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,