Resection of dominant opercular gliosis in refractory partial epilepsy

Report of two cases

Restricted access

✓ Frontal opercular gliosis in the dominant hemisphere caused medically refractory partial epilepsy in two patients. Both patients were aphasic during their seizures, but otherwise had normal speech. Magnetic resonance images showed well-demarcated lesions resembling tumors in each patient; on heavily T2-weighted images, the lesions were hyperintense compared with normal brain. Cortical mapping with subdural grids localized speech to the area of the lesions; therefore, the resections were performed under local anesthesia and speech was tested throughout the procedure. Postoperatively, both patients were seizure-free and had no new neurological deficits. Well-demarcated lesions, even in the dominant operculum, can be safely removed in patients with medically refractory partial epilepsy.

Article Information

Contributor Notes

Address reprint requests to: Nicholas M. Barbara, M.D., c/o The Editorial Office, Department of Neurological Surgery, 1360 Ninth Avenue, Suite 210, San Francisco, California 94122.
Headings
References
  • 1.

    Bergen DBleck TRamsey Ret al: Magnetic resonance imaging as a sensitive and specific predictor of neoplasms removed for intractable epilepsy. Epilepsia 30:3183211989Bergen D Bleck T Ramsey R et al: Magnetic resonance imaging as a sensitive and specific predictor of neoplasms removed for intractable epilepsy. Epilepsia 30:318–321 1989

    • Search Google Scholar
    • Export Citation
  • 2.

    Berger MSKincaid JOjemann GAet al: Brain mapping techniques to maximize resection, safety, and seizure control in children with brain tumors. Neurosurgery 25:7867921989Berger MS Kincaid J Ojemann GA et al: Brain mapping techniques to maximize resection safety and seizure control in children with brain tumors. Neurosurgery 25:786–792 1989

    • Search Google Scholar
    • Export Citation
  • 3.

    Bruyn GWGathier JC: The operculum syndrome in Vinken PJBruyn GW (eds): Handbook of Clinical Neurology Vol 2. Localization in Clinical Neurology. New York: John Wiley & Sons1969 pp 776783Bruyn GW Gathier JC: The operculum syndrome in Vinken PJ Bruyn GW (eds): Handbook of Clinical Neurology Vol 2. Localization in Clinical Neurology. New York: John Wiley & Sons 1969 pp 776–783

    • Search Google Scholar
    • Export Citation
  • 4.

    Cascino GDHirschorn KAJack CRet al: Gadolinium-DTPA-enhanced magnetic resonance imaging in intractable partial epilepsy. Neurology 39:111511181989Cascino GD Hirschorn KA Jack CR et al: Gadolinium-DTPA-enhanced magnetic resonance imaging in intractable partial epilepsy. Neurology 39:1115–1118 1989

    • Search Google Scholar
    • Export Citation
  • 5.

    Cazenave CReid SVirapongse Cet al: Reactive gliosis simulating butterfly glioma: a neuroradiological case study. Neurosurgery 19:8168191986Cazenave C Reid S Virapongse C et al: Reactive gliosis simulating butterfly glioma: a neuroradiological case study. Neurosurgery 19:816–819 1986

    • Search Google Scholar
    • Export Citation
  • 6.

    Cosnett JEMoodley MBill PLAet al: Operculum syndrome from brain abscess in a left-hander. J Neurol Neurosurg Psychiatry 51:3073081988 (Letter)Cosnett JE Moodley M Bill PLA et al: Operculum syndrome from brain abscess in a left-hander. J Neurol Neurosurg Psychiatry 51:307–308 1988 (Letter)

    • Search Google Scholar
    • Export Citation
  • 7.

    Dowd CFDillon WPBarbara NMet al: Magnetic resonance imaging in intractable complex partial seizures: pathologic and electroencephalographic correlation. Epilepsia 32:4544591991Dowd CF Dillon WP Barbara NM et al: Magnetic resonance imaging in intractable complex partial seizures: pathologic and electroencephalographic correlation. Epilepsia 32:454–459 1991

    • Search Google Scholar
    • Export Citation
  • 8.

    Goldring S: Surgical management of epilepsy in children in Engel J Jr (ed): Surgical Treatment of the Epilepsies. New York: Raven Press1987 pp 445464Goldring S: Surgical management of epilepsy in children in Engel J Jr (ed): Surgical Treatment of the Epilepsies. New York: Raven Press 1987 pp 445–464

    • Search Google Scholar
    • Export Citation
  • 9.

    Gregorie EMGoldring S: Localization of function in the excision of lesions from the sensorimotor region. J Neurosurg 61:104710541984Gregorie EM Goldring S: Localization of function in the excision of lesions from the sensorimotor region. J Neurosurg 61:1047–1054 1984

    • Search Google Scholar
    • Export Citation
  • 10.

    Hausser-Hauw CBancaud J: Gustatory hallucinations in epileptic seizures. Electrophysiological, clinical and anatomical correlates. Brain 110:3393591987Hausser-Hauw C Bancaud J: Gustatory hallucinations in epileptic seizures. Electrophysiological clinical and anatomical correlates. Brain 110:339–359 1987

    • Search Google Scholar
    • Export Citation
  • 11.

    Hecaen HConsoli S: Analyse des troubles du langage au cours des lesions de l'aire de Broca. Neuropsychologia 11:3773881973 (cited by Zangwill)Hecaen H Consoli S: Analyse des troubles du langage au cours des lesions de l'aire de Broca. Neuropsychologia 11:377–388 1973 (cited by Zangwill)

    • Search Google Scholar
    • Export Citation
  • 12.

    Kuzniecky Rde la Sayette VEthier Ret al: Magnetic resonance imaging in temporal lobe epilepsy: pathological correlations. Ann Neurol 22:3413471987Kuzniecky R de la Sayette V Ethier R et al: Magnetic resonance imaging in temporal lobe epilepsy: pathological correlations. Ann Neurol 22:341–347 1987

    • Search Google Scholar
    • Export Citation
  • 13.

    Lesser RPLueders HDinner DSet al: The location of speech and writing functions in the frontal language area. Results of extraoperative cortical stimulation. Brain 107:2752911984Lesser RP Lueders H Dinner DS et al: The location of speech and writing functions in the frontal language area. Results of extraoperative cortical stimulation. Brain 107:275–291 1984

    • Search Google Scholar
    • Export Citation
  • 14.

    Levine DNSweet E: The neuropathological basis of Broca's aphasia and its implications for the cerebral control of speech in Arbib MACaplan DMarshall JC (eds): Neural Models Language Process. New York: Academic Press1982299326Levine DN Sweet E: The neuropathological basis of Broca's aphasia and its implications for the cerebral control of speech in Arbib MA Caplan D Marshall JC (eds): Neural Models Language Process. New York: Academic Press 1982 299–326

    • Search Google Scholar
    • Export Citation
  • 15.

    Mathieson G: Pathologic aspects of epilepsy with special reference to the surgical pathology of focal cerebral seizures. Adv Neurol 8:1071381975Mathieson G: Pathologic aspects of epilepsy with special reference to the surgical pathology of focal cerebral seizures. Adv Neurol 8:107–138 1975

    • Search Google Scholar
    • Export Citation
  • 16.

    McLachlan RSNicholson RLBlack Set al: Nuclear magnetic resonance imaging, a new approach to the investigation of refractory temporal lobe epilepsy. Epilepsia 26:5555621985McLachlan RS Nicholson RL Black S et al: Nuclear magnetic resonance imaging a new approach to the investigation of refractory temporal lobe epilepsy. Epilepsia 26:555–562 1985

    • Search Google Scholar
    • Export Citation
  • 17.

    Mohr JP: Aphasia, apraxia, and agnosia in Rowland LP (ed): Merritt's Textbook of Neurologyed 8. Philadelphia: Lea & Febiger1989 pp 913Mohr JP: Aphasia apraxia and agnosia in Rowland LP (ed): Merritt's Textbook of Neurology ed 8. Philadelphia: Lea & Febiger 1989 pp 9–13

    • Search Google Scholar
    • Export Citation
  • 18.

    Mohr JPPessin MSFinkelstein Set al: Broca aphasia: pathologic and clinical. Neurology 28:3113241978Mohr JP Pessin MS Finkelstein S et al: Broca aphasia: pathologic and clinical. Neurology 28:311–324 1978

    • Search Google Scholar
    • Export Citation
  • 19.

    Ojemann GOjemann JLettich Eet al: Cortical language localization in left, dominant hemisphere. An electrical stimulation mapping investigation in 117 patients. J Neurosurg 71:3163261989Ojemann G Ojemann J Lettich E et al: Cortical language localization in left dominant hemisphere. An electrical stimulation mapping investigation in 117 patients. J Neurosurg 71:316–326 1989

    • Search Google Scholar
    • Export Citation
  • 20.

    Ojemann GA: Brain organization for language from the perspective of electrical stimulation mapping. Behav Brain Sci 6:1892301983Ojemann GA: Brain organization for language from the perspective of electrical stimulation mapping. Behav Brain Sci 6:189–230 1983

    • Search Google Scholar
    • Export Citation
  • 21.

    Ojemann GA: Individual variability in cortical localization of language. J Neurosurg 50:1641691979Ojemann GA: Individual variability in cortical localization of language. J Neurosurg 50:164–169 1979

    • Search Google Scholar
    • Export Citation
  • 22.

    Ojemann GA: Surgical therapy for medically intractable epilepsy. J Neurosurg 66:4894991987Ojemann GA: Surgical therapy for medically intractable epilepsy. J Neurosurg 66:489–499 1987

    • Search Google Scholar
    • Export Citation
  • 23.

    Ojemann GAWhitaker HA: Language localization and variability. Brain Lang 6:2392601978Ojemann GA Whitaker HA: Language localization and variability. Brain Lang 6:239–260 1978

    • Search Google Scholar
    • Export Citation
  • 24.

    Olivier A: Commentary: cortical resection in Engel J Jr (ed): Surgical Treatment of the Epilepsies. New York: Raven Press1987 pp 405416Olivier A: Commentary: cortical resection in Engel J Jr (ed): Surgical Treatment of the Epilepsies. New York: Raven Press 1987 pp 405–416

    • Search Google Scholar
    • Export Citation
  • 25.

    Ormson MJKispert DBSharbrough FWet al: Cryptic structural lesions in refractory partial epilepsy: MR imaging and CT studies. Radiology 160:2152191986Ormson MJ Kispert DB Sharbrough FW et al: Cryptic structural lesions in refractory partial epilepsy: MR imaging and CT studies. Radiology 160:215–219 1986

    • Search Google Scholar
    • Export Citation
  • 26.

    Penfield WFaulk ME Jr: The insula. Further observations on its function. Brain 78:4454701955Penfield W Faulk ME Jr: The insula. Further observations on its function. Brain 78:445–470 1955

    • Search Google Scholar
    • Export Citation
  • 27.

    Rasmussen T: Commentary: Extratemporal cortical excisions and hemispherectomy in Engel J Jr (ed): Surgical Treatment of the Epilepsies. New York: Raven Press1987 pp 417424Rasmussen T: Commentary: Extratemporal cortical excisions and hemispherectomy in Engel J Jr (ed): Surgical Treatment of the Epilepsies. New York: Raven Press 1987 pp 417–424

    • Search Google Scholar
    • Export Citation
  • 28.

    Rasmussen T: Surgery of frontal lobe epilepsy. Adv Neurol 8:1972051975Rasmussen T: Surgery of frontal lobe epilepsy. Adv Neurol 8:197–205 1975

    • Search Google Scholar
    • Export Citation
  • 29.

    Rasmussen TMilner B: Clinical and surgical studies of the cerebral speech areas in man in Zülch KJCreutzfeldt OGalbraith GC (eds): Cerebral Localization. New York: Springer-Verlag1975 pp 238257Rasmussen T Milner B: Clinical and surgical studies of the cerebral speech areas in man in Zülch KJ Creutzfeldt O Galbraith GC (eds): Cerebral Localization. New York: Springer-Verlag 1975 pp 238–257

    • Search Google Scholar
    • Export Citation
  • 30.

    Spencer DDSpencer SSMattson RHet al: Intracerebral masses in patients with intractable partial epilepsy. Neurology 34:4324361984Spencer DD Spencer SS Mattson RH et al: Intracerebral masses in patients with intractable partial epilepsy. Neurology 34:432–436 1984

    • Search Google Scholar
    • Export Citation
  • 31.

    Sperling MRWilson GEngel J Jret al: Magnetic resonance imaging in intractable partial epilepsy: correlative studies. Ann Neurol 20:57621986Sperling MR Wilson G Engel J Jr et al: Magnetic resonance imaging in intractable partial epilepsy: correlative studies. Ann Neurol 20:57–62 1986

    • Search Google Scholar
    • Export Citation
  • 32.

    Zangwill OL: Excision of Broca's area without persistent aphasia in Zülch KJCreutzfeldt OGalbraith GC (eds): Cerebral Localization. New York: Springer-Verlag1975 pp 258263Zangwill OL: Excision of Broca's area without persistent aphasia in Zülch KJ Creutzfeldt O Galbraith GC (eds): Cerebral Localization. New York: Springer-Verlag 1975 pp 258–263

    • Search Google Scholar
    • Export Citation
TrendMD
Metrics

Metrics

All Time Past Year Past 30 Days
Abstract Views 100 93 4
Full Text Views 119 61 1
PDF Downloads 90 18 0
EPUB Downloads 0 0 0
PubMed
Google Scholar