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Sandeep Sood, Eishi Asano and Harry T. Chugani

Object

Preservation of the vein of Labbé is recommended to prevent temporal lobe infarction after skull base surgery. However, the importance of preserving the vein in epilepsy surgery involving resection of the temporal lobe is unclear.

Methods

Retrospective analysis was performed in 47 cases, in which patients underwent temporal lobe resection, out of 148 cases in which patients underwent surgery for intractable seizures over a 5-year period. Standard temporal lobe resection anterior to the vein of Labbé was performed in 11 patients. In 24 patients, the temporal lobe resection extended posterior to the vein of Labbé; the vein was preserved in eight patients, who underwent surgery prior to 2002, and resected in the other 16 patients, who underwent surgery after 2002. Twelve patients underwent a temporopari-etooccipital resection.

There was no significant difference in the pattern of venous anatomy (based on analysis of the relative size of veins [chi-square test, p = 0.1] and the number of superficial veins draining the temporal lobe [p = 1]) in patients in whom the vein was resected compared with those in whom it was preserved. No patient experienced postoperative infarction.

Conclusions

The authors conclude that the vein of Labbé may be safely resected in epilepsy surgery involving temporal lobe resection. The decision whether to resect the vein need not be based on the surface venous drainage pattern or number of veins draining the temporal lobe.

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Sandeep Sood, Eishi Asano and Harry T. Chugani

Object

Fever is a common occurrence after cerebral hemispherectomy in children and prolongs the hospital stay. The authors determined whether an external ventriculostomy might reduce the incidence of fever following a hemispherectomy.

Methods

The postoperative courses of 27 patients who had undergone cerebral hemispherectomy for intractable seizures were retrospectively analyzed.

Results

Thirteen children underwent an external ventriculostomy, and only 1 had an elevated axillary body temperature of ≥ 39°C during the postoperative period. Among 14 patients who did not undergo an external ventriculostomy, 7 had a posthemispherectomy fever of ≥ 39°C. Patients who underwent an external ventriculostomy had a lower risk of postoperative fever compared with those who did not undergo the procedure (8 vs 50%, respectively; p = 0.03, Fisher exact test). None of the patients had an infection accounting for the cause of the fever. The hospital stay for patients who had undergone postoperative external ventriculostomy was significantly shorter than for those who had not (7.2 ± 2 vs 11.3 ± 5 days, respectively; p = 0.01, Student t-test).

Conclusions

The use of external ventriculostomy following hemispherectomy for intractable epilepsy in children reduces the incidence of postoperative fever due to infection.

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Csaba Juhász, Amy Buth, Diane C. Chugani, William J. Kupsky, Harry T. Chugani, Aashit K. Shah and Sandeep Mittal

New-onset refractory status epilepticus (NORSE) has high morbidity and mortality. The authors describe the successful surgical treatment of a 56-year-old man presenting with NORSE. Magnetic resonance imaging showed a left temporal lobe lesion suspicious for a low-grade tumor, while PET imaging with the alpha[11C]methyl-L-tryptophan (AMT) radiotracer showed increased cortical uptake extending beyond this lesion and partly overlapping with epileptogenic cortex mapped by chronic intracranial electroencephalographic monitoring. Resection of the epileptic focus resulted in long-term seizure freedom, and the nonresected portion of the PET-documented abnormality normalized. Histopathology showed reactive gliosis and inflammatory markers in the AMT-PET–positive cortex. Molecular imaging of neuroinflammation can be instrumental in the management of NORSE by guiding placement of intracranial electrodes or assessing the extent and severity of inflammation for antiinflammatory interventions.