Epilepsy surgery in bifrontal injury from prior craniopharyngioma resections
Epilepsy surgery in frontal lobe epilepsy (FLE) has less favorable seizure-free outcomes than temporal lobe epilepsies. Possible contributing factors include fast propagation patterns and large clinically silent areas which are characteristics of the frontal lobes. Bilateral frontal lobe abnormaliti...
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| Format: | Article |
| Language: | English |
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Elsevier
2014-01-01
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| Series: | Epilepsy and Behavior Case Reports |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2213323213000443 |
| _version_ | 1819144058867548160 |
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| author | Monisha Goyal Matthew Thompson Alyssa Reddy Allan Harrison Jeffrey Blount |
| author_facet | Monisha Goyal Matthew Thompson Alyssa Reddy Allan Harrison Jeffrey Blount |
| author_sort | Monisha Goyal |
| collection | DOAJ |
| description | Epilepsy surgery in frontal lobe epilepsy (FLE) has less favorable seizure-free outcomes than temporal lobe epilepsies. Possible contributing factors include fast propagation patterns and large clinically silent areas which are characteristics of the frontal lobes. Bilateral frontal lobe abnormalities on MRI are another relative contraindication to epilepsy surgery. For example, bilateral encephalomalacia may be a presupposition to bilateral or multifocal epilepsy. The possibility of potential disinhibition with already poor reserves may be another deterrent to consideration for resective epilepsy surgery. As such, conventional surgical approaches to intractable epilepsy with bilateral frontal injury may be limited to palliative procedures like vagus nerve stimulation and corpus callosotomy. We present a case in which the epileptogenic zone was a subset of the acquired, bilateral, cystic encephalomalacia. This iatrogenic injury resulted from two prior craniotomies for excision of craniopharyngioma and its recurrence.
Following the initial bilateral and subsequent unilateral, subdural grid- and depth electrode-based localization and resection, our patient has remained seizure-free 2 years after epilepsy surgery with marked improvement in her quality of life, as corroborated by her neuropsychological test scores. Our patient's clinical course is testament to the potential role for resective strategies in selected cases of intractable epilepsy associated with bifrontal injury. Reversal of behavioral deficits with frontal lobe epilepsy surgery such as in this patient provides a unique opportunity to further our understanding of the complex nature of frontal lobe function. |
| first_indexed | 2024-12-22T12:36:06Z |
| format | Article |
| id | doaj.art-6243e73a372f4d58a225126665e8370a |
| institution | Directory Open Access Journal |
| issn | 2213-3232 |
| language | English |
| last_indexed | 2024-12-22T12:36:06Z |
| publishDate | 2014-01-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Epilepsy and Behavior Case Reports |
| spelling | doaj.art-6243e73a372f4d58a225126665e8370a2022-12-21T18:25:33ZengElsevierEpilepsy and Behavior Case Reports2213-32322014-01-012C4710.1016/j.ebcr.2013.11.001Epilepsy surgery in bifrontal injury from prior craniopharyngioma resectionsMonisha Goyal0Matthew Thompson1Alyssa Reddy2Allan Harrison3Jeffrey Blount4University of Alabama, Birmingham, AL, USAChildren's Hospital of Alabama, Birmingham, AL, USAUniversity of Alabama, Birmingham, AL, USAChildren's Hospital of Alabama, Birmingham, AL, USAUniversity of Alabama, Birmingham, AL, USAEpilepsy surgery in frontal lobe epilepsy (FLE) has less favorable seizure-free outcomes than temporal lobe epilepsies. Possible contributing factors include fast propagation patterns and large clinically silent areas which are characteristics of the frontal lobes. Bilateral frontal lobe abnormalities on MRI are another relative contraindication to epilepsy surgery. For example, bilateral encephalomalacia may be a presupposition to bilateral or multifocal epilepsy. The possibility of potential disinhibition with already poor reserves may be another deterrent to consideration for resective epilepsy surgery. As such, conventional surgical approaches to intractable epilepsy with bilateral frontal injury may be limited to palliative procedures like vagus nerve stimulation and corpus callosotomy. We present a case in which the epileptogenic zone was a subset of the acquired, bilateral, cystic encephalomalacia. This iatrogenic injury resulted from two prior craniotomies for excision of craniopharyngioma and its recurrence. Following the initial bilateral and subsequent unilateral, subdural grid- and depth electrode-based localization and resection, our patient has remained seizure-free 2 years after epilepsy surgery with marked improvement in her quality of life, as corroborated by her neuropsychological test scores. Our patient's clinical course is testament to the potential role for resective strategies in selected cases of intractable epilepsy associated with bifrontal injury. Reversal of behavioral deficits with frontal lobe epilepsy surgery such as in this patient provides a unique opportunity to further our understanding of the complex nature of frontal lobe function.http://www.sciencedirect.com/science/article/pii/S2213323213000443Frontal lobe epilepsyEpilepsy surgeryCraniopharyngiomaBifrontal encephalomalaciaFrontal lobe syndrome |
| spellingShingle | Monisha Goyal Matthew Thompson Alyssa Reddy Allan Harrison Jeffrey Blount Epilepsy surgery in bifrontal injury from prior craniopharyngioma resections Epilepsy and Behavior Case Reports Frontal lobe epilepsy Epilepsy surgery Craniopharyngioma Bifrontal encephalomalacia Frontal lobe syndrome |
| title | Epilepsy surgery in bifrontal injury from prior craniopharyngioma resections |
| title_full | Epilepsy surgery in bifrontal injury from prior craniopharyngioma resections |
| title_fullStr | Epilepsy surgery in bifrontal injury from prior craniopharyngioma resections |
| title_full_unstemmed | Epilepsy surgery in bifrontal injury from prior craniopharyngioma resections |
| title_short | Epilepsy surgery in bifrontal injury from prior craniopharyngioma resections |
| title_sort | epilepsy surgery in bifrontal injury from prior craniopharyngioma resections |
| topic | Frontal lobe epilepsy Epilepsy surgery Craniopharyngioma Bifrontal encephalomalacia Frontal lobe syndrome |
| url | http://www.sciencedirect.com/science/article/pii/S2213323213000443 |
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