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Epilepsy Borrowed Decks > Epilepsy Surgery > Flashcards

Epilepsy Surgery Flashcards

1
Q

Factors that suggest good postsurgical outcomes

A
  • Later age at onset
  • Shorter duration of epilepsy
  • presence of febrile seizures
  • Positive MRI or PET
  • Unilateral findings on PET
  • Concordant data (between MRI/PET/EEG)
  • lack of need for intracranial monitoring
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2
Q

MRI sequence best to identify subtle features of temporal lobes (MTS, incomplete hippocampal inversion)

A

Oblique coronal

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3
Q

Criteria for MTS
Main (3)
Other features you may see (5

A

Main
- hippocampal atrophy
- increased T2 signal
- abnormal morphology or loss of internal architecture of hippocampus

Secondary features
- dilation of temporal horn of lateral ventricle
- Loss of gray-white matter differentiation in the temporal lobe
- decreased white matter in the adjacent temporal lobe
- atrophy of ipsilateral forinx
- atrophy of mamillary body

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4
Q

% of MTS cases that are bilateral

A

10%

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5
Q

What 3 things do you see in this picture?

A
  • Enlargement of left lateral ventricle temporal horn
  • left hippocampus smaller and hyperintense compared to contralateral side
  • Left hippocampus is abnormally smooth
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6
Q

What 3 things do you see in this picture

A

Left hippocampal volume loss
- Hyperintense hippocampus
- subtle laminar blurring

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7
Q

What sequence is this?
What is this showing?

A
  • T2-waited image
  • globular let hippocampus
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8
Q

What sequence is this?
What is the arrow showing? (1+2

A

-T2-weighted image
Showing incomplete hippocampal inversion
- More vertical left collateral sulcus
- Low-lying left body of the fornyx

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9
Q

What sequence is this?
What is this showing?

A
  • Coronal Flair
  • FLAIR hyperintensity in bilateral MTS
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10
Q

What is this sequence?
What is this showing?

A

T2 waited
- laminar blurring bilateral MTS

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11
Q

What is this sequence?
What is this showing? (2)

A

Coronal T2
Right volume loss and laminar blurring (Right MTS and right fornix atrophy)

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12
Q

What is this Sequence?
What is this showing?

A
  • 3D T1-weighted image
  • volume loss in bilateral MTS
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13
Q

What are these sequences?
What is this showing?

A

Small Gray matter heterotopia on T2-weighted(B), but better seen on Coronal double-inversion (C) and T1 (D)

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14
Q

What are these sequences?
What are they showing?

A

Axial + coronal T2 (A+B), Coronal Flair (C)
small emphalocele in fusiform gyrus extending to right foramen ovale

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15
Q

What is this sequence
What is this showing (2)

A

Coronal FLAIR
- gray-white Blurring
- FLAIR hyperintensity in left frontal anterior cingulate gyrus (FCD)

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16
Q

What is this sequence
What is this showing (2)

A

Axial FLAIR sequences
- gray-white Blurring
FLAIR hyperintensity in left medial frontal gyrus (FCD)

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17
Q

What are these sequences?
what do they show?

A
  • T1-weighted (A) and Axial FLAIR (B)
  • Pachygyria
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18
Q

What are these sequences? (2)
What are they showing?

A
  • Coronal and axial FLAIR
  • thickened cortex in right posterior sylvian fissure (Polymicrogyria)
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19
Q

What are these sequences? (2)
What are they showing?

A
  • Sagittal and axial post-contrast T1
  • Thickened cortex extending from right sylvian fissure toward vertex (Polymicrogyria)
20
Q

What are these sequences?
What are they showing

A

Coronal / Axial FLAIR (A,B) and Sagittal/Axial Post-contrast T1 (CD)
- thickened cortex in right posterior sylvian fissure, extending to vertex (Polymicrogyria)

21
Q

Symptoms of a common side effect syndrome following :
ANTERIOR corpus callosotomy (3)
POSTERIOR Corpus Callsotomy (2)
TOTAL callostomy (4)

A

Anterior disconnection syndrome
- Mutism
- left leg paresis
- urge urinary incontinence
Posterior acute disconnection syndrome
- tactile transfer deficits
- visual transfer defects
TOTAL / near total resection: Split brain syndrome
- language impairment
- disordered attention
- disordered memory sequencing
- hemisphere competition

22
Q

What type of electrodes are best used to detect DC shift?
What is the best Time constant?
What type of impedence?

A

Platinum electrodes
long time constant
High impedence

23
Q

What is included in a “standard” anterior temporal lobectomy (4 + one omitted)

A
  • amygdala
  • hippocampus
  • parahippocampal gyrus
  • 3.5-4 cm of lateral temporal neocortex
    NOT resected:
  • Superior temporal gyrus
24
Q

what is included in a selective amygadlo-hippocampectomy (3 + omitted)

A
  • amygdala
  • hippocampus
  • limited resection of parahippocampal gyrus
    NOT resected:
  • temporal neocortex
25
Q

In standard anterior temporal lobectomy, how much of the lateral temporal neocortex is resected, and why?

A

3.5-4 cm of lateral temporal neocortex
- minimizes verbal memory

26
Q

In standard anterior temporal lobectomy, why do we not resect the superior temporal gyrus?

A

minimizes naming difficulties after dominant resections.

27
Q

factors associated with HIGHER rates of post-operative seizures following resection

A
  • widespread (>2cm) ictal onset pattern
  • short latency to onset of seizure
  • failure to resect tissue
28
Q

factors associated with LOWER rates of post-operative seizures following resection (2)

A
  • beta-to-gamma-range activity at seizure onset
  • resesction of tissue that shows discharges in the first 3 seconds after onset (best one)
29
Q

Frontal lobectomy statistics:
- probability of complete seizure freedom at
1 year
3 years
5 years
If seizures are going to recur, when are they most likely to?

A

1 year: 56%
3 years: 45%
5 years: 30%
80% of seizure recurrences occur within first 6 months

30
Q

Frontal lobectomy Statistics:
Independent risk factors for seizure recurrence (5)

A
  • Causative focus is MRI-negative
  • Any extrafrontal MRI abnormality
  • Generalized / nonlocalized ictal EEG patterns
  • occurrence of postoperative sizures
  • incomplete surgical resection
31
Q

Requirements for capturing HFO’s (3)

A
  • Sampling rate of at least 1000 Hz
  • LFF > 50 Hz
  • HFF > 600 Hz
32
Q

HFO’s: Criteria for:
Ripples:
Fast ripples:

A

Ripples: 80-200Hz
Fast ripples: 250-500Hz

33
Q

Percentage of patients who will be free of disabling seizures after:
- anteromedial temporal resection
- neocortical resection

A
  • 2/3
  • 1/2
34
Q

What “non-discharge” feature, when present at ictal onset, can be a predictor of a favorable surgical outcome?

A

beta activity at ictal onset

35
Q

Percentage of patients with bilateral language:
- left handed
- Right handed

A

Left handed: 0-38%
Right-handed: 0-30%

36
Q

Lesion at or before what age increases likelihood of bilateral language

A

6 years

37
Q

patient with bilateral language has Wada. What are two possible reactions to look for?

A

Prolonged speech arrest after injection (“bilateral dependent”) or no speech arrest after either injection (“bilateral autonomous”)

38
Q

vessel most commonly injured during anteromedial temporal resection and common effect

A
  • Anterior choroidal artery
  • hemiparesis
39
Q

Sensitivity and specificity of SPECT with TLE
Ictal
Postictal (2)
Interictal (2)

A

Ictal
- Sensitivity: 75-95% (similar temporal and extratemporal)
- Specificity 70-100% (Similar in temporal and extratemporal
Postictal
- TLE: 75% (slightly lower) and 1.5% false-positive
Interictal
- Sensitivity: 44%
- False-positive rate 7.5%

40
Q

Where is Subtraction ictal SPECT co-registered to MRI (SISCOM) most used in epilepsy surgery?

A

in Extratemporal epilepsy, presence of a SISCOM focus that is subsequently resected has better probability for postsurgical seizure control than when it is unresected or absent (58% vs 18%)

41
Q

Likelihood of favorable postoperative outcome in FCD

A

50-60%

42
Q

Patient with focal epilepsy has this MRI, what does he have?

A

L Temporal FCD

43
Q

types of resections that can actually improve the following:
- Verbal memory
- visuospatial

A

Verbal memory
- Can improve after nondominant temporal lobectomy
Visuospacial memory
- Can improve following dominant temporal lobectomy

44
Q

what 4 neuropsych tests are most helpful in assessing coexisting frontal lobe testing in patient with TLE (and what do they test)

A

Stroop Color Word Test (tests attention)
Wisconsin Card Sorting Test (problem Solving)
Animal Fluency test (language)
Grooved Pegboard test (motor speed)

45
Q

Risk of intracerebral hemorrhage with Depth electrode placement

A

1-4%

46
Q

cortical stimulation:
- biphasic or monophasic?
- longer or shorter trains for language cortex
- longer or shorter for motor cortex

A
  • biphasic
  • longer trains for language cortex
  • shorter for motor cortex
47
Q
A

Epilepsy Borrowed Decks (57 decks)

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