ABSTRACT
Epilepsy in children is a common and disabling disorder. Approximately 10% to 20% of patients who develop seizures will have medically intractable epilepsy. This group of patients may be candidates for epilepsy surgery. Unlike adults, epilepsy in children frequently arises in extratemporal sites. The surgical treatment of this extratemporal epilepsy is discussed in this article.
Subject(s)
Cerebral Cortex/surgery , Epilepsies, Partial/surgery , Adolescent , Child , Child, Preschool , HumansABSTRACT
A series of 12 patients with infectious intracranial aneurysms is presented, and a number of unusual features of the disorder are emphasized. A comparison of characteristics of the aneurysms and clinical course is made between patients with and without infective endocarditis. Most of the unusual characteristics of infectious aneurysms, including rare locations, causative organisms, and predisposing medical conditions, occurred in the group without endocarditis. The relationship of atypical features of infectious aneurysms to the etiology of aneurysm formation is discussed, and an approach to treatment is presented.
Subject(s)
Aneurysm, Infected/diagnostic imaging , Endocarditis, Bacterial/complications , Intracranial Aneurysm/diagnostic imaging , Adolescent , Adult , Aged , Aneurysm, Infected/etiology , Aneurysm, Infected/therapy , Anti-Bacterial Agents/therapeutic use , Cerebral Angiography , Child , Child, Preschool , Endocarditis, Bacterial/drug therapy , Female , Humans , Intracranial Aneurysm/etiology , Intracranial Aneurysm/therapy , Male , Middle Aged , Tomography, X-Ray ComputedABSTRACT
Experimental hemodilutional therapy has been shown to raise collateral perfusion to acutely ischemic brain regions distal to occluded internal carotid (ICA) and middle cerebral (MCA) arteries and to reduce infarct size. Superficial temporal (STA)-MCA anastomosis surgically establishes additional regional collateralization, and this bypass angiographically enlarges over time. Despite bypass patency verification by Doppler recording made at the edge of the craniectomy, the microsurgical STA-MCA anastomosis in 11 stroke patients did not produce early changes in cerebral perfusion parameters in the MCA territory of either hemisphere as determined by 133xenon inhalation. Therefore, hemodilution was initiated in an effort to increase cerebral perfusion during this marginal period when the STA was beginning to dilate progressively. Incremental venesections with equal intravenous volume replacement with 5% human serum albumin caused a significant lowering of the hematocrit from 40 +/- 1 to 33 +/- 1%. This isovolemic hemodilutional therapy resulted in significant mean regional cerebral blood flow (rCBF) elevations of 23 +/- 5% (SE) in the bypassed MCA territory and of 25 +/- 6% in the opposite MCA region. The mean gray flow (F1) in the involved and homologous MCA regions significantly increased 27 +/- 8% and 30 +/- 11%, respectively. Similarly, the initial slope index (ISI2) significantly rose by 17 +/- 5% in the bypassed MCA territory and by 18 +/- 6% in the homologous region. These data objectively support the premise that reductions in hematocrit without intravascular volume expansion augment cerebral blood flow, probably by reducing blood viscosity.(ABSTRACT TRUNCATED AT 250 WORDS)
