Index

Note: Page numbers followed by f and t indicate fi gures and tables, respectively.

A Anesthesia Academic skills assessment, in neuropsychological assess- for anatomical hemispherectomy, 217 ment, 105 antiepileptic drugs and, 114 Acid-base status, perioperative management of, 114 for awake craniotomy, 116 Adaptive function assessment, in neuropsychological for corpus callosotomy, 116 assessment, 106 for hemispherectomy, 116–117, 217 After-discharges, 31 induction of, 114 Age of patient maintenance of, 115 and adaptive plasticity, 15–16 for posterior quadrantic surgery, 197–198 and cerebral blood fl ow, 113 Sturge-Weber syndrome and, 113 at lesion occurrence, and EEG fi ndings, 16 in surgery for subhemispheric epilepsy, 197–198 and pediatric epilepsy surgery, 3 tuberous sclerosis and, 113 and physiological diff erences, 113 for vagus nerve stimulation, 116 and seizure semiology, 41 Angioma(s) at surgery, and outcomes, 19 cutaneous, in Sturge-Weber syndrome, 206 Airway facial, 206 intraoperative management of, 114–115 Angular gyrus, electrical stimulation of, 48 preoperative evaluation, 113 Anterior lobe lobectomy (ATL) Alien limb phenomenon, stimulation-induced, 49 left (L-ATL), and language function, 76 [11C]Alphamethyl-L-tryptophan (AMT), as PET radiotracer, and memory function, 77–78 83–84, 86 Anteromesial temporal lobectomy (AMTL), 136–146 in extratemporal lobe epilepsy, 86–87, 175 complications of, 144–145 in postsurgical evaluation, 90 craniotomy in, 138, 139f in temporal lobe epilepsy, 86 historical perspective on, 136–137 in tuberous sclerosis, 87–88, 88f mesial temporal resection in, 140–144, 140f–143f 18F-Altanserin, as PET radiotracer, 90 neocortical resection in, 138–140, 139f Amobarbital, intracarotid procedure. See Wada test outcomes with, 145 Amygdalohippocampectomy, selective, 147 patient positioning for, 137, 138f complications of, 153 scalp incision for, 137–138, 138f defi nition of, 152 surgical technique for, 136, 137–144, 138f–143f indications for, 147 Antiepileptic drugs (AEDs) outcomes with, 147, 153–154 adverse eff ects and side eff ects of, 114 presurgical patient evaluation for, 147–148 in children, 3 safety of, 152–153 anesthetic considerations with, 114 surgical considerations, 152–153 for mesial temporal sclerosis, 132 transsylvian, 147–155 therapy with, after epilepsy surgery, 328 surgical technique for, 148–151, 148f–149f, 151f–153f Arachnoid cyst(s), with hypothalamic Amytal test. See Wada test hamartomas, 67 Anatomical posterior quadrantectomy, 197 Arteriovenous malformations (AVMs), 69 operative technique for, 202 reoperation for, 316–317

363 364 Index

Arteriovenous malformations (AVMs) (Continued) Breach rhythm, 343 temporal lobe epilepsy caused by, 162 reverse, 343 surgical management of, 169–170 Broca’s area, response to electrocortical stimulation, 48 outcomes with, 171 Brodmann’s area(s) Aspiration pneumonitis, prevention of, 114 area 4, 43 Assessment. See also Evaluation area 6, 43 electrophysiologic, new techniques for, 341–347 preoperative, 2–3 age of patient and, 3 C Astrocytoma, low-grade (fi brillary), 63, 63f Callosotomy, 20 temporal lobe epilepsy caused by, 162, 162t Carbatrol, 114 Atkins diet, 285 Cardiovascular system, preoperative evaluation, 113 Auditory cortex, electrical stimulation of, 49 11C-Carfentanyl, as PET radiotracer, 90 Auditory verbal learning test (AVLT), after hippocampal Catastrophic epilepsy, 9 transection, 276–277 Caudate nucleus, direct neurostimulation in, 290 Aura(s), detection of, on EEG, 31–32 Cavernous hemangioma, temporal lobe epilepsy caused by, Autoregulation, age-related changes in, 113 162 Awake craniotomy, anesthetic considerations for, 116 surgical management of, 168–169, 169f outcomes with, 170–171 Cavernous malformations B radiosurgery for, 302–303 Ballism, after hemispherectomy, 222 reoperation for, 316–317 Benign rolandic epilepsy (BRE), magnetoencephalography Central sulcus, localization of, intraoperative SSEP recording in, 55 for, 198 Bereitschaftspotential, 50 Cerebellum, direct neurostimulation in, 290 Blood loss Cerebral blood fl ow, age-related changes in, 113 in hemispherectomy, 212, 221 Cerebral cortex, direct neurostimulation in, 291 intraoperative, 115, 117 Cerebral disconnection syndrome, after corpus callosotomy, in peri-insular hemispherotomy, 258 264–265 with transsylvian hemispheric deaff erentation, 249 Cerebral edema Blood pressure, age-related changes in, 113 after corpus callosotomy, 264 Blood transfusion, 115 after peri-insular hemispherotomy, 258 with hemispherectomy, 221 with hemispherectomy, 221–222 in peri-insular hemispherotomy, 258 with invasive monitoring, 126 Blood volume, 115 management of, 115–116 BOLD (blood oxygen dependent) signal, on fMRI, 74, 78, Cerebral ischemia, with hemispherectomy, 221 351–354, 351f, 353f, 357 Cerebrospinal fl uid (CSF), leak, with invasive monitoring, Brain 126 atrophy, 69 Cerebyx, 114 destructive lesions of, 69 Chaos theory, 345 developing Chronaxie, 43 functional plasticity of, 3–4 Coagulopathy, after hemispherectomy, 212, 221 harmful eff ects of seizures on, 3 Cognitive function direct neurostimulation in, regions for, 290–291 general, assessment of, 105 focal scars on, 69 lateralization, special tests for, 108 injury, in intractable epilepsy, 19 localization, special tests for, 108 malformations, and preoperative electrophysiologic postoperative improvement, 20 assessment, 44f–46f, 45–46 Comorbidity. See also Dual pathology maturation, and cortical electrical stimulation, 43–44 and preoperative evaluation, 113 perinatal injury, transsylvian hemispheric deaff erentation Computed tomography (CT), 59 for, 241 preoperative, normal or nonspecifi c, 35 subcortical structures, direct neurostimulation in, in presurgical evaluation, 10 290–291 structural lesion on, 35 swelling, management of, 115–116 Computer anatomical reconstruction and editing toolkit, 93 Brainstem edema, with hemispherectomy, 221–222 Congenital epileptogenic lesions, types of, 14–15 Index 365

Coregistration, 93–95, 94f, 95f. See also MRI/PET functional, 175 multimodal, 94–95 intraoperative, in surgery for subhemispheric epi- triple technique (MRI/CT/PET), 94 lepsy, 198–199 Corpus callosotomy, 8 magnetoencephalography in, 57 anatomical considerations in, 261–262 historical perspective on, 41–42 anesthetic considerations for, 116 indications for, 41 complications of, 264–265 noninvasive techniques for, 49–50 histological refi nement of, 261 Cortical stimulation, 290–294 historical perspective on, 261 brain maturation and, 43–44 indications for, 262, 285 complications of, 42–43 outcomes with, 265 extraoperative patient selection for, 262 goals of, 42 physiological considerations in, 261–262 technique for, 42 postoperative assessment, 265 historical perspective on, 41–42 preoperative assessment of patient for, 262 intraoperative, 50 rationale for, 261–262 pathology and, 44–46 reoperation in, 315 in surgery for subhemispheric epilepsy, 198–199 surgical technique for, 262–264, 263f–264f paradigm for, 43 at Taipei Veterans General Hospital, 262, 265–266 parameters for, 43 Cortical dysplasia. See also Malformations of cortical pathology and, 44–46 development (MCD) in pediatric patients, 293 abnormal neurons in, 186–187 physiology, 42 altered synaptic connectivity in, 187–188 in presurgical evaluation, goals of, 42 classifi cation of, 185–186, 187t principles of, 43 epileptogenesis with, mechanisms of, 186–188 safety issues, 42–43 epileptogenic zone in, defi ning boundaries of, 188–189 special considerations in children, 43–44 focal, 15, 64–66, 187t techniques for, 43 magnetic resonance imaging of, 185f, 186f, 188 Cortical zones, 8, 8t functional hemispherectomy for, 236–238, 237t 11C-PK11195, as PET radiotracer, 89 hemispherectomy in, 207–212 Cranial nerve palsies, with anteromesial temporal lobec- as indication for surgical referral, 9 tomy, 144–145 in intractable epilepsy Craniotomy, awake, anesthetic considerations for, 116 epidemiology of, 185 18F-Cyclofoxy, as PET radiotracer, 90 long-term outcome with, 188 Cytochrome P450, hepatic microsomal, 114 long-term outcome in, uncontrolled seizures and, 188 Cytomegalovirus (CMV), and polymicrogyria and magnetic resonance imaging of, 185f, 186f, 188 schizencephaly, 66 multiple subpial transections for, 269 pathology of, 185, 185f, 186f reoperation in, 313–314 D structural neuroimaging in, 185f, 186f, 188 Deep brain stimulation, 290–294 surgery for, seizure control after, 324–325 in pediatric patients, 293 surgical management of, 188–193 11C-L-Deprenyl, as PET radiotracer, 90 advances in (future directions for), 193 Desfl urane, 115 case scenario, 189–191, 190f, 191f Desmoplastic infantile ganglioglioma (DIG), 61 challenges in, 191–193 Developmental quotient failure of, 309–313 age at surgery and, 19 outcomes with, 20, 185, 192t, 193 postoperative improvement in, 19, 20 resection, 189 Dexmedetomidine, 117, 158 temporal lobe epilepsy caused by, 161t Diet, ketogenic, 114 transsylvian hemispheric deaff erentation for, 241 Diff use tensor tractography MRI (DT-MRI), of corpus cal- and uncontrolled seizures, 207 losum, 262, 262f long-term outcome with, 188 Diff usion imaging, applications of, 59–60 Cortical malformations. See Malformations of cortical Diff usion tensor imaging (DTI), 96, 96f, 314–315 development (MCD) applications of, 60, 60f Cortical mapping. See also Statistical parametric mapping in presurgical evaluation, 11 (SPM) 366 Index

Diff usion-weighted imaging (DWI), in presurgical in functional mapping, 49–50 evaluation, 11 in localization of language cortex, 76–77, 77f 11C-Diprenorphine, as PET radiotracer, 90 negative functional eff ects of, 49 Disconnection syndrome, after corpus callosotomy, Electrocorticography (ECoG) 264–265 drugs aff ecting, 114, 115 Disseminated intravascular coagulation (DIC), 221 intraoperative, 156, 158–159, 158f–159f, 176–177 11C-Doxepin, as PET radiotracer, 90 in hippocampal transection, 274, 275f 3D Slicer software, 93 historical perspective on, 41–42 Dual pathology, 32, 128 Electrodes. See also Grid electrodes; Strip electrodes with lesional temporal lobe epilepsy, 166 depth, 120–121, 121f mesial temporal sclerosis and, 128, 129 advantages of, 123 PET of, 89 complications of, 126 surgery for, seizure control after, 323–325, 324t indications for, 120 temporal lobe epilepsy and, tailored resection for, 157, placement, 121, 121f 157f surgical technique for, 124–125 Dysembryoplastic neuroepithelial tumor (DNET), 62, 62f, and strip electrodes, combined, 120–121 187t epidural peg, 120 lateral temporal lobe, 166, 166f for invasive monitoring, 119–120, 120f mesial temporal lobe, 166, 166f, 167, 167f Electroencephalography (EEG), 96, 348–349. See also Elec- SISCOM (subtraction ictal SPECT co-registered to MRI) tric source imaging (ESI); Video-EEG of, 86 in children, 3 temporal lobe epilepsy caused by, 162, 162t contralesional patterns on, 16, 18f, 32 Dysphasia, with anteromesial temporal lobectomy, 144 drugs aff ecting, 114, 115 Dystonia, after hemispherectomy, 222 early epileptogenic lesions and, 16–19, 17f, 18f electrodes, array (montage) for, 28 10/10, 28, 28f 10/20, 28 E and fMRI, combined, 352–353, 353f Early acquired epileptogenic lesions full band, 341–343 EEG manifestations of, 16–19, 17f, 18f and functional MRI, for localization of epileptic eff ects of, 15–19 discharge activity, 78–79 surgery for, types of, 20 hypsarrhythmia on, 16, 19 types of, 14–15 ictal surface, in localization of epileptic focus, 27–28 ECD. See Technetium-99m ethylene cysteine dimer (ECD) infraslow, 343 EEG. See Electroencephalography (EEG) interictal background, analysis of, 28, 29f, 29t EEG–fMRI, 352–353, 353f interpretation of, 28–31 EEG source localization (ESL), 343–345, 344f for localization of eloquent cortex, 351 Electrical stimulation. See also Cortical stimulation long-term monitoring, 27 alien limb phenomenon produced by, 49 in mesial temporal sclerosis, 129–131, 130f of angular gyrus, 48 patterns, generalized, in focal lesions, 16–19, 32 of auditory cortex, 49 and surgical outcomes, 19 with depth electrodes, 46–47 preoperative extra-operative, 41–52 in hemispherectomy candidate, 208 of insular cortex, 49 in transsylvian hemispheric deaff erentation candi- of interhemispheric connections of motor areas, 48 date, 241–242 intraoperative, 41–52 in presurgical evaluation, 10 laughter produced by, 49 slow-spike-wave complexes on, 16, 17f, 19 of visual cortex, 49 source analysis (3D dipole localization algorithms), 31, Electric source imaging (ESI), 348–352, 350f 34 clinical applications of, 349–351 source localization, 343–345, 344f and EEG-fMRI, combined, 353–354 surface, pitfalls of, 31–32 electrodes for Electrophysiologic assessment, new techniques for, 341–347 number of, 349 Eloquent cortex, 8t, 27. See also Language function(s) positioning of, 349 encroachment on, and invasive EEG monitoring, 35, 36f source model, 349, 350f focal seizures in, multiple subpial transections for, Electrocortical stimulation (ECS), 47 268–269 Index 367

localization, 189 PET in, 85–86 on cortical electrical stimulation, 43 SPECT in, 86 with EEG, 351 identifi cation of, 10–11 with electric source imaging, 351, 351f, 352f potential, 9, 9t with fMRI, 351, 351f, 352f Epileptogenic substrates, 60 with magnetoencephalography, 351 Epileptogenic zone, 8t, 27 PET of, 89 in cortical dysplasia, defi ning boundaries of, 188–189 primary, resection of, sequelae, 43 Evaluation. See also Assessment; Neuropsychological secondary, 43 assessment Encephalomalacia, 15 postsurgical cystic, surgery for, outcomes with, 20 PET in, 90 EEG fi ndings in, 18f, 19 SPECT in, 89–90 unilateral, EEG patterns with, 16, 18f presurgical, 41, 132 Encephalopathy, epileptic, 69 anesthetic considerations in, 113–114 Encephalotrigeminal angiomatosis. See Sturge-Weber clinical, 8–9, 8t, 9t syndrome for corpus callosotomy, 262 Endotracheal intubation, 114–115 cortical stimulation in, goals of, 42 Epidermal nevus syndrome, 14 for extratemporal resection, 174–175 Epilepsia partialis continua (EPC), 314 for functional hemispherectomy, 232 multiple subpial transections for, 269 functional MRI in, 10–11, 75–79 Epilepsy, pediatric. See also Pediatric epilepsy syndromes for hemidecorticectomy, 226, 227t and adult epilepsy, comparison of, 2 for hemispherectomy, 207, 216–217, 217t associated disabilities, 1, 3 modalities for, 10–12 catastrophic, 9 for multiple subpial transections, 270 surgery for, timing of, 19 noninvasive modalities for, 34, 175 causes of, 2 for peri-insular hemispherotomy, 251 eff ect on neuropsychological function, 106 in posterior quadrantic subhemispheric epilepsy, electrophysiologic characteristics of, 3 196–197, 197f epidemiology of, 1, 59 for selective amygdalohippocampectomy, focal, epidemiology of, 59 147–148 of infl ammatory origin, PET in, 89 techniques for, 10–12 intractable, defi nition of, 9, 9t testing in, 10–12 medically intractable, 1, 2 for selection of surgical candidates, 7–8 criteria for, 3 Executive function documentation of intractability in, 207 assessment, in neuropsychological assessment, 105 epidemiology of, 59 lateralization, neuropsychological data for, 108 nonpharmacologic treatments for, 285 localization, neuropsychological data for, 108 medically refractile, localization-related (LRMRE), 309, Extratemporal lobe epilepsy 313, 317 invasive monitoring in, indications for, 119 misdiagnosis of, 9 magnetoencephalography in, 54–55, 55f psychosocial burden of, 3 PET in, 86–87, 87f refractory, 69 SPECT in, 87 defi nition of, 9, 9t Extratemporal resection, 174–184 surgery for. See Pediatric epilepsy surgery frequency of, 5t, 12 Epilepsy surgery conference, 12 outcomes with, 182, 321, 323t Epileptic focus in pediatric patient, unique considerations for, 174 identifi cation of, 10, 11, 27–28, 31 presurgical evaluation for, 174–175 modalities for, 7, 7t seizure control after, 321, 323t pitfalls of, 31–32 surgical considerations, 175–179 secondary surgical technique, 181–182, 182f defi nition of, 89 PET of, 89 Epileptogenic lesion(s), 8t, 27. See also Congenital epilep- togenic lesions; Early acquired epileptogenic F lesions Fast ripples, 341 detection of 11C/18F-FCWAY, as PET radiotracer, 90 368 Index

FDG. See [18F]Fluorodeoxyglucose advantages of, 123 Febrile seizures, and mesial temporal sclerosis, complications of, 126 128–129 limitations of, 123 Felbamate, adverse eff ects and side eff ects of, 114 placement Fever, postoperative anesthetic considerations for, 116 with hemispherectomy, 222 surgical technique for, 125–126, 125f with peri-insular hemispherotomy, 258 subdural, 177, 177f, 178 with transsylvian hemispheric deaff erentation, 249 placement, 120, 120f, 121–122, 122f, 180–181, 180f Fluid and electrolytes intraoperative management of, 115–116 postoperative management of, 117 H [11C]Flumazenil (FMZ), 83–84, 85 Hamartoma(s), 113 [18F]Fluorodeoxyglucose, 82–83, 85, 175 hypothalamic, 15 FMZ. See [11C]Flumazenil (FMZ) classifi cation of, 300–301, 300f Focal cortical dysplasia (FCD), 64–66 clinical features of, 67 classifi cation of, 64 epileptogenic, 67 imaging appearance of, 64–65, 65f evolution of epilepsy with, 16 origin of, 64 as indication for surgical referral, 9 surgical outcomes with, 65–66 pathology of, 67 Focal epileptogenic lesions, 15 radiosurgery for, 299–302, 301f Focal resection, frequency of, 12 structural imaging of, 67 Follow-up, postsurgical, 12 Handedness, transfer of, 15 Frontal lobectomy, 179–180, 179f Health-related quality of life, postoperative, 336 neuropsychological outcomes with, 333–334 Hematoma, subdural, with invasive monitoring, 126 Frontal lobe epilepsy (FLE) Hemianopsia, 208 clinical manifestations, 31 postoperative, 212 EEG fi ndings in, 29–30, 31f Hemiatrophia cerebri, 206 magnetoencephalography in, 55 Hemiatrophy, transsylvian hemispheric deaff erentation for, Frontal lobe resection, frequency of, 12 241 Functional defi cit zone, 8t, 27 Hemiconvulsion-hemiplegia-epilepsy (HHE) syndrome identifi cation of, 10, 11, 28 causes, 206 on invasive EEG monitoring, 39 clinical course of, 206 Functional imaging. See also Magnetic resonance imaging clinical presentation of, 206 (MRI), functional (fMRI) hemispherectomy for, 206–212 in hemispherectomy candidate, 208–209 transsylvian hemispheric deaff erentation for, 241 in presurgical evaluation, 10–11 Hemicortectomy. See Hemidecortication; Hemidecorticec- Functional magnetic resonance imaging. See Magnetic tomy resonance imaging (MRI), functional (fMRI) Hemidecortication, 225. See also Hemidecorticectomy Furosemide, 116 special considerations in, 212 surgical approach for, 210 Hemidecorticectomy, 225–229. See also Hemidecortication G complications of, 228 Gamma knife surgery (GKS), 295 historical perspective on, 225 for hypothalamic hamartomas, 299–302, 301f indications for, 225–226 for mesial temporal lobe epilepsy, 295–298, 296f mortality rate for, 228 Gangliocytoma, 15, 61 planning for, 226 Ganglioglioma, 15, 61, 61f, 187t presurgical evaluation for, 226, 227t desmoplastic infantile, 61 surgical technique for, 227–228, 227t temporal lobe epilepsy caused by, 162, 162t Hemi-hemimegalencephaly, 14 Gliomatosis cerebri, 15 Hemimegalencephaly (HME), 14 Gliosis, 15 associated neurocutaneous syndromes, 66, 206 surgery for, seizure control after, 323–325, 324t clinical presentation of, 206 Glucose, metabolism, in pediatric brain, 82–83 EEG fi ndings in, 29f Gray matter heterotopia, 66 functional hemispherectomy for, 236–238, 237t Grid electrodes hemispherectomy for, 206–212 Index 369

histology of, 66 operation time, 237 pathology of, 206 operative technique for, 232–235, 233f, 235f PET in, 89 outcomes with, 230–231, 231f, 238, 238f sporadic, 66 patient cohort, characteristics of, 236–238, 237t structural imaging of, 66 patient positioning for, 232 surgery for, 66 postoperative care for, 235–236 transsylvian hemispheric deaff erentation for, 241 and postoperative CSF shunts, 237, 237t Hemiplegia, with anteromesial temporal lobectomy, 145 rationale for, 230–232 Hemispherectomy, 8 reoperations, 237–238 anatomical, 205, 215–224 functional status of contralateral hemisphere in, anesthesia for, 217 preoperative assessment of, 89 closure, 221 historical perspective on, 205, 251 complications of, 221–222 indications for, 14, 20, 66, 205, 207, 314 historical perspective on, 215–216, 251 and invasion of surgical cavity by healthy hemisphere, indications for, 216, 239 222 mortality rate for, 221 mortality rate for, 212 opening for, 217–218, 218f mortality with, causes, 212 outcomes with, 222–223 neuropsychological outcomes with, 334–335 patient positioning for, 217 outcomes with, 20, 212–213, 321–323, 323t perioperative monitoring with, 217 Oxford-Adams modifi cation, 216 preoperative evaluation for, 216–217, 217t preoperative assessment for, 207 surgical approach for, 209–210 seizure control after, 321–323, 323t surgical technique for, 217–221, 218f–220f special considerations in, 211–212 timing of, 216 subtotal, historical perspective on, 215–216 anesthetic considerations for, 116–117, 217 surgical approaches for, 209–211 candidates for, 207 surgical failure after, 212–213 EEG fi ndings in, 208 surgical planning for, 209 functional imaging in, 208–209 Hemispheric deaff erentation neuropsychological assessment of, 209 perisylvian transcortical transventricular, 211 physical examination of, 208 transsylvian, 241–250 structural imaging in, 208 indications for, 241 Wada testing in, 209 presurgical evaluation of patient for, 241–243, 242f complications of, 212 transsylvian/transventricular keyhole, 241–250 frequency of, 4, 5t, 12 Hemispheric epilepsy, causes, 205–206, 216 functional, 205 Hemispheric lesions, 14–15 historical perspective on, 215–216, 230, 251 epilepsy syndromes associated with, 205–207 indications for, 216, 230–232, 230t, 236–238, 237t physical fi ndings with, 208 limitations of, 239 postencephalitic, transsylvian hemispheric outcomes with, 230–231, 231f deaff erentation for, 241 presurgical evaluation for, 232 posttraumatic, transsylvian hemispheric deaff erentation rationale for, 230–232 for, 241 reoperation after, 314–315 Hemispheric resections, neuropsychological outcomes risk stratifi cation, by etiology, 237, 237t with, 334–335 surgical approach for, 210 Hemispheric syndromes, as indication for surgical referral, transsylvian keyhole, 211, 255f, 256–257 9 at UCLA, 230–240 Hemispherotomy, 205 advances in (future directions for), 238–239 development of, 205 assessment of, 238–239 historical perspective on, 251 blood loss in, 237 indications for, 216 closure for, 233f, 235 modifi ed lateral, 256f, 257 complications of, 237–238 peri-insular, 211, 251–260, 314 goals of, 230–232 complications of, 258–259 histopathologic fi ndings in, 230, 230t modifi ed, 211, 254–257 ICU care after, 235–236 mortality with, 258–259 long-term follow-up, 236, 238 operative procedure for, 251–254, 252f–254f opening for, 232–233, 233f outcomes with, 257–258 370 Index

Hemispherotomy (Continued) Imaging preoperative evaluation of patient for, 251 advances in (future directions for), 354 transsylvian approach for, 255–256 diff usion, applications of, 59–60 with ultrasound guidance, 255f, 256 diff usion-weighted, in presurgical evaluation, 11 special considerations in, 212 electric source. See Electric source imaging (ESI) surgical approach for, 210 functional. See also Magnetic resonance imaging (MRI), transopercular, 254, 255f functional transsylvian keyhole, 241 in hemispherectomy candidate, 208–209 transventricular vertical, 210–211 in presurgical evaluation, 10–11 Hemodynamics, age-related changes in, 113 magnetic source, 348 Hemorrhage principles of, 53 with arteriovenous malformation, 162 new techniques, 348–356 intrauterine, transsylvian hemispheric deaff erentation for, optical techniques, in neocortical epilepsy, 357–360 241 perfusion, 60 Hemosiderosis, superfi cial cerebral (SCH), 251 structural, 59–73 Heterotopia, 15 in hemispherectomy candidate, 208 High-frequency oscillations (HFO), 32, 341 of malformations of cortical development, 63–67 analysis of, 341–342 in presurgical evaluation, 10 in ictal periods, 342, 342f Infancy, surgery in in interictal periods, 342 outcomes with, 20 and muscle activity, 343 risks of, 20 propagation of, during seizures, 342 Infantile spasms, 32 recording, 341 causes, 206 topographic movie mapping technique for, 342–343 clinical presentation of, 206 Hippocampal sclerosis, 67, 68f EEG fi ndings with, 206 prevalence of, 60 hemispherectomy for, 206–212 Hippocampal transection Infarction(s) case study, 277f, 278 after corpus callosotomy, 264 outcomes with, 274–278, 276f, 277f after peri-insular hemispherotomy, 258 rationale for, 274 as indication for surgical referral, 9 technique for, 274, 275f, 276f Infection(s), with invasive monitoring, 126 verbal memory after, 276–277 Insular cortex, electrical stimulation of, 49 Hippocampus, direct neurostimulation in, 291 Intensive care unit (ICU) care, postoperative, 117 HMPAO. See Technetium-99m hexamethylpropylene Intracarotid amobarbital test (IAT). See Wada test amineoxime (HMPAO) Intrinsic optical signals (IOSs), 357 Homonymous hemianopia, with anteromesial temporal Invasive electroencephalography monitoring (IEM), 34 lobectomy, 144 after inconclusive preoperative CT/MRI, 35 Human herpesvirus 6 (HHV-6), and mesial temporal sclerosis, applications of, 34 129 with divergent preoperative data, 35 Hydrocephalus electrodes for after corpus callosotomy, 264 surgical insertion, 37 after hemispherectomy, 212, 222 types of, 36 after peri-insular hemispherotomy, 258 for encroachment on eloquent cortex, 35, 36f after transsylvian hemispheric deaff erentation, 249 grid placement for, anesthetic considerations for, 116 Hypomelanosis of Ito, 14 indications for, 12, 34–35, 41 and hemimegalencephaly, 206 interpretation, 37–39 Hypothalamic hamartomas (HH). See Hamartoma(s), limitations of, 34 hypothalamic practical considerations in, 34 Hypothalamic resection, frequency of, 12 recording, 37 risks of, 37 spatial coverage, 35–36 strip placement for, anesthetic considerations for, 116 I technical aspects, 35–37 Ictal (seizure) onset zone, 8t, 27 Invasive monitoring, 34–40 identifi cation of, 10, 28, 31–32 advantages of, 122–123 on invasive EEG monitoring, 37, 38f complications of, 126, 177–178 Index 371

in extratemporal lobe epilepsy, 175–178, 176f, 177f, 178f electrocortical stimulation for, 48 indications for, 119 noninvasive techniques for, 49–50 indications for, 12, 119 postoperative reorganization, 107 limitations of, 123 Laughter, stimulation-induced, 49 in mesial temporal sclerosis, 130–131 Lennox-Gastaut syndrome postoperative monitoring with, 126 EEG patterns in, 16 technical problems with, 123 PET in, 88 techniques for, 119–122 SPECT in, 88 in temporal lobe epilepsy, indications for, 119, 120t surgical treatment of, 16 Inverse problem, 28 vagus nerve stimulation in, 281 Inverse solution, 27 Lesionectomy. See also Lobar resection 123I-Iododexetimide, as PET radiotracer, 90 indications for, 20 IOS imaging. See Optical imaging Linear nevus sebaceous of Jadassohn, and Irritative zone, 8t, 27 hemimegalencephaly, 206 identifi cation of, 10, 28 Lissencephaly, 14 on invasive EEG monitoring, 37–39 transsylvian hemispheric deaff erentation for, 241 Isofl urane, 115 Lobar resection frequency of, 12 indications for, 14, 20 outcomes with, 20 K Low-grade (fi brillary) astrocytoma, 63, 63f 11C-(S)-[N-methyl]-Ketamine, as PET radiotracer, 90 Ketogenic diet, 114, 285 Kindling, 19 Klippel-Trenaunay-Weber syndrome, 14 M and hemimegalencephaly, 206 Magnetic resonance imaging (MRI), 175. See also Diff usion tensor imaging (DTI); MRI/PET; SISCOM (subtraction ictal SPECT co-registered to MRI) L advantages of, 59 Laboratory test(s), preoperative, 113–114 in epilepsy, sensitivity of, 59 Landau-Kleff ner syndrome, 5 FLAIR sequence, 10, 15, 59 as indication for surgical referral, 9 of focal cortical dysplasia, 64–65, 65f, 185f, 186f, 188 magnetoencephalography in, 55 functional (fMRI), 95 multiple subpial transections for, 269 activation, laterality of, assessment of, 74–75 Language assessment, in neuropsychological BOLD (blood oxygen dependent) signal, 74, 78, 351, assessment, 105 351f, 352–353, 353f, 354, 357 Language cortex, localization of. See also Eloquent cortex in cortical functional mapping, 49–50 functional MRI in, 76–77, 77f and EEG, combined, 352–353, 353f Wada test in, 76–77, 77f EEG-guided, 11 Language function(s). See also Eloquent cortex experimental designs, 74 hemispheric transfer of, 15–16 in hemispherectomy candidate, 208–209 interhemispheric transfer of, 107 lateralization intraoperative mapping of, factors aff ecting, 34 assessment of, 74 lateralization defi nition of, 74 electrical stimulation for, 44f–46f, 45–46 for localization of eloquent cortex, 351, 351f, 352f functional MRI in, 75–76, 75f for localization of epileptic discharge activity, 78–79 magnetoencephalography in, 57 in localization of language cortex, 76–77, 77f neuropsychological data for, 107 of memory lateralization, 77–78 preoperative assessment of, 75, 75f in pediatric epilepsy surgery, 74–81 testing for, 16 in presurgical evaluation, 10–11, 75–79 Wada test in, 75–76, 75f principles of, 74 localization response monitoring, 74 magnetoencephalography in, 57 and Wada test, comparison of, 75–76 neuropsychological data for, 107 in hemispherectomy candidate, 208 Wada testing for, 100 intraoperative, 96 mapping lesion defi ned on, and EEG fi ndings, 32 372 Index

Magnetic resonance imaging (MRI) (Continued) structural imaging of, 63–67 of mesial temporal sclerosis, 131, 131f surgery for nonlesional, 15 outcomes with, 20 phased-array, at 3 Tesla (3T PA), 10 seizure control after, 323–325, 324t in posterior quadrantic subhemispheric epilepsy, 196–197, surgical management of, failure of, 309–313 197f Malignant rolandic-sylvian epilepsy, 55 preoperative multiple subpial transections for, 269 normal or nonspecifi c, 35 Manipulation hemiplegia, with anteromesial temporal in transsylvian hemispheric deaff erentation candi- lobectomy, 145 date, 242–243, 242f Mannitol, 116 in presurgical evaluation, 10 Mechanical ventilation, postoperative, 117 proton density, 59 Medial temporal lobe (MTL), and memory function, 78 structural lesion on, 35 Megalencephaly, 14 techniques for, 59 Memory T1-weighted, 59 assessment, in neuropsychological assessment, 105 T2-weighted, 59, 60f lateralization Magnetic resonance spectroscopy (MRS) neuropsychological data for, 107–108 applications of, 59 preoperative assessment of, 77–78 in presurgical evaluation, 10–11 localization, neuropsychological data for, 107–108 Magnetic resonance venography, in Sturge-Weber syndrome, nonverbal, temporal lobe epilepsy and, 108 208 verbal Magnetic source imaging (MSI), 348 after hippocampal transection, 276–277 principles of, 53 temporal lobe epilepsy and, 107–108 Magnetoencephalography (MEG), 34, 53–58, 96, 175, 348 Wada testing for, 100–101 in benign rolandic epilepsy, 55 Meningitis in cortical functional mapping, 49–50 after corpus callosotomy, 264 in extratemporal lobe epilepsy, 54–55, 55f after hemispherectomy, 212 in extratemporal localization-related epilepsy, 54–55, 55f after transsylvian hemispheric deaff erentation, 249 in frontal lobe epilepsy, 55 Mesial temporal sclerosis (MTS), 15 in functional mapping, 57 bilateral, 128 in Landau-Kleff ner syndrome, 55 in children, 128–135 in lesional epilepsy, 54, 54f epidemiology of, 2 for localization of eloquent cortex, 351 pathophysiology of, 128 in nonlesional epilepsy, 56 clinical presentation of, 129 in occipital lobe epilepsy, 54–55 diff erential diagnosis of, 132 in presurgical evaluation, 10 and dual pathology, 128, 129 principles of, 53 EEG fi ndings in, 129–131, 130f with recurrent/residual postoperative seizures, 56 etiology, 128 in recurrent seizures, 32 evaluation of patient, 129–132 in temporal lobe epilepsy, 55–56 febrile seizures and, 128–129 in tuberous sclerosis, 54, 54f HHV-6 and, 129 Magnetoencephalography spike sources (MEGSS), 53–54 magnetic resonance imaging of, 131, 131f Malformations of cortical development (MCD), 14, 60. See PET of, 131, 131f also Cortical dysplasia SPECT of, 131–132 classifi cation of, 185–186, 187t surgery for, seizure control after, 323–325, 324t clinical features of, 225–226 and temporal lobe epilepsy, 128 diff use, abnormal synaptic connectivity in, 186, 187–188 temporal lobe epilepsy caused by, 161t EEG fi ndings in, 17f treatment of, 132–133 epidemiology of, 2 11C-Methylnaltrindole, as PET radiotracer, 90 epileptogenesis with, mechanisms of, 186–188 Midazolam, 115 focal, abnormal cells in, 186–187 premedication with, 114 hemidecorticectomy for, 225–226 Middle cerebral artery infarct, functional hemispherectomy magnetic resonance imaging of, 17f for, 236–238, 237t and mesial temporal sclerosis, 128, 129 Motor area(s) mild, 187t interhemispheric connections of, electrical stimulation and Rasmussen syndrome, 226 of, 48 Index 373

primary, response to electrocortical stimulation, Neuropsychological outcome(s), 332–335 47 with frontal lobe resections, 333–334 Motor function, assessment, in neuropsychological with hemispheric resections, 334–335 assessment, 105 with multilobar resections, 334 18F-MPPF, as PET radiotracer, 90 with parietal lobe resections, 334 MRI/PET, 93–95, 94f, 95f predictors of, 336–337 in presurgical evaluation, 10 with temporal lobe resections, 332–333 Multilobar surgery, 8 11C-NMBP, as PET radiotracer, 90 frequency of, 4, 12 Nonlesional epilepsy, magnetoencephalography in, 56 indications for, 14, 20 Nonlinear analysis, 345 neuropsychological outcomes with, 334 Multiple band frequency analysis, of high-frequency oscillations, 341–342 O Multiple subpial transection (MST), 8, 268–273 Occipital lobe epilepsy complications of, 271 EEG fi ndings in, 31 for focal seizures in eloquent cortex, 268–269 magnetoencephalography in, 54–55 indications for, 268–269 Occipital lobe resection, frequency of, 12 for Landau-Kleff ner syndrome, 269 Oligodendroglioma, temporal lobe epilepsy caused by, 162, outcomes with, 271 162t presurgical evaluation of patient for, 270 Ophthalmologic examination, preoperative, 208 rationale for, 268 Opioid(s), 115, 117 surgical technique for, 270–271, 270f, 271f Optical imaging for syndrome of malignant rolandic-sylvian epilepsy, 269 cerebral hemodynamics and, 357–360, 358f, 359f Multistage resective procedures, frequency of, 4–5 cortical activity and, 357–360, 358f, 359f Muscle relaxants, 114, 115 in neocortical epilepsy, 357–361 practical clinical applications of, advances in (future directions for), 360 Outcome(s), 12, 20. See also Seizure control, postoperative; N Surgical failure Nausea and vomiting, postoperative, management of, 117 with anatomical hemispherectomy, 222–223 Neurocutaneous syndromes, 14 with anteromesial temporal lobectomy, 145 Neurofi bromatosis (NF), type 1, 14 classifi cation of, 320 Neuroimaging. See also Imaging; specifi c modality with corpus callosotomy, 265 functional, in presurgical evaluation, 10–11 with extratemporal resection, 182 structural, in presurgical evaluation, 10 with functional hemispherectomy, at UCLA, 238, 238f Neurological examination, presurgical, 10, 11t with hemispherectomy, 212–213, 222–223 NeuroPace, 292, 292f with hippocampal transection, 274–278, 276f, 277f surgical technique for, 292–293 with lesional temporal lobe epilepsy, 170–171 Neurophysiology, in presurgical evaluation, 10 with multiple subpial transections, 271 Neuropsychological assessment neuropsychological, 332–335 of children, 104–109 predictors of, 336–337 of children with epilepsy, special considerations in, 107 with peri-insular hemispherotomy, 257–258 domains of, 105–106 psychosocial, 335–336 follow-up, 109 predictors of, 336–337 of hemispherectomy candidate, 209 seizure-free, predictive factors, 20 for localizing and lateralizing epileptogenic area, with selective amygdalohippocampectomy, 147, 153– 107–108 154 postsurgical, 109 with surgery for mesial temporal sclerosis, 132–133 presurgical, 11–12 goals of, 106–107 for transsylvian hemispheric deaff erentation candidate, 243 P Neuropsychological function. See also Cognitive function Pain, postoperative, treatment of, 117 pediatric epilepsy and, 106 Parietal lobe resection potential postoperative issues, advice to parents and frequency of, 12 teachers about, 108–109 neuropsychological outcomes with, 334 374 Index

Parietal lobe seizures, EEG fi ndings in, 30–31 in tuberous sclerosis, 87–88, 88f Pediatric epilepsy surgery. See also Surgical failure [11C]fl umazenil (FMZ), 83–84, 85 advances in (future directions for), 5 in extratemporal lobe epilepsy, 86–87, 87f candidates, selection of, 19–20 11C-PK11195, 89 evaluation for, 7–8 of dual pathology, 89 characteristics of, 2–5 of eloquent cortex, 89 frequency of, by procedure type, 4, 5t, 12 in extratemporal lobe epilepsy, 86–87, 87f, 175 general criteria for, 217t [18F]fl uorodeoxyglucose (FDG), 82–83, 85, 175 goals of, 4 of brain regions outside epileptogenic zone, 89 historical perspective on, 1–2 in extratemporal lobe epilepsy, 86–87, 87f, 175 indications for, 3–4, 9, 9t hypometabolism on, 83, 83f, 84f medical management after, 328 in postsurgical evaluation, 90 for mesial temporal sclerosis, 132–133 in tuberous sclerosis, 87, 88f present status of, 5 in hemimegalencephaly, 89 procedures, 4–5, 5t, 8 in hemispherectomy candidate, 208–209 special considerations in, 2–5 in infantile spasms, 32, 87 as special expertise, 2 in Lennox-Gastaut syndrome, 88 specifi c criteria for, 217t of mesial temporal sclerosis, 131, 131f timing of, 4, 19 neuroreceptor tracers for, 90 Pediatric epilepsy syndromes, 2–3 15O-water, 89 Perfusion imaging, 60 in pediatric epilepsy surgery, 85–90 Peri-insular posterior quadrantectomy (PIPQ) in postsurgical evaluation, 90 evolution of, 197 principles of, 82–84 functional neuroanatomy for, 199f, 200–202, 201f radiotracers for, 82–84, 85–86 operative technique for, 199–202, 199f–201f rationale for, 82 Perisylvian transcortical transventricular hemispherical of secondary epileptic foci, 89 deaff erentation, 211 in Sturge-Weber syndrome, 88 PET-MRI coregistration. See MRI/PET technique for, 82–84 Plasticity in temporal lobe epilepsy, 85–86 adaptive in tuberous sclerosis, 66 defi nition of, 15 Posterior quadrantic subhemispheric epilepsy, surgical early epileptogenic lesions and, 15–16 management of and brain reorganization anesthetic considerations in, 197–198 with acquired pathology, 46 complications, prevention of, 202–203 with malformations, 45 evolution of, 197 defi nition of, 15 indications for, 196 functional, of developing brain, 3–4 and intraoperative functional mapping, 198–199 Plasticity window, surgery in, 16, 19 operative techniques for, 199–202 Pleomorphic xanthoastrocytoma, 15, 62–63, 63f outcomes with, 203 Polymicrogyria (PMG), 14, 15, 66 preoperative assessment for, 196–197, 197f as indication for surgical referral, 9 Posterior quadrantic surgery. See also Anatomical posterior transsylvian hemispheric deaff erentation for, 241 quadrantectomy; Peri-insular posterior Porencephalic cyst quadrantectomy (PIPQ) causes, 207 anesthetic considerations in, 197–198 clinical features of, 207 complications, prevention of, 202–203 hemispherectomy for, 207–212 evolution of, 197 pathology of, 207 indications for, 196 treatment of, 207 intraoperative functional mapping in, 198–199 Porencephaly, 69 outcomes with, 203 Port-wine stain, 206 preoperative assessment for, 196–197, 197f Positioning, patient, intraoperative, 115 Postoperative care, 117 Positron emission tomography (PET), 175. See also MRI/PET Postsurgical follow-up, 12 [11C]alphamethyl-L-tryptophan (AMT), 83–84, 86, 175 Premedication, 114 in extratemporal lobe epilepsy, 86–87, 175 Primary negative motor area, 48 in postsurgical evaluation, 90 Propofol, 114, 115, 117 in temporal lobe epilepsy, 86 Propofol infusion syndrome, 117 Index 375

Proteus syndrome, 14 after functional hemispherectomy, 314–315 and hemimegalencephaly, 206 consideration for, 312–313 Pseudoseizures, diff erential diagnosis of, 30 in corpus callosotomy, 315 Psychological test(s), standardized, 104 in focal cortical resections, 313–314 Psychosocial adjustment, assessment, in neuropsychologi- in grid-based resections, 313–314 cal seizure control after, 325 assessment, 105 in temporal lobectomy, 317 Psychosocial outcome(s), 335–336 for tumor, 315–316, 316f predictors of, 336–337 for vascular lesions, 316–317 Responsive neurostimulation device for, 292, 292f surgical technique for, 292–293 Q Reverse breach rhythm, 343 Quadrantanopsia, with anteromesial temporal lobectomy, Rhabdomyomas, cardiac, 113 144 Rheobase, 43 Ripples, 341 fast, 341 R Rocuronium, 114 Radiosurgery for cavernous malformations, 302–303 dose selection in, 303–304 for epilepsy S historical perspective on, 295 SANTE (Stimulation of the Anterior Nucleus of the Thala- principles of, 295 mus for Epilepsy), 291, 291f, 293 rationale for, 295 Schizencephaly, 14, 15, 66–67 for hypothalamic hamartomas, 299–302, 301f Sedative(s), premedication with, 114 for mesial temporal lobe epilepsy, 295–298, 296f Sedative/hypnotics, 115 target defi nition in, 303 Seizure(s). See also Febrile seizures technical considerations in, 303–304 acute postoperative, 309–310 Radiotracer(s), 82 classifi cation of, 27 Rasmussen encephalitis. See Rasmussen syndrome complex partial, 27 Rasmussen syndrome, 5, 15, 67–68, 68f electrographic onset, temporal relationship to clinical acute stage of, 225 onset, 28 clinical course of, 207 focal, 27 clinical presentation of, 207, 225 generalized, 27 diagnosis of, 243 harmful eff ects on developing brain, 3 diagnostic criteria for, 225 localization, pitfalls of, 31–32 EEG fi ndings in, 225 mechanism of, in lesion-related epilepsy, 162–163 etiology of, 225 phases of, 27 functional hemispherectomy for, 236–238, 237t postoperative, management of, 117 hemidecorticectomy for, 225 prediction of, 345 hemispherectomy in, 207–212, 314 psychosocial eff ects of, in children, 3 as indication for surgical referral, 9 recurrent and malformations of cortical development, 226 evaluation of, 32 medical therapy for, 225 postoperative, magnetoencephalography in, 56 multiple subpial transections for, 269 residual, postoperative, magnetoencephalography in, 56 PET in, 89 semiology, 31 prodrome of, 225 age-dependence of, 41 residual stage of, 225 by lobe, 10, 11t stages of, 225 relation to electrophysiologic fi ndings, 27 surgery for, 314 simple partial, 27 outcomes with, 20 Seizure control, postoperative, 320–331. See also transsylvian hemispheric deaff erentation for, 241 Outcome(s) Remifentanil, 115 after extratemporal resection, 321, 323t Reoperation, 313–318 after hemispherectomy, 321–323, 323t after epileptogenic lesional resection, 315–317, 316f after reoperation, 325 376 Index

Seizure control, postoperative (Continued) Stereoelectroencephalography (SEEG), 47 after surgery for nonlesional epilepsy, 325, 326t, 327t Strip electrodes, 175–176, 176f after surgery for structural lesion, 321 advantages of, 123 after temporal lobe surgery, 321, 322t complications of, 126 classifi cation of, 320 limitations of, 123 data, systematic evaluation of, pitfalls, 320–321 placement factors aff ecting, 325–328 anesthetic considerations for, 116 postsurgical, 328 surgical technique for, 124–125 presurgical, 327 subdural, placement, 120, 120f, 121–122, 122f surgical, 327–328 Structural image analyses, 60 literature resources (pediatric epilepsy surgery studies) Structural imaging, 59–73 on, 321, 322t in hemispherectomy candidate, 208 pathology of epileptogenic substrate and, 323–325, 324t of malformations of cortical development, 63–67 Sensory area(s) in presurgical evaluation, 10 response to electrocortical stimulation, 47–48 Sturge-Weber syndrome, 5, 68–69 somatotopic organization, 47 anesthetic considerations in, 113 Sensory cortex, primary (S1), 47–48 clinical presentation of, 14, 206, 226 response to electrocortical stimulation, 47–48 hemidecorticectomy for, 226 Sevofl urane, 114, 115 hemispherectomy in, 206–212, 226 Silent cortex, 27 as indication for surgical referral, 9 Single-photon emission computed tomography (SPECT), magnetic resonance imaging of, 241, 242f 175. See also SISCOM (subtraction ictal SPECT neurological defi cits in, pathogenesis of, 19 co-registered to MRI) pathology of, 206, 226 in extratemporal lobe epilepsy, 87 PET in, 88 in hemispherectomy candidate, 208–209 SPECT in, 88–89 in Lennox-Gastaut syndrome, 88 surgery for, outcomes with, 20 limitations of, 85 transsylvian hemispheric deaff erentation for, 241 of mesial temporal sclerosis, 131–132 treatment of, 206 in pediatric epilepsy surgery, 85–90 Subcommission for Pediatric Epilepsy Surgery, 2 in postsurgical evaluation, 89–90 Subcortical band heterotopia, 14 in presurgical evaluation, 10 Subdural electrode (SDE), 43, 47 principles of, 84–85 Subhemispheric epilepsy, surgical management of radiotracer for, 84–85 anesthetic considerations in, 197–198 rationale for, 82 complications, prevention of, 202–203 in Sturge-Weber syndrome, 88–89 evolution of, 197 technique for, 84–85 indications for, 196 in temporal lobe epilepsy, 86 and intraoperative functional mapping, 198–199 in tuberous sclerosis, 66, 88 operative techniques for, 199–202 SISCOM (subtraction ictal SPECT co-registered to MRI), 85, outcomes with, 203 175 preoperative assessment for, 196–197, 197f of dysembryoplastic neuroepithelial tumor, 86 Succinylcholine, 114 in extratemporal lobe epilepsy, 87 Supplementary sensorimotor area (SSMA), response to in postsurgical evaluation, 89–90 electrocortical stimulation, 47 in temporal lobe epilepsy, 86 Supplementary sensorimotor cortex, in mesial frontal and Sodium valproate, adverse eff ects and side eff ects of, 114 parietal cortex (S3), response to electrocortical Somatosensory cortex, secondary (S2), 47–48 stimulation, 47–48 response to electrocortical stimulation, 47–48 Supplementary sensory-motor seizures, EEG fi ndings in, 30 Somatosensory evoked magnetic fi eld (SEF), 57 Surgery, for pediatric epilepsy. See Pediatric epilepsy sur- Somatosensory evoked potentials, for localization of gery central sulcus, in surgery for subhemispheric Surgical failure epilepsy, 198 after hemispherectomy, 212–213 SPECT-CT, 93. See also Coregistration and consideration for reoperation, 312–313 Statistical parametric mapping (SPM), 85, 93, 95, 349–351 with correct localization and suffi cient resection but Status epilepticus evolution of epilepsy, 311, 312f refractory, 69 with correct localization but insuffi cient resection, 311 vagus nerve stimulation in, 281 defi nition of, 309 Index 377

with localization errors, 311–312, 313f frequency of, 5t, 12 patterns of, 311–312 outcomes with, 20 prediction of, 310 Thalamus, direct neurostimulation in, 290–291, 291f recognition of, 309–310 Thiopental, 114, 115 response to, 312–313 Time 0, 28 Symptomatogenic zone, 8t, 27 Topiramate, 132 identifi cation of, 28, 31–32 adverse eff ects and side eff ects of, 114 Transcranial magnetic stimulation (TMS), 291–292 Transsylvian hemispheric deaff erentation, 241–250 advantages of, 243 T complications of, 249 Technetium-99m ethylene cysteine dimer (ECD), 84 limitations of, 243 Technetium-99m hexamethylpropylene amineoxime (HM- mortality rate for, 249 PAO), 84 postoperative care for, 248–249 Temporal lobectomy presurgical management of patient for, 243–244 aggressive, 156f surgical technique for, 244–248, 244f–247f anteromesial. See Anteromesial temporal lobectomy Transsylvian keyhole functional hemispherectomy, 211, (AMTL) 255f, 256–257 neuropsychological outcomes with, 332–333 Transsylvian/transventricular keyhole hemispheric outcomes with, 321, 322t deaff erentation, 241–250 reoperation in, 317 Tuberous sclerosis, 14, 15 seizure control after, 321, 322t, 324–325 anesthetic considerations in, 113 selective, 156f EEG in, 19–20 tailored resection for histology of, 66 advantages of, 156–157 as indication for surgical referral, 9 defi nition of, 156 magnetoencephalography in, 54, 54f functional considerations, 157–158, 157f multistage resective procedures for, frequency of, 4–5 rationale for, 156, 156f PET in, 87–88, 88f strategies for, 156–157 SPECT in, 88 technique for, 158–159, 158f structural imaging of, 66 Temporal lobe epilepsy (TLE) Tumor(s) in children, 156 basal temporal lobe, 166, 168 diagnostic challenges, 41 dysplastic, 187t clinical manifestations, 31 and EEG fi ndings, 32 EEG fi ndings in, 28–29, 30f epilepsy-associated, 60–63 imaging, coregistration technique, 95 as indication for surgical referral, 9, 15 invasive monitoring in, indications for, 119, 120t lateral temporal lobe, 166, 166f, 168 lesional, 161–173 mesial temporal lobe, 166, 166f mechanism of seizures in, 162–163 and preoperative electrophysiologic assessment, pathological substrates in, 161–162, 161t 44–45 surgical management of reoperation for, 315–316, 316f and dual pathology, 166 surgery for, seizure control after, 323–325, 324t epileptogenic zone in, 163–165, 164f temporal lobe epilepsy caused by, 161t, 162, 162t extent of resection, 163–166 surgical management of, outcomes with, 170 lesionectomy in, 163 and location of lesion, 166–168, 166f, 167f mesial temporal structures in, 165–166 strategy for, 163–168 V magnetoencephalography in, 55–56 Vagus nerve stimulation (VNS), 20 and memory lateralization, 77–78, 107–108 adverse eff ects of, 284–285 mesial (MTLE), radiosurgery for, 295–298, 296f alternative indications for, 285–286 mesial temporal sclerosis and, 128 anatomical considerations in, 279–280 PET in, 85–86 anesthetic considerations for, 116 seizure types in, 29 complications of, 283–284 SPECT in, 86 effi cacy of, in epilepsy, 280 Temporal surgery hardware for, 284 378 Index

Vagus nerve stimulation (VNS) (Continued) assessment, in neuropsychological assessment, 105 historical perspective on, 279 lateralization, neuropsychological data for, 108 in Lennox-Gastaut syndrome, 281 localization, neuropsychological data for, 108 in pediatric patients, 280–281 and specifi c seizure types, 281 physiologic considerations in, 279–280 procedure for, frequency of, 12 W safety of, in epilepsy, 280 Wada memory asymmetry (WMA), 100–101 in status epilepticus, 281 Wada test, 11–12 stimulation parameters for, 284, 284t and functional MRI, comparison of, 75–76 surgical technique for, 281–283, 282f, 283f in hemispherectomy candidate, 209 Vascular access, 115 neuropsychological testing during, 11–12 Vascular lesion(s). See also Arteriovenous malformations pediatric, 99–103 (AVMs) catheter placement in, sedation for, 99–100 hemidecorticectomy for, 226 for language testing, 100 reoperation for, 316–317 for memory testing, 100–101 temporal lobe epilepsy caused by, 161t, 162 special considerations in, 99–100 surgical management of, 168–170 preoperative, in transsylvian hemispheric Video-EEG, 19, 27 deaff erentation candidate, 243 intracranial, 53, 175 in preoperative language lateralization, 75–76, 75f scalp, 53, 175 principles of, 99 Visual cortex, electrical stimulation of, 49 technique for, 99 Visual fi eld defect Wernicke’s area, response to electrocortical stimulation, 48 with anteromesial temporal lobectomy, 144 West syndrome with hemispheric lesions, 208 EEG patterns in, 16 Visual-spatial processing surgical treatment of, 16