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Tactical Considerations Leading to Surgical Treatment of the Partial Epilepsies

  • Paul H. Crandall
  • William Sutherling

Abstract

The goal of surgical treatment of the epilepsies is to achieve safety and efficacy, much as has been done with antiepileptic medical treatment since about 1969 (3). The partial epilepsies are of cerebral cortical origin and the safety of the operation depends on the cortical locale, the relationship to important vessels and the avoidance of damage to long subcortical fasciculi. The efficacy of the operations depends on the accuracy of the diagnosis. Of the two considerations the latter seems to be the more important, for surgical operations for epilepsy are largely a onetime opportunity. Second operations seldom can be expected to be successful. If it is the temporal lobe, the opposite cannot be removed. If another lobe is responsible, the cost in additional cognitive loss of a second operation is usually too great. In our opinion the electrophysiological verification of epileptogenesis in each patient prior to surgery is essential for successful surgery, especially in the cases which it is difficult to localize the epileptic focus.

Keywords

Temporal Lobe Temporal Lobe Epilepsy Hippocampal Formation Partial Epilepsy Complex Partial Seizure 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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References

  1. 1.
    Collins, R. and Caston, T. Functional anatomy of occipital lobe seizures: an experimental study in rats. Neurol. 29: 705–716, 1979.CrossRefGoogle Scholar
  2. 2.
    Rossi, G. Problems of analysis and interpretation of electrocerebral signals in human epilepsy. A neurosurgeon’s view. In: Epilepsy - Its Phenomena in Man. M. Brazier (ed). New York: Academic Press, p. 391, 1973.Google Scholar
  3. 3.
    Woodbury, D., Penry J., Schmidt, R. Antiepileptic drugs. New York: Raven Press, p. 536, 1972.Google Scholar
  4. 4.
    Olivier A., Gloor P., Andermann, F., Quesney, L. The place of stereotactic depth electrode recording in epilepsy. Proc. 9th Meeting World Soc. Stereotactic and Functional Neurosurgery. Appl. Neurophysiol. 48: 395–399, 1985.CrossRefGoogle Scholar
  5. 5.
    MacLean, P. The Triune Brain, Emotion and Scientific Bias. In: The Neurosciences, Second Study Program, Boston: MIT Press, pp. 336–349, 1976.Google Scholar
  6. 6.
    Talairach, J., David, M., Tournoux, P. L’exploration chirurgicale stéréotaxique du lobe temporale dans l’epilepsie temporale. Paris: Masson et Cie, p. 132, 1958.Google Scholar
  7. 7.
    Crandall, P., Walter, R., Rand, R. Clinical applications of studies on stereotactically implanted electrodes in temporal lobe epilepsy. J. Neurosurg. 20: 827–840, 1963.PubMedCrossRefGoogle Scholar
  8. 8.
    Talairach, J. and Szikla, G. Atlas d’anatomie stéréotaxique du télencéphale. Paris: Masson et Cie, p. 323, 1967.Google Scholar
  9. 9.
    Collins, R., Tearse, R., Lothman, E. Functional anatomy of limbic seizures: focal discharges from medial entorhinal cortex in rat. Brain Research 280: 25–40, 1983.PubMedCrossRefGoogle Scholar
  10. 10.
    Collins, R., Kennedy, C., Sokoloff, L,. Plum, F. Metabolic anatomy of focal motor seizures. Arch. Neurol. 33: 536–542, 1976.PubMedCrossRefGoogle Scholar
  11. 11.
    Williamson, P., Spencer, D., Spencer, S., Novelly, R., Mattson, R. Complex partial status epilepticus: A depth electrode study. Ann. Neurol. 18: 647–654, 1985a.PubMedCrossRefGoogle Scholar
  12. 12.
    Bancaud, J., Talairach, J., Bonis, A., Schaub, C., Szikla, G., Morel, P., Bordas-Ferrer, M. La stéréoelectroencéphalographie dans l’épilepsie. Paris, Masson et Cie, pp. 321, 1965.Google Scholar
  13. 13.
    Bancaud, J., Talairach, J., Geier, S. and Scarabin, J. EEG et SEEG dans les tumeurs cérébrales et l’épilepsie. Paris, Edifor, pp. 351, 1973.Google Scholar
  14. 14.
    Goldring, S. A method for surgical management of focal epilepsy, especially as it relates to children. J. Neurosurg. 49: 344–356, 1978.PubMedCrossRefGoogle Scholar
  15. 15.
    Bladin, P., Woodward, J. Epilepsy and the frontal lobe. Proc. Aust. Assoc. Neurol. 11: 229–237, 1974.Google Scholar
  16. 16.
    Williamson, P., Spencer, D., Spencer, S., Novelly, R., Mattson, R. Complex partial seizures of frontal lobe origin. Ann. Neurol. 18: 497–504, 1985b.PubMedCrossRefGoogle Scholar
  17. 17.
    Walter, R. Tactical considerations leading to surgical treatment of limbic epilepsy. In: Epilepsy–Its Phenomena in Man. M. Brazier, (ed.), New York: Academic Press, pp. 99–118, 1973.Google Scholar
  18. 18.
    Brazier, M. Electrical seizure discharges within the human brain: the problem of spread. In: Epilepsy–Phenomena in Man. M. Brazier (ed). New York: Academic Press, pp. 153–170, 1973.Google Scholar
  19. 19.
    Crandall, P. Developments in direct recordings from epileptogenic regions in the surgical treatment of partial epilepsies. In: Epilepsy–Phenomena in Man. M. Brazier (ed). New York: Academic Press, pp. 288–309, 1973.Google Scholar
  20. 20.
    Takeda A., Bancaud, J., Talairach, J., Bonis, A., Bordas-Ferrer, M. A propos des accès épileptiques d’origine occipitale. Rev. Neurol. 121: 306–315, 1969.PubMedGoogle Scholar
  21. 21.
    Bailey, P. and VonBonin, G. The Isocortex of Man. Urbana: University of Illinois Press, p. 301, 1951.Google Scholar
  22. 22.
    Mesulam, M. Principles of Behavioral Neurology. Contempory Neurology Series, Philadelphia: F.A. Davis Co., p. 405, 1985.Google Scholar
  23. 23.
    Kaada, B. Cingulate, posterior orbital, anterior insular and temporal pole cortex. In: Handbook of Physiology, J. Field (ed), Section I, Volume II. Washington, D.C., American Physiological Society, Chapter 55, pp. 1345–1372, 1960.Google Scholar
  24. 24.
    Willis, Thomas Cerebri Anatome: cui accessit nervorum descriptio et usus. Studio.Londini, Typis Tho. Roycroft, ispensis J. Martyrn and Ja. Allestry, p. 240, 1664.Google Scholar
  25. 25.
    Broca P. Anatomie comparée des circonvolutions cérébrales. Le grand lobe limbique et la scissure limbique dans la série des mammifères. Rev. Anthrop., 5. 2 1: 385–498, 1878.Google Scholar
  26. 26.
    Elliott Smith G. The morphology of the true “limbic lobe”, corpus callosum, septum pellucidum and fornix“. J. Anat. Physiol. 30:157–167, 185–205, 1896.Google Scholar
  27. 27.
    Gloor, P., Olivier, A., Quesney, L., Andermann, F., Horowitz, S. The role of the limbic system in experiential phenomena of temporal lobe epilepsy. Ann. Neurol. 12: 129–144, 1982.PubMedCrossRefGoogle Scholar
  28. 28.
    Penfield W. and Jasper H. Epilepsy and the Functional Anatomy of the Human Brain. Boston: Little, Brown & Co., p. 896, 1954.Google Scholar
  29. 29.
    Cahan, L., Sutherling, W., McCullough, M., Rausch R., Engel, J., Crandall, P. Review of the 20-year UCLA experience with surgery for epilepsy. Cleve. Clin. Q. 51: 313–318, 1984.PubMedCrossRefGoogle Scholar
  30. 30.
    Penfield, W. and Kristiansen, K. Epileptic Seizure Patterns. Springfield: C.C. Thomas, p. 104, 1951.Google Scholar
  31. 31.
    Halgren, E., Walter, R., Cherlow, D., Crandall, P. Mental phenomena evoked by electrical stimulation of the human hippocampal formation and amygdala. Brain 101: 83–117, 1978.PubMedCrossRefGoogle Scholar
  32. 32.
    Valenstein, E. Brain Control: A Critical Examination of Brain Stimulation and Psychosurgery. New York: Wiley, p. 250, 1973.Google Scholar
  33. 33.
    Weingarten, S., Cherlow D., Halgren, E. The relatonship of hallucinations to the depth structures of the temporal lobe. In: Sweet, W., Obrador, S., Martin-Rodriquez, J. (eds). Neurosurgical Treatment in Psychiatry, Pain and Epilepsy. Baltimore: Univ. Park Press, pp. 553–568, 1976.Google Scholar
  34. 34.
    Penfield, W. and Perot, P. The brain’s record of auditory and visual experience. A final summary and discussion. Brain 86: 595–696, 1963.PubMedCrossRefGoogle Scholar
  35. 35.
    Jackson, J. and Steward, P. Epileptic attacks with a warning of a crude sensation of smell and with the intellectual aura (dreamy state) in a patient who had symptoms pointing to gross organic disease of the right temporo-sphenoidal lobe. Brain 22: 534–549, 1899.CrossRefGoogle Scholar
  36. 36.
    Weiser, H. Electroclinical features of the psychomotor seizures. New York: Butterworths, p. 242, 1983.Google Scholar
  37. 37.
    Babb, T. and Brown, W. Pathological findings in epilepsy. (In press)Google Scholar
  38. 38.
    Babb, T., Brown, W., Pretorius, J., Davenport, C., Lieb, J., Crandall, P. Temporal lobe volumetric cell densities in temporal lobe epilepsy. Epilepsia 25: 729–740, 1984.PubMedCrossRefGoogle Scholar
  39. 39.
    Proceedings of the Staff Meeting of the Mayo Clinic - Symposium on intracerebral electrography, 28:145–192, 1953.Google Scholar
  40. 40.
    Geier, S., Bancaud, J., Talairach, J. et al. The seizures of frontal lobe epilepsy: a study of clinical manifestations. Neurol. 27: 951–958, 1977.CrossRefGoogle Scholar
  41. 41.
    Lesser, R., Dinner, D., Lueders, H., Morris, H. Differential diagnosis and treatment of intractable seizures. Cleve. Clin. Q. 51: 227–240, 1984.Google Scholar
  42. 42.
    Lueders, H., Hahn, J., Lesser, R., Dinner, D., Rothner, D., Erenberg, G. Localizaton of epileptogenic spike foci: comparative study of closely spaced scalp electrodes, nasopharyngeal, sphenoidal, subdural, and depth electrodes. In: Advances in Epileptology: XII Epilepsy International Symposium, Sept.,1981. Akimoto, H., Kazamatsui, H., Seino, M., Ward, A. (eds). New York: Raven Press, pp. 185–189, 1982.Google Scholar
  43. 43.
    Lueders, H., Lesser, R., Dinner, D., Morris, H., Hahn, J. Inhibition of motor activity elicited by electrical stimulation of the human cortex. Epilepsia 24: 519–525, 1983.Google Scholar
  44. 44.
    Lueders, H., Lesser, R., Morris, H., Dinner, D., Hahn, J. Negative motor response (NMR) elicited by stimulation of the human cortex. 16th Epilepsy International Congress, Hamburg, Sept 6–9, 1985.Google Scholar
  45. 45.
    Morris, H., Lueders, H., Hahn, J., Lesser, R., Dinner, D., Estes, M. Neurophysiological techniques as an aid to surgical treatment of primary brain tumors. Ann. Neurol. 19: 559–567, 1986.PubMedCrossRefGoogle Scholar
  46. 46.
    Lueders, H., Dinner D., Lesser, R., Morris, H. Evoked potentials in cortical localization. J. Clin. Neurophysiol. 3: 75–84, 1986.CrossRefGoogle Scholar
  47. 47.
    Talairach, J., Bancaud, J., Szikla, G., Bonis, A., Geier, S., Vedrenne, C. Méthodologie stéréotaxique et résultats thérapeutiques. Neurochirurgie, 20, Suppl. 1, 1974.Google Scholar
  48. 48.
    Bernoulli, C., Siegfried, J., Baumgartner, G., Regli, F., Rabinowicz, T., Gajdusek, D. Gibbs, C. Danger of accidental person-to-person transmission of Creutzfeldt-Jacob disease by surgery. Lancet 1: 478, 1977.PubMedCrossRefGoogle Scholar
  49. 49.
    Goldring, S. A method for surgical management of focal epilepsy, especially as it relates to children. J. Neurosurg. 49: 344–356, 1978.PubMedCrossRefGoogle Scholar
  50. 50.
    Goldring, S. and Gregorie, E. Surgical management of epilepsy using epidural recordings to localize the seizure focus. J. Neurosurg. 60: 457–466, 1984.PubMedCrossRefGoogle Scholar
  51. 51.
    Hahn, J. and Sellers, M. Surgical techniques for relief from seizures. Cleve. Clin. Q. 51: 307–311, 1984.Google Scholar
  52. 52.
    Kuhl, D., Engel, J., Phelps, M. Epileptic patterns of local cerebral metabolism and perfusion in humans determined by emission computed tomograpy of FDG and NH. Annals Neurol. 8: 348–360, 1980.CrossRefGoogle Scholar
  53. 53.
    Engel, J., Kuhl, D., Phelps, M., Mazziotta, J. Interictal cerebral glucose, metabolism in partial epilepsy and its relation to EEG changes. Ann. Neurol. 12: 510–517, 1982a.PubMedCrossRefGoogle Scholar
  54. 54.
    Engel, J., Brown, W., Kuhl, D., Phelps, M, Mazziotta, J., Crandall, P. Pathological findings underlying focal temporal lobe hypometabolism in partial epilepsy. Annals Neurol. 12: 518–528, 1982b.CrossRefGoogle Scholar
  55. 55.
    Phelps, M. and Mazziotta J. Positron emission tomography: human brain function and biochemistry. Science 228: 799–809, 1985.PubMedCrossRefGoogle Scholar
  56. 56.
    Foley K., Cahan, L., Hieshima, G. Intraoperative angiography using a portable digital subraction unit. J. Neurosurg. 64: 816–818, 1986.PubMedCrossRefGoogle Scholar
  57. 57.
    Engel, J., Crandall, P., Rausch, R. The partial epilepsies. In: The Clinical Neurosciences. R. Rosenberg and R. Grossman (eds). New York: Churchill Livingstone, pp. 1349–1380, 1983.Google Scholar
  58. 58.
    Spencer, D., Spencer, S., Mattson, R., Williamson, P., Novelly, R. Access to the posterior medial temporal lobe structures in the surgical treatment of temporal lobe epilepsy. Neurosurg. 15: 667–670, 1984.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 1988

Authors and Affiliations

  • Paul H. Crandall
    • 1
  • William Sutherling
    • 1
  1. 1.Division of Neurosurgery and Department of NeurologyUCLA Medical CenterLos AngelesUSA

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