frontal regions. Finally, at histology, Taylor's focal cortical dysplasia (TFCD) was the most common finding (90% of patients), independent of the site of seizure onset. CONCLUSION: As previously reported by other studies, this histologic substrate may be a major determinant of sleep-related seizures in drug-resistant epileptic patients.
Subject(s)
Epilepsy/physiopathology , Sleep Wake Disorders/physiopathology , Adolescent , Brain/pathology , Brain/physiopathology , Brain/surgery , Child , Child, Preschool , Electroencephalography , Epilepsy/complications , Epilepsy/pathology , Epilepsy/surgery , Female , Humans , Infant , Male , Polysomnography , Sleep/physiology , Sleep Wake Disorders/etiology , Sleep Wake Disorders/pathology , Sleep Wake Disorders/surgery , Treatment Outcome , Young AdultABSTRACT
After reviewing the historical background, the morphology and physiopathology of left ventricular aneurysms, the authors review the physiology, the technical aspects, and the current surgical indications of aneurysmectomy, with a particular emphasis on the concept of endoventriculoplasty of Jatène & Dor.
Subject(s)
Cardiac Surgical Procedures/methods , Heart Aneurysm/surgery , Heart Ventricles/surgery , Aged , Heart Aneurysm/etiology , Heart Aneurysm/physiopathology , Heart Ventricles/physiopathology , HumansABSTRACT
Pulmonary bronchogenic cysts are benign lesions that can be suspected from clinical background and imaging. We present the case of a huge subcarinal bronchogenic cyst and review the embryology, physiopathology, surgical indications and techniques of this congenital lesion.
Subject(s)
Bronchogenic Cyst/pathology , Adult , Bronchogenic Cyst/diagnosis , Bronchogenic Cyst/surgery , Diagnosis, Differential , Female , Humans , Lung/embryologyABSTRACT
The elective unilateral approach, sometimes under local anaesthesia, offers many advantages in terms of less invasive and faster surgical approach compared to the conventional surgery under general anaesthesia. Nevertheless this approach is restricted to patients unsuspected of multiglandular disease, free from thyroid disease and for whom localization studies are contributive. Surgery under hypnosedation offers the same advantages and provides the possibility of not only exploring the four glands but also of performing a partial thyroidectomy if needed. In our experience 21 patients underwent a cervicotomy under hypnosedation for primary hyperparathyroidism (HPT). No conversion to general anaesthesia was needed; mean operative time was 52 +/- 16 min. In 17 cases, HPT was due to a single adenoma, in 3 cases to hyperplasia (among them a MEN-1 case), and in one last case to a double adenoma. The four glands were identified in 85%. With a follow-up running from 4 to 45 months, all patients are cured. Hypnosedation offers the same medical and economic advantages than the unilateral access under local anaesthesia. Moreover indications are not restricted to selected patients.
