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Focal Epilepsy of Psychomotor Type

A Preliminary Report of Observations on Effects of Surgical Therapy

John R. Green, R. E. H. Duisberg and William B. McGrath

assembly (Grass-Gibbs) is fixed to the calvarium, and accessible cortex is covered with the wick electrodes. The electrode placements are recorded. Recordings are made at varying depths of anesthesia and over the entire area. (B) Depth electrode (Grass-Bailey) studies are then made, through the focus, if found, synchronously with the cortical studies. When accurate localization of the electrographic focus has been obtained, surgical removal is carried out, if feasible. (5) Anterior Temporal Lobectomy . This procedure is carried out by means of subpial

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Howard Freedman

the possibility of amputating the swollen temporal lobe, the medial aspect of which had herniated through the tentorial incisura. In effect, this was carried out in 1 patient of this series who suffered a contusion and dissolution of a temporal lobe as a result of trauma. In this instance, as a procedure of desperation, the pulpified temporal lobe was aspirated and irrigated out through two ventricular cannulas. In retrospect, it would probably have been a more sound surgical procedure if an open craniotomy had been done and the temporal lobectomy performed under

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S. Obrador

neurosurgical treatment has emerged from the recent development of electroencephalographic techniques. There are 10 examples in our series: 8 patients with psychomotor epilepsy treated by anterior temporal lobectomy and 2 patients on whom we tried the effect of stereotaxic lesions of the thalamus. The histories of the first 7 patients with psychomotor epilepsy have already been reported 8 and the results are in agreement with the larger experience of Bailey and Gibbs 1 and Green and coworkers. 5 The patients with psychomotor epilepsy were young, from 22 to 38 years old

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W. B. Scoville

, we have been embarked on a study of the limbic area in man, which, as you know, includes the rhinencephalon, the anterior cingulate, and posterior orbital cortices. We have isolated, by the “undercutting” technique, the anterior cingulate gyrus and the posterior orbital cortex in a series of fractional lobotomies performed on schizophrenic and neurotic patients. More recently, we have both stimulated and resected bilaterally various portions of the rhinencephalon in carrying out medial temporal lobectomies on schizophrenic patients and certain epileptic patients. I

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J. Lawrence Pool

the ventral margin. As the posterior margin was completed the patient suddenly exclaimed: “Oh, doctor, my bowels are moving, my bowels are moving and I'm trying to stop them but I can't. I'm terribly sorry—I apologize, but I just can't help it.” A large stool was evacuated at this juncture. Course . Following operation she was never incontinent of either urine or feces. The left extremities were temporarily weak, though never paralyzed. Improvement in rigidity was only transitory. 2. Bilateral Anteromedial Temporal Lobectomy: Abnormal oral or “feeding

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J. P. Segundo, E. Balea and R. Arana

procedures (5 cases), by operation (34 cases) or by autopsy (4 cases). Most of these patients had tumors (34 cases) but 3 had hydatid cysts, 1 a giant and partially thrombosed aneurysm of the temporal fossa, 1 a spontaneous intracerebral hematoma, 2 platybasia with modifications of the cervical vertebrae, and 2 cervical spinal cord traumatic injuries. Group II consisted of 7 leucotomized schizophrenics, 2 cingulectomized idiots, and a patient who, because of a large oligodendroglioma, was subjected to a right temporal lobectomy; this patient was included in Group II

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E. H. Botterell, W. M. Lougheed, J. W. Scott and S. L. Vandewater

no sensory deficit. He is doing odd jobs on a farm. Comment The full advantage of hypothermia was not utilized as the vertebrals were not occluded. This made the elimination of the aneurysm more difficult. It appears that spasm of the internal carotid arterial tree recurred postoperatively with the development of a limited and as yet undefined amount of cerebral softening. A fair result to date. Case 23 . Recurrent subarachnoid haemorrhage; aneurysm of left middle cerebral artery. Clipping of neck of aneurysm: left anterior temporal lobectomy: hypothermia

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Norman H. Horwitz and Rembrandt H. Dunsmore

opening the dura mater the brain was very tense and edematous but no clot was seen. An inferior right temporal lobectomy was performed followed by incision of the tentorium. This procedure was followed by a gush of normal spinal fluid from the region of the incisura. The 3rd nerve was seen to be lying freely. At the end of the procedure the brain was pulsating well. Postoperative Course . The right pupil became reactive and less dilated. On July 27, 1955 he was speaking well. The pupils were equal and reactive. The left hemiparesis showed gradual improvement. By

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John F. Kendrick and Frederic A. Gibbs

do not occur with either unilateral temporal lobectomy or limited bilateral anterior temporal lobectomy in man, 3, 4, 11, 14–16 but comparable disturbances have been reported by Terzian and Dalle Ore 36 and Petit-Dutaillis et al. 30 in cases of bitemporal lobectomy. Heath et al. 37 have observed epileptiform discharges in the depths of the frontal lobes in the “septal” region and also to a lesser extent in the hippocampus of patients with psychosis unassociated with epilepsy. As will be reported in a later part of this paper, we obtained spike discharges

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J. Lawrence Pool and Laibe A. Kessler

the scalp incision was infiltrated locally with 1 per cent procaine or Novocain in all 40 cases. The 3 patients operated upon under local anesthesia alone were given additional Demerol by vein from time to time throughout the procedure to render them drowsy but not incapable of response. In one a posterior rhizotomy for tic douloureux was performed; in another, a subtotal temporal lobectomy for psychomotor epilepsy, while in the third no anesthesia other than local Novocain was given until exposure of a bleeding aneurysm of the internal carotid artery was