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Valeri Borger, Motaz Hamed, Julia Taube, Gülsah Aydin, Inja Ilic, Matthias Schneider, Patrick Schuss, Erdem Güresir, Albert Becker, Christoph Helmstaedter, Christian E. Elger, and Hartmut Vatter

preserved specimens by local neuropathologists. The histopathological findings were differentiated into three categories. First were hippocampal pathologies such as hippocampal sclerosis (HS) or hippocampal gliosis (HG) according to the International League Against Epilepsy (ILAE) classification. 8 Next were pathologies within the temporal lobe without the involvement of the hippocampus, such as gliosis, ganglioglioma, cavernoma, and focal cortical dysplasia (FCD). The diagnosis of HG was histologically confirmed as reactive astrogliosis without neuronal loss within the

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Maria T. Toczek, Martha J. Morrell, Gerald A. Silverberg, and Gina M. Lowe

including the hippocampus and amygdala. Surgery was without complications. Histological findings were consistent with hippocampal gliosis. At the end of the operation, a No. 7 Jackson—Pratt drain was placed in the patient's epidural space and attached to bulb suction. Approximately 6 hours after surgery, a total of 460 ml 3 of fluid was drained. An additional 65 ml 3 was drained overnight, and the Jackson—Pratt drain was removed the next morning. Postoperative Course Postoperatively, the patient was without seizures and his MAP was within normal limits. On the

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Karen L. Skjei, Ephraim W. Church, Brian N. Harding, Mariarita Santi, Katherine D. Holland-Bouley, Robert R. Clancy, Brenda E. Porter, Gregory G. Heuer, and Eric D. Marsh

mutations were shown to have abnormal cortical histopathology that was similar to or more extensive than that seen in our series. 13 , 15 , 18 Two of the 3 revealed excessive neurons in the white matter, 13 , 18 similar to that described herein in addition to irregularities in the laminar structure of the cerebellum and cortex in one patient 18 and polymicrogyria and hippocampal gliosis/calcification in the other. 13 A third patient with an SCN1A duplication resulting in a frame shift revealed multifocal micronodular dysplasia of the left temporal cortex and

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Daniel L. Silbergeld and John W. Miller

shown, with the medial contact numbered 1 and the most lateral 4. These recordings demonstrate electrical seizure onset from the medial subtemporal region. Operation and Postoperative Course . The patient underwent a left temporal lobectomy under general anesthesia, with resection of 3 cm of lateral (neocortical) tissue and 2 cm of mesial (allocortical) tissue. Histopathological evaluation showed hippocampal gliosis and neuronal dropout. One month after resection, the patient had a brief seizure with speech arrest but without amnesia. He has been seizure-free in

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Kristian Aquilina, Dave F. Clarke, James W. Wheless, and Frederick A. Boop

the amygdala supports the possibility that these encephaloceles were also congenital. In our patient the relationship of the temporal microencephaloceles to the pathological findings of hippocampal gliosis and amygdala microdysgenesis, or the more diffuse temporal gliotic changes, is unclear. Subdural electrodes demonstrated that, during seizures, anterior temporal activity along the inferior and middle temporal gyri, closely located to the microencephaloceles, preceded changes along the anterior and posterior mesial structures. This suggests that the histological

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Kostas N. Fountas, Ioannis Tsougos, Efstathios D. Gotsis, Stylianos Giannakodimos, Joseph R. Smith, and Eftychia Z. Kapsalaki

/Cho, NAA/Cr, NAA/Cho+Cr are calculated in the vast majority of temporal epilepsy cases. 2 , 4 , 5 , 8 , 11 , 13 , 20 Furthermore, the concentrations of inhibitory and excitatory neurotransmitters such as GABA and glutamate plus glutamine (GLX) have been used in a limited number of epilepsy cases of temporal origin. 24 There is a general consensus that proton MRS of the hippocampus in patients with MTS demonstrates decreased concentrations of NAA as a result of hippocampal gliosis and neuronal loss. 17 , 18 On the contrary, concentrations of Cho and Cr are increased

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Pathology of temporal lobectomy for refractory seizures in children

Review of 20 cases including some unique malformative lesions

Venita Jay, Laurence E. Becker, Hiroshi Otsubo, Paul A. Hwang, Harold J. Hoffman, and Derek Harwood-Nash

quotient greater than 70. In contrast, our series included 20 consecutively treated children with refractory complex partial seizures who were considered for epilepsy surgery, most of whom had radiologically identified focal lesions. The precise mechanisms responsible for this selective neuronal loss in the hippocampus remain unknown; however, one of the recognized associations is febrile seizures in childhood. 6 The pattern of neuronal loss is different from that seen in hypoglycemic or hypoxic/ischemic injury. Bilateral but usually asymmetrical hippocampal gliosis

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James L. Leach, Reem Awwad, Hansel M. Greiner, Jennifer J. Vannest, Lili Miles, and Francesco T. Mangano

, there was a significant correlation of the total MTL score (combined score of both temporal lobes) and outcome with 79% (19/24) of patients with good outcome having an MTL score of at least 1 versus 42% (8/19) of patients with a poor outcome (p = 0.02). Pathology of HIMAL Of the 4 patients in which a malrotated hippocampus was resected, 2 had hippocampal sclerosis (hippocampal gliosis and neuronal loss in the cornu ammonis 1 (CA1) and CA2 regions of Ammon's horn) with no evidence of frank dysplasia within the hippocampus (one had adjacent Type I CD in the

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Aaron A. Cohen-Gadol, Brian G. Wilhelmi, Frederic Collignon, J. Bradley White, Jeffrey W. Britton, Denise M. Cambier, Teresa J. H. Christianson, W. Richard Marsh, Fredric B. Meyer, and Gregory D. Cascino

. Patients with gliosis had a more satisfactory outcome than those in whom pathological findings were normal; however, the proportion of those with freedom from seizures continued to decline after their 1st surgical anniversary. Because histopathological classification of MTS was used at our institution in 1992, patients who underwent ATL for MTS before this date were categorized as having hippocampal gliosis, and a minority of them underwent partial hippocampectomy. These patients subsequently presented with seizure recurrence and underwent repeated imaging and a more