Temporal lobe resection for intractable epilepsy: review of 11 cases

OBJECTIVE. To review the management of medically intractable epilepsy by performing temporal lobe resection. DESIGN. Retrospective study. SETTING. University teaching hospital, Hong Kong. PATIENTS. Eleven patients: seven women and four men (mean age, 28 years; range, 19-49 years) who underwent temporal lobe resection for intractable epilepsy from 1994 through 1998. MAIN OUTCOME MEASURES. Preoperative and operative aspects of treatment, postoperative complications, mortality, and seizure control before and after surgery. RESULTS. All but one patient had long-standing medically intractable temporal lobe epilepsy; the duration between the onset of seizure and surgery ranged from 12 to 27 years (mean, 17.2 years). A total of 12 resections were performed without any mortalities or major postoperative complications. After surgery, two patients became seizure-free without the need for antiepileptic medication; six patients were seizure-free but required medication; and two patients showed >90% of improvement in seizure control, whereas one patient showed between 50% and 90% of improvement. Nine (81%) of the 11 patients reported significant improvement in their social life and performance of daily activities. Two (18%) patients, including one with improved seizure control, reported no improvement in their performance of daily functions. CONCLUSIONS. Temporal lobe resection can produce significant improvements in patients who have medically intractable epilepsy. The risks of surgery are relatively small and justifiable.published_or_final_versio

Surgical treatment for Parkinson's disease

Advances in stereotactic and functional neurosurgical techniques have brought about new developments in the surgical treatment for Parkinson's disease, including methods such as ablative therapy, chronic brain stimulation, stereotactic radiosurgery and transplantation. Significant benefits can be provided for patients who have become refractory to medical therapy or developed adverse side-effects after prolonged administration of levodopa.published_or_final_versio

Combined simultaneous transcranial and transsphenoidal resection of large-to-giant pituitary adenomas

Background: While large-to-giant pituitary adenomas (PAs) may be safely removed by experienced surgeons through a single route, the procedure is technically challenging. We present the outcome of a simultaneous combined transcranial and transsphenoidal approach and discuss its applications. Methods: A retrospective review was conducted on 12 consecutive patients. Surgical complications, visual and endocrinological functions, and tumour control were reviewed. Results: There were four men and eight women, with a mean age of 47.6 years. All but one patient had non-functioning PAs. The mean tumour height was 4.1 cm (range: 2.3-5.5). The predominant presenting symptoms were visual field loss in eight patients, headache in three patients and mental confusion in one patient. There was no operative mortality. Post-operative cerebrospinal fluid leakage occurred in one patient. Five of the eight patients who presented with visual field loss achieved full recovery, and three had partial improvement. Two patients developed permanent diabetes insipidus after surgery. Panhypopituitarism occurred in one patient. Gross total removal (GTR) was achieved in five, and subtotal removal (STR) in seven patients. Seven patients received post-operative external irradiation. All patients who had GTR remained tumour-free and all those with STR had stable diseases after a mean follow-up period of 53.1 months (range: 14.1-92.1). Conclusion: The simultaneous 'above and below' approach is a safe and effective surgical strategy for large-to-giant PAs, particularly when expertise in endoscopic transsphenoidal surgery is unavailable. Its use, however, should be limited to a carefully selected group of patients, and tailored to individual user's expertise and experience. © 2011 The Author(s).published_or_final_versio

Outcome analysis of epilepsy surgery in Queen Mary Hospital

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Myxofibrosarcoma of the sphenoid sinus

Myxofibrosarcoma was originally described as the myxoid variant of malignant fibrous histiocytoma (MFH). It is uncommon in the head and neck region. We hereby report a case of myxofibrosarcoma in the sphenoid sinuses. The diagnostic and management difficulties are discussed. Close collaboration between surgeon, radiologist, histopathologist and clinical oncologist in makng accurate diagnosis and appropriate management of this rare tumour are emphasized.published_or_final_versio

Content-aware photo collage using circle packing

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Sample entropy analysis of EEG signals via artificial neural networks to model patients' consciousness level based on anesthesiologists experience.

Electroencephalogram (EEG) signals, as it can express the human brain's activities and reflect awareness, have been widely used in many research and medical equipment to build a noninvasive monitoring index to the depth of anesthesia (DOA). Bispectral (BIS) index monitor is one of the famous and important indicators for anesthesiologists primarily using EEG signals when assessing the DOA. In this study, an attempt is made to build a new indicator using EEG signals to provide a more valuable reference to the DOA for clinical researchers. The EEG signals are collected from patients under anesthetic surgery which are filtered using multivariate empirical mode decomposition (MEMD) method and analyzed using sample entropy (SampEn) analysis. The calculated signals from SampEn are utilized to train an artificial neural network (ANN) model through using expert assessment of consciousness level (EACL) which is assessed by experienced anesthesiologists as the target to train, validate, and test the ANN. The results that are achieved using the proposed system are compared to BIS index. The proposed system results show that it is not only having similar characteristic to BIS index but also more close to experienced anesthesiologists which illustrates the consciousness level and reflects the DOA successfully.This research is supported by the Center forDynamical Biomarkers and Translational Medicine, National Central University, Taiwan, which is sponsored by Ministry of Science and Technology (Grant no. MOST103-2911-I-008-001). Also, it is supported by National Chung-Shan Institute of Science & Technology in Taiwan (Grant nos. CSIST-095-V301 and CSIST-095-V302)

Long term results of Gamma Knife surgery for trigeminal neuralgia using 90 Gy distal to root entry zone protocol

Meeting Theme: Degenerative Lumbar SpineFree Paper 7OBJECT: Gamma Knife surgery (GKS) is one of the options for medically refractory trigeminal neuralgia (TN), but long term results were regarded as inferior to microvascular decompression (MVD). The authors reported the long term results of treating primary TN by GKS, using a high dose non root entry zone protocol. METHODS: 64 patients between March 1995 and June 2013 were included. Minimum follow up time was 12 months. Mean age was 62 years. Follow up duration was mean 76 months (median 61 months, range 12-210 months). Radiosurgical technique included TN frame position, 3D MRI, and one 4 mm shot delivering 90 Gy maximum at the cisternal part …published_or_final_versio

Towards zero facial palsy in management of large acoustic neuroma: combining the merits of microsurgery and radiosurgery

Free Paper 7Meeting Theme: Degenerative Lumbar SpineOBJECT: Despite advances in microsurgical techniques, complete surgical resection of large acoustic neuroma is still associated with significant morbidity related to facial palsy. By modifying the techniques of microsurgery and combined it with planned post-operative radiosurgery, the authors aimed to reduce the incidence of permanent facial nerve palsy to near zero in a prospective study. METHODS: Between 2000 and 2011, 54 large (Koo’s classification stage 4) acoustic neuromas (AN), were managed by the senior authors with planned microsurgery (MS) followed by Gamma Knife surgery (GKS). Mean tumor volume before MS was 17.6 cc (4.9 - 44.5). Mean follow up time was 70 months with minimum 3 years follow up. The authors adhered …published_or_final_versio

Paediatric Epilepsy Surgery Programme in Hong Kong: experience in Queen Mary Hospital / Duchess of Kent Children's Hospital

Poster: no. P6BACKGROUND: Surgery is a well-established treatment for adults with intractable seizures. Increasingly, infants and children are being considered for epilepsy surgery. In a growing child, epilepsy surgery has the additional benefit of aborting cognitive decline and improving development and behaviour ...published_or_final_versio