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Arteriovenous malformations of the medial temporal lobe

Surgical approach and neuroradiological characterization

Roberto C. Heros

T he terms “arteriovenous malformation (AVM) of the hippocampal area,” 10 “subtrigonal AVM,” 10 “anterior choroidal AVM,” 21, 27 “juxtapeduncular angioma,” 18 “juxtathalamic AVM,” 2 and “angioma of the external wall of the fissure of Bichat (hippocampal fissure)” 25 have been used to denote deep AVM's located primarily in the medial temporal lobe. The following cases illustrate the spectrum of these lesions. Case Reports Case 1 This 22-year-old right-handed man was referred to the Presbyterian-University Hospital in Pittsburgh after his fifth

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Aaron A. Cohen-Gadol and Dennis D. Spencer

strip implantation involves placement of two electrode strips perpendicular to the long axis of the temporal lobe. These two (anterior and posterior) temporobasal strips allow reasonable coverage of the basal medial temporal lobe cortex. The authors describe the use of an anteromedial strip as an alternative to provide more extensive and consistent coverage of the entorhinal cortex and parahippocampal gyrus. Surgical Indications and Technique The anteromedial strip may be used to evaluate the involvement of medial temporal lobe structures in epileptogenesis

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Woorim Jeong, Hyeongrae Lee, June Sic Kim and Chun Kee Chung

A lthough postoperative episodic memory decline is a major complication of medial temporal lobe resection (MTLR), which is the standard treatment for medically intractable medial temporal lobe epilepsy (TLE), 4 , 12 two-thirds of patients with TLE maintain stable or even improved episodic memory function within the first 1–2 years after surgery. 3 , 21 With the longstanding history of neuropsychological evaluation in epilepsy surgery programs, increasing studies are now investigating the intermediate- to long-term outcomes of memory function. 28 These studies

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Aaron A. Cohen-Gadol, Christopher C. Bradley, Anne Williamson, Jung H. Kim, Michael Westerveld, Robert B. Duckrow and Dennis D. Spencer

. Clinical Material and Methods Patient Population The epilepsy surgery database at the Yale—New Haven Medical Center was searched to find all patients who underwent temporal lobectomy between 1987 and 2002. Among the 350 patients yielded by this search, we found 12 patients whose preoperative MR images lacked evidence of hippocampal atrophy or signal changes on T 2 -weighted and fluid-attenuated inversion recovery sequences, despite the occurrence of a medial temporal lobe seizure confirmed by long-term intracranial monitoring. Two of the 12 patients had other

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M. Yashar S. Kalani, Ting Lei, Nikolay L. Martirosyan, Mark E. Oppenlander, Robert F. Spetzler and Peter Nakaji

The mesial temporal lobe can be approached via a pterional or orbitozygomatic craniotomy, the subtemporal approach, or transcortically. Alternatively, the entire mesial temporal lobe can be accessed using a lateral supracerebellar transtentorial (SCTT) approach. Here we describe the technical nuances of patient positioning, craniotomy, supracerebellar dissection, and tentorial disconnection to traverse the tentorial incisura to arrive at the posterior mesial temporal lobe for a cavernous malformation. The SCTT approach is especially useful for lesions in the dominant temporal lobe where an anterolateral approach may endanger language centers or the vein of Labbé.

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Nelly Amador and Itzhak Fried

example, the pre-SMA, SMA, premotor, parietal, and basal ganglia regions) that are active during motor performance are also active during motor imagery. 15, 17, 60 From this model of motor imagery we can infer that the same areas would be active during the execution and mental motor imagery of a motor program, except at the final output stage, at which no activation is seen during motor imagery. 17, 23, 25 A role for the medial temporal lobe, specifically the hippocampus, in sensory integration and planning for movements has been suggested in some studies. 41, 42

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Dahye Kim, June Sic Kim, Woorim Jeong, Min-Sup Shin and Chun Kee Chung

who had surgery by a single neurosurgeon (C.K.C.) were included. Finally, we included 74 patients (60.8% female; 42 left-sided surgeries) in this study. All patients underwent either a temporal pole resection with an amygdalohippocampectomy (TPR+AH) or a selective amygdalohippocampectomy (SAH). The type of surgery was randomly assigned to the patients whose epileptogenic zone was located in the medial temporal lobe determined by preoperative evaluation. In TPR+AH, the patients underwent a TPR (the average extent of the resection was 3.39 ± 0.78 cm from the temporal

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Arne Ekstrom, Nanthia Suthana, Eric Behnke, B.S.E., Noriko Salamon, Susan Bookheimer and Itzhak Fried

regions such as thalamus, subthalamic nucleus, and globus pallidus, which are important therapeutic targets for DBS. Furthermore, as our understanding of the pathophysiological origins of neurological disorders increases, future procedures for diagnosis or stimulation may be aimed at much more refined brain circuitry than are current methods, which are limited to the several-millimeter accuracy range. Conclusions Our results demonstrate that electrode localization in the medial temporal lobe can be improved using registration of high-resolution MR imaging

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Kensuke Kawai, Ichiro Suzuki, Hiroki Kurita, Masahiro Shin, Nobutaka Arai and Takaaki Kirino

accompanied by salivation and manual automatism. Examination An EEG study demonstrated interictal epileptiform discharges issuing from the patient's right anterior temporal region. An MR imaging study revealed right hippocampal sclerosis. Hippocampal volumes were 2577 mm 3 on the right side and 3373 mm 3 on the left, and hippocampal T 2 relaxation times were 153.9 msec on the right side and 125.4 msec on the left. An FDG-PET study revealed interictal hypometabolism in the right medial temporal lobe. The patient's intelligence and memory tests yielded normal

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Kris A. Smith and Robert F. Spetzler

approach to improve access to the medial temporal lobe. 6, 9 Spencer, et al. , 10 reported a modification of the standard temporal lobectomy to improve access to the middle and posterior hippocampal formation; however, this approach requires an anterolateral temporal lobectomy for access to the posteromedial temporal lobe. 7 Kelly, et al. , 5 have advocated the stereotactic computer-assisted resection of posterior temporal lesions via a posterolateral approach. All of their patients, however, suffered a postoperative visual field cut due to transection of the optic