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At least 883 records · Page 49Linked to original sources
PubMed1987

Spontaneous subdural hygromas: a complication following craniofacial surgery.

We present a case report of symptomatic, spontaneous subdural hygromas complicating craniofacial resection of a malignant skull base tumor. This complication occurs after prolonged spinal drainage instituted to prevent cerebrospinal fluid fistulas secondary to insecure dural repair. We believe that this complication may be seen repeatedly as indications for craniofacial surgery in the elderly continue to expand.

Aged↗
PubMed1998

Dipole source localization of ictal epileptiform activity.

Dipole source localization of ictal epileptiform activity recorded by scalp EEG was performed in patients prior to surgical treatment. The dipole tracing method combined with the scalp-skull-brain head model was used to locate epileptogenic foci. A digital EEG system was used for data collection. The accuracy of dipole source localization was evaluated by comparing the focus location with that obtained by chronic subdural electrocorticography. In a case of frontal lobe epilepsy with epileptogenic focus in the frontoparietal convexity, the results of dipole source localization agreed well with those obtained with chronic subdural electrocorticography. In a case of lateral temporal lobe epilepsy, the results of dipole source localization were consistent with those obtained with chronic subdural electrocorticography, but a small localization error was observed. The clinical usefulness of and suggestions for improving this method are discussed.

Adult↗
PubMed2004

A motor resonance mechanism in children? Evidence from subdural electrodes in a 36-month-old child.

The presence of a neural mechanism matching execution and observation of actions in the adult human brain is well established. In children, however, description of a resonance motor mechanism is still preliminary. In the present study, we recorded electroencephalographic signals from a subdural 64-contact grid electrode in a 36-month-old child with epilepsy. Spectral analysis was performed on sequences where the child drew with her right hand, watched an experimenter drawing with his right hand or was at rest. Contact sites corresponding to sensorimotor areas were discovered where absolute power was decreased during both observation and execution of hand/arm actions. These data suggest the presence of a mirror neuron system early in the developing brain.

Analysis of Variance↗
PubMed2002

Migration of Tc-99m DTPA from the cerebral ventricle to the subarachnoid space.

A 70-year-old woman was examined because of increasing problems with cognition. She had a history of a cerebral shunt placed surgically 10 years previously. Introduction of Tc-99m DTPA directly into the ventricular cavity revealed good ventricular distribution, followed by progression downward, as though into a previous ventriculoperitoneal shunt. However, a chest radiograph revealed what appeared to be a shunt tube in the right atrium. Delayed lateral images showed activity in proximity to the vertebral column, indicating migration of tracer and cerebrospinal fluid into the dorsal and lumbar subarachnoid space.

Aged↗
PubMed1982

Percutaneous placement of subdural catheter for measurement of intracranial pressure in small children.

Broadening indications for continuous monitoring of intracranial pressure (ICP) in neonates and small infants have created increasing interest in modalities which would permit measurement of ICP safely and accurately. Such monitoring allows rapid initiation of treatment when increased ICP is observed. Using a new technique for subdural tap, the authors inserted percutaneously a subdural catheter in 9 patients, 5 had cerebral ischemia, and 4 had CNS infection. These patients exhibited marked changes in ICP during the course of their disease, often within a short time period. Continuous monitoring made it possible to initiate treatment immediately at the onset of increased ICP. In this series, no complication related to the subdural catheter placement was observed., This technique proved to be highly accurate, effective, safe, and very easy to perform.

Brain Edema↗
PubMed1999

Indications and outcome of ictal recording with intracerebral and subdural electrodes in refractory complex partial seizures.

Intracranial electrophysiologic recording has often been used to localize ictal onset zones in presurgical evaluation of refractory complex partial seizures. Specific indications for intracranial ictal monitoring have not been analyzed in detail, however. The authors designed this study to test the utility of intracranial monitoring in specific indications and considered six specific indications for intracranial monitoring. They compared prospectively determined indications and outcomes of chronic intracerebral and subdural electrophysiologic recording in 50 consecutive patients whose ictal onset zones had been inadequately localized with interictal and ictal EEG using extracranial electrodes, magnetic resonance imaging, interictal[18F]fluorodeoxyglucose positron emission tomography, and neuropsychological testing. In 47 patients ictal onset zones were localized with intracranial recordings, leading to resections in 38 patients. Each indication for intracranial monitoring selected a group in which the majority went on to have efficacious epilepsy surgery (5-year follow-up). Definitive diagnosis of bilateral independent ictal onset zones in temporal lobe epilepsy required intracranial ictal EEG. Intracranial EEG localization supported efficacious resection in most patients, despite contradictory or nonlocalizing extracranial ictal EEG and neuroimaging abnormalities. Critical analysis of these specific indications for intracranial monitoring may be useful in multicenter evaluation of these techniques.

Brain↗
PubMedDate not supplied

Extent of ictal origin in mesial temporal sclerosis patients monitored with subdural intracranial electrodes predicts outcome.

In patients with mesiotemporal sclerosis, posterior hippocampal involvement at the ictal onset is not associated with an excellent outcome. A study confirmed that ictal onset in the posterior parahippocampal gyrus is associated with a less favorable outcome compared with ictal onset in the anterior parahippocampal gyrus in patients with mesiobasal temporal lobe epilepsy who are undergoing foramen ovale recording. The authors hypothesized that involvement of the two medial contact points of posterior basal temporal subdural (SD) strip at the ictal onset, representing ictal onset in the posterior parahippocampal gyrus, may also adversely influence the surgical outcome. With this objective, the authors assessed the incidence of posterior basal temporal SD strip (the two medial contact points) involvement at the ictal onset in patients with mesiotemporal sclerosis and determined whether presence of this finding influenced surgical outcome. Thirty-six patients with mesiotemporal sclerosis underwent a single SD grid (lateral frontotemporal) and strips (three basal temporal and one orbitosubfrontal) monitoring. Based on the earliest involvement of basal temporal strips (the two medial contact points) during the seizure, patients were classified into (1) anterior and/or middle basal temporal, or (2) posterior basal temporal (with or without involvement of anterior and/or middle basal temporal) ictal onset groups. A temporal lobectomy with adequate resection of the ictal onset zone was performed in all patients. Surgical outcome was based on Engel's classification. Six of 36 (17%) patients were classified into the posterior basal temporal ictal onset group. Only two patients from the posterior basal temporal ictal onset group experienced a good outcome compared with 26 of 30 patients from anterior and/or middle basal temporal ictal onset group (P = 0.01). In patients with mesiotemporal sclerosis who were monitored with SD electrodes, involvement of the two medial contact points of posterior basal temporal strip at the ictal onset (representing ictal onset in the posterior parahippocampal gyrus) occurred in 17% of the patients. These patients might not experience an excellent surgical outcome despite including the ictal onset zone in resection. These findings may be useful in presurgical counseling of patients with mesiotemporal sclerosis who undergo intracranial SD monitoring.

Adolescent↗
PubMedDate not supplied

Retrospective fusion of radiographic and MR data for localization of subdural electrodes.

Prior to epilepsy surgery, subdural electrodes are often implanted and monitored for a few days to identify the focus of abnormal electrical activity. During the implantation and subsequent brain resection, there may be uncertainty about the exact location of the electrodes with respect to features of brain anatomy such as specific gyral convolutions or lesions. In experiments with a phantom and patients, implanted electrodes were imaged with multiplanar skull radiographs (or CT scans). After retrospective registration with preimplantation MR data, the electrodes were mapped from these studies onto an MR-derived three-dimensional brain model. The resulting multimodality displays showed the relationship of the electrodes to brain anatomy. In one patient the position of each electrode with respect to a metabolic lesion was also displayed by mapping preimplantation PET data onto the same brain model. This new display of electrode positions may strengthen the interpretation of subdural electrical recordings and thereby reduce uncertainty in planning the resection of epileptic tissue.

Adult↗
PubMed1975

Delayed post-traumatic subdural empyema.

A case of subdural empyema is reported, treated through a frontal bone flap, with exenteration of the infected frontal sinus at operation, and subdural instillation of antibiotics for 48 hours postoperatively. Diagnostic findings are reviewed, and the likelihood of anaerobic infection this case and similar cases discussed.

Adult↗
PubMed1990

Combined use of subdural and intracerebral electrodes in preoperative evaluation of epilepsy.

For intracranial recording of partial seizures considered to originate from one of the temporal or frontal lobes, the team in the Utrecht Academic Hospital has used subdural, multicontact, flexible electrodes since 1972. These are introduced through bilateral, frontocentral trephine holes and are manipulated under fluoroscopy to cover most of the cerebral convexity. It became evident that in many patients, additional placements to record from intracerebral structures were indispensable. Therefore, using the same trephine holes, an additional 2 to 4 depth electrodes were stereotactically implanted in the mesial temporal and/or frontal structures, as appropriate. An extensive intra- and extracerebral spatial representation of the epileptogenic zone was thus obtained. We report here the methods for manufacturing and applying these electrodes and our clinical experience with 28 patients. The results obtained so far stress the value of combining subdural and depth electroencephalographic monitoring in the presurgical selection of patients suffering from medically refractory complex partial seizures. By miniaturizing the electrodes, extensive areas of the brain can be investigated without craniotomy or multiple burr holes.

Adult↗