Cíl: Cílem této práce bylo vyhodnocení bezpečnosti supracerebellárního transtentoriálního přístupu na našem souboru pacientů. Jedná se o technicky náročný přístup, který jsme využili při operacích zadní a střední mediotemporální oblasti, laterálního mezencefala a posteromediálního talamu. Soubor a metodika: Jedná se vyhodnocení souboru našich 8 pacientů operovaných supracerebellárním transtentoriálním přístupem v letech 2013–2021. V jednom případě se jednalo o anaplastický astrocytom, 3× o primooperaci glioblastoma multiforme, 1× difuzního středočárového H3K27M gliomu, 1× o operaci recidivy glioblastoma multiforme, 1× o operaci nízkostupňového gliomu a jednou jsme tímto přístupem operovali akutně prokrvácený kavernom lemniskálního trigona mesencefali. Všichni naši pacienti byli operováni v poloze v polosedě. Výsledky: 30denní mortalita v našem souboru je nulová. U pacientky s difuzním středočárovým H3K27M gliomem primárně operované v neurologicky těžkém stavu jsme museli provést časnou reoperaci stejným přístupem z důvodu prokrvácení rezidua tumoru. U našeho prvního pacienta s rozsáhlým mediotemporálním anaplastickým astrocytomem jsme museli po první době časně doplnit subokcipitální přístup ke zvýšení radikality resekce, po operaci měl horní kvadrantanopsii. U jednoho pacienta došlo k ischemii okcipitálního laloku z důvodu peroperačně pozorovatelné léze arteria cerebri posterior obklopené glioblastomem. Klinicky byla po operaci přítomna hemianopsie. Závěr: Jedná se o technicky náročný, přitom ale o bezpečný přístup. U lézí postihujících mediotemporální oblast je výhodný pro její střední a zadní část, ale při resekci lze dosáhnout anteriorně až k uncu a amygdale. Předpokládanou podmínkou je precizní znalost anatomie, na našem pracovišti pro tento přístup preferujeme polohu v polosedě. Důležitá je dostatečná likvorová dekomprese vypuštěním moku z cisterna magna ze separátní durální incize a šetrná manipulace s cévními strukturami tentoriální incisury.

Aim: The aim of this work was a retrospective evaluation of the safety of the supracerebellar transtentorial approach in our patient series. It represents a technically challenging approach, which we used during surgeries of the posterior and medial mediotemporal area, lateral mesencephalon and posteromedial thalamus. Materials and methods: We evaluate the series of our 8 patients, which we operated on using the supracerebellar transtentorial approach during 2013–2021. In one case, we dealt with anaplastic astrocytoma, 3× with glioblastoma multiforme primary surgery, 1× with diffuse midline H3K27M glioma, 1× with glioblastoma multiforme recurrence surgery, 1× with low-grade glioma surgery and once we operated using this approach an acutely bleeding cavernoma of the lemniscal trigone of the mesencephalon. All our patients were operated on in a semisitting position. Results: The thirty-day mortality rate of our series is zero. In case of a patient with diffuse midline H3K27M glioma which was primarily operated on in a bad neurological condition, we had to perform early revision surgery using the same approach due to residual tumor hemorrhage. In case of our first patient with extensive mediotemporal anaplastic astrocytoma, we had to add the suboccipital approach for resection radicality increase early after the first phase of surgery; after the surgery, he had superior quadrantanopsia. In one patient’s case, ischemia of the occipital lobe occurred due to an intraoperatively visible lesion of the posterior cerebral artery inside the glioblastoma. After surgery, hemianopsia was present. Conclusion: The approach poses a technically challenging, but concurrently safe surgical trajectory. In case of the lesions affecting the mediotemporal area, it is advantageous for its medial and posterior part, but during the resection it is possible to reach as far as the uncus and amygdala. The prerequisite condition is accurate anatomical knowledge; in our department, we prefer the semisitting position for this approach. It is important to have a sufficient cerebrospinal fluid decompression by releasing the fluid from the cisterna magna from a separate dural incision and a gentle manipulation of the vascular structures of the tentorial incisura.

• Klíčová slova
• supracerebellární transteritoriální přístup,
• MeSH
• dospělí MeSH
• gliom chirurgie   MeSH
• hipokampus chirurgie   MeSH
• kraniotomie metody   MeSH
• lidé středního věku MeSH
• lidé MeSH
• mikrochirurgie * metody   MeSH
• nádory mozku * chirurgie   MeSH
• neurochirurgické výkony metody   MeSH
• spánkový lalok chirurgie   MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• kazuistiky MeSH
• práce podpořená grantem MeSH

OBJECTIVE: It is assumed that temporal lobe resection in older people is associated with worse seizure outcomes and potential postsurgical memory decline. We studied postsurgical memory development and surgical efficacy in patients over 45 years of age compared with younger patients. METHODS: We studied 88 patients (51 male and 37 female) after temporal lobe surgery, which involved hippocampal resection. The patients were evaluated before surgery and in the first (72 patients) and/or third (57 patients) postsurgical year. The Wechsler Memory Scale III test was performed to evaluate the MQ postsurgical development. Engel's classification was used to evaluate the postsurgical seizure outcome. RESULTS: The presurgical MQ (median 88) in ≥45 years age group was significantly lower than in both younger groups (median MQ = 100 for ≤30 years age group, p = 0.002; median MQ = 107 for 31-44 years age group, p = 0.002). Three years after the surgery, the MQ decreased significantly in ≤30 years age group (p = 0.012), while only non-significant MQ decline was observed in both older groups. We found no significant impact of age on the surgical outcome. CONCLUSION: Higher age at the time of surgery does not significantly increase the risk for postsurgical memory decline; however, older patients are more likely to have lowered presurgical MQ. We did not find significant differences in the impact of surgery on seizure outcome among the age groups. Epilepsy surgery appears to be a safe and effective method in the age over 45 years even though an earlier surgery should be preferred.

• MeSH
• dospělí MeSH
• epilepsie temporálního laloku diagnóza   psychologie   chirurgie   MeSH
• hipokampus chirurgie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• mladý dospělý MeSH
• následné studie MeSH
• neurochirurgické výkony škodlivé účinky   psychologie   trendy   MeSH
• paměť fyziologie   MeSH
• poruchy paměti diagnóza   psychologie   MeSH
• předoperační péče metody   psychologie   MeSH
• prospektivní studie MeSH
• senioři MeSH
• spánkový lalok chirurgie   MeSH
• výsledek terapie MeSH
• Wechslerovy škály MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• mladý dospělý MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

OBJECTIVE: The extreme lateral supracerebellar infratentorial (ELSI) approach has the potential to access several distinct anatomical regions that are otherwise difficult to reach. We have illustrated the surgical anatomy through cadaveric dissections and provided an extensive review of the literature to highlight the versatility of this approach, its limits, and comparisons with alternative approaches. METHODS: The surgical anatomy of the ELSI has been described using 1 adult-injected cadaveric head. Formalized noninjected brain specimens were also dissected to describe the brain parenchymal anatomy of the region. An extensive review of the literature was performed according to each targeted anatomical region. Illustrative cases are also presented. RESULTS: The ELSI approach allows for wide exposure of the middle and posterolateral incisural spaces with direct access to centrally located intra-axial structures such as the splenium, pulvinar, brainstem, and mesial temporal lobe. In addition, for skull base extra-axial tumors such as petroclival meningiomas, the ELSI approach represents a rapid and adequate method of access without the use of extensive skull base approaches. CONCLUSIONS: The ELSI approach represents one of the most versatile approaches with respect to its ability to address several anatomical regions centered at the posterior and middle incisural spaces. For intra-axial pathologies, the approach allows for access to the central core of the brain with several advantages compared with alternate approaches that frequently involve significant brain retraction and cortical incisions. In specific cases of skull base lesions, the ELSI approach is an elegant alternative to traditionally used skull base approaches, thereby avoiding approach-related morbidity.

• MeSH
• disekce MeSH
• dura mater anatomie a histologie   MeSH
• hluboké zádové svaly anatomie a histologie   chirurgie   MeSH
• lidé MeSH
• mozeček anatomie a histologie   MeSH
• mozkový kmen anatomie a histologie   chirurgie   MeSH
• mrtvola MeSH
• neurochirurgické výkony metody   MeSH
• pulvinar anatomie a histologie   chirurgie   MeSH
• skalní kost anatomie a histologie   chirurgie   MeSH
• spánkový lalok anatomie a histologie   chirurgie   MeSH
• thalamus anatomie a histologie   chirurgie   MeSH
• zadní jáma lební anatomie a histologie   chirurgie   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• přehledy MeSH

PURPOSE: The purpose of the study was to evaluate cerebral morphological changes in temporal lobe epilepsy with hippocampal sclerosis (TLE-HS) and their relationship to the cerebellum. METHODS: The study cohort included 21 patients with intractable TLE-HS (14 left-sided, 7 right-sided) and 38 healthy controls (HC). All patients later underwent anteromedial temporal lobe resection. All subjects were examined using a 1.5-T magnetic resonance imaging (MRI). Volumes of distinct cerebral and cerebellar structures were measured using voxel-based morphometry. The structural covariance of temporal lobe structures, insula, and thalamus with cerebellar substructures was examined using partial least squares regression. RESULTS: Morphological changes were more significant in the group with left TLE-HS when comparing left-sided with right-sided structures as well as when comparing patients with controls. The gray matter volume (GMV) of the temporal lobe structures was smaller ipsilaterally to the seizure onset side in most cases. There was a significant amygdala enlargement contralateral to the side of hippocampal sclerosis in both patients with right and left TLE-HS as compared with controls. Selected vermian structures in patients with left but not right TLE-HS had significantly larger GMV than the identical substructures in controls. The structural covariance differed significantly between patients with left and right TLE-HS as compared with HC. The analysis revealed significant negative covariance between anterior vermis and mesial temporal structures in the group with left TLE-HS. No significance was observed for the group with right TLE-HS. CONCLUSION: There is significant asymmetry in the GMV of cerebral and cerebellar structures in patients with TLE-HS. Morphological changes are distinctly more pronounced in patients with left TLE-HS. The observed structural covariance between the cerebellum and supratentorial structures in TLE-HS suggests associations beyond the mesial temporal lobe structures and thalamus.

• MeSH
• dospělí MeSH
• epilepsie temporálního laloku diagnostické zobrazování   chirurgie   MeSH
• hipokampus diagnostické zobrazování   MeSH
• kohortové studie MeSH
• lidé středního věku MeSH
• lidé MeSH
• magnetická rezonanční tomografie metody   MeSH
• mladiství MeSH
• mladý dospělý MeSH
• mozeček diagnostické zobrazování   MeSH
• mozková kůra diagnostické zobrazování   MeSH
• šedá hmota diagnostické zobrazování   MeSH
• skleróza diagnostické zobrazování   chirurgie   MeSH
• spánkový lalok diagnostické zobrazování   chirurgie   MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• mladý dospělý MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH

This study evaluated language organization in children with intractable epilepsy caused by temporal lobe focal cortical dysplasia (FCD) alone or dual pathology (temporal lobe FCD and hippocampal sclerosis, HS). We analyzed clinical, neurological, fMRI, neuropsychological, and histopathologic data in 46 pediatric patients with temporal lobe lesions who underwent excisional epilepsy surgery. The frequency of atypical language representation was similar in both groups, but children with dual pathology were more likely to be left-handed. Atypical receptive language cortex correlated with lower intellectual capacity, verbal abstract conceptualization, receptive language abilities, verbal working memory, and a history of status epilepticus but did not correlate with higher seizure frequency or early seizure onset. Histopathologic substrate had only a minor influence on neuropsychological status. Greater verbal comprehension deficits were noted in children with atypical receptive language representation, a risk factor for cognitive morbidity.

• MeSH
• dítě MeSH
• epilepsie temporálního laloku diagnostické zobrazování   psychologie   chirurgie   MeSH
• jazyk (prostředek komunikace) * MeSH
• krátkodobá paměť fyziologie   MeSH
• lidé MeSH
• magnetická rezonanční tomografie metody   MeSH
• mladiství MeSH
• mladý dospělý MeSH
• mozková kůra diagnostické zobrazování   fyziologie   chirurgie   MeSH
• předškolní dítě MeSH
• refrakterní epilepsie diagnostické zobrazování   psychologie   chirurgie   MeSH
• spánkový lalok diagnostické zobrazování   fyziologie   chirurgie   MeSH
• Check Tag
• dítě MeSH
• lidé MeSH
• mladiství MeSH
• mladý dospělý MeSH
• mužské pohlaví MeSH
• předškolní dítě MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

BACKGROUND: To review our experience with morphological developments during the long-term follow-up of patients treated by Gamma Knife radiosurgery for mesial temporal lobe epilepsy. METHOD: Between 1995 and 1999, we treated 14 patients with marginal doses of 24 Gy (n = 6) and 18-20 Gy (n = 8). Nine of these were operated on for insufficient seizure control. We reviewed seizure outcome and magnetic resonance images in both operated and unoperated patients and also re-examined histopathology specimens. RESULTS: Of the nine operated patients, two were Engel IIIA, one was IVA, five were IVB, and one was Engel IVC prior to surgery. At their final visit, five cases had become Engel class IA, one patient was ID, and two were IIC. In one patient the follow-up was not long enough for classification. Of the five unoperated patients, one was Engel class IB, one was IIIA, one IIB and one IVB at their final visit. Radionecrosis developed in 11 patients, occurring more often and earlier in those treated with higher doses. Collateral edema reached outside the temporal lobe in six patients, caused uncal herniation in two and intracranial hypertension in three. During longer follow-up, postnecrotic pseudocysts developed in 9 patients, and postcontrast enhancement persisted for 2.5-16 years after GKRS in all 14 patients. In five of them we detected its progression between 2 and 16 years after treatment. Signs of neoangiogenesis were found in two patients and microbleeds could be seen in five. Histopathology revealed blood vessel proliferation and macrophage infiltration. CONCLUSIONS: Early delayed complications and morphological signs suggesting a risk of development of late delayed complications are frequent after radiosurgery for mesial temporal lobe epilepsy. Together with its unproven antiseizure efficacy, these issues should be taken into account when planning future studies of this method.

• MeSH
• dítě MeSH
• dospělí MeSH
• epilepsie temporálního laloku chirurgie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• magnetická rezonanční tomografie MeSH
• mladiství MeSH
• radiochirurgie škodlivé účinky   MeSH
• spánkový lalok patologie   chirurgie   MeSH
• Check Tag
• dítě MeSH
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH

BACKGROUND: Surgical therapy of intractable mesial temporal lobe epilepsy (MTLE) is an effective and well-established treatment. OBJECTIVES: We compared two different surgical approaches, standard microsurgical anterior temporal resection (ATL) and stereotactic radiofrequency amygdalohippocampectomy (SAHE) for MTLE, with respect to the extent of resection or destruction, clinical outcomes, and complications. MATERIAL AND METHODS: 75 MTLE patients were included: 41 treated by SAHE (11 right sided, 30 left sided) and 34 treated by ATL (21 right sided, 13 left sided). RESULTS: SAHE and ATL seizure control were comparable (Engel I in 75.6 and 76.5% 2 years after surgery and 79.3 and 76.5% 5 years after procedures, respectively). The neuropsychological results of SAHE patients were better than in ATL. In SAHE patients, no memory deficit was found. Hippocampal (60.6 ± 18.7%) and amygdalar (50.3 ± 21.9%) volume reduction by SAHE was significantly lower than by ATL (86.0 ± 12.7% and 80.2 ± 20.9%, respectively). The overall rate of surgical nonsilent complications without permanent neurological deficit after ATL was 11.8%, and another 8.8% silent infarctions were found on MRI. The rate of clinically manifest complications after SAHE was 4.9%. The rate of visual field defects after SAHE was expectably less frequent than after ATL. CONCLUSION: Seizure control by SAHE was comparable to ATL. However, SAHE was safer with better neuropsychological results.

• MeSH
• dospělí MeSH
• epilepsie temporálního laloku psychologie   chirurgie   MeSH
• inteligence fyziologie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• neuropsychologické testy MeSH
• paměť fyziologie   MeSH
• retrospektivní studie MeSH
• spánkový lalok chirurgie   MeSH
• výsledek terapie MeSH
• záchvaty psychologie   chirurgie   MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

V krátkém sdělení prezentujeme kazuistiku 64letého pacienta s gliomem celé délky mediobazální temporální oblasti vpravo. Pro jeho resekci jsme zvolili paramediánní supracerebellární‑transtentoriální přístup, který jsme museli doplnit minimálně invazivním subokcipitálním přístupem. Popisujeme anatomický aspekt, chirurgické detaily a limity tohoto elegantního přístupu k mediobazální temporální oblasti, častému cíli onkoneurochirurgických a epileptochirurgických výkonů.

In a short communication, we describe a case of a 64 years old patient suffering from glioma of the entire length of the mediobasal temporal area of the right hemisphere. For its resection, we have selected paramedian supracerebellar-transtentorial approach that had to be supplemented with the minimally invasive suboccipital approach. We discuss an anatomical aspect, surgical details and limits of this elegant approach to the mediobasal temporal area, the frequent target of cancer and epilepsy surgeries. Key words: brain glioma – epilepsy – hippocampus – temporal lobe The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study. The Editorial Board declares that the manu­script met the ICMJE “uniform requirements” for biomedical papers.

• MeSH
• dura mater chirurgie   MeSH
• gliom * chirurgie   MeSH
• hipokampus * chirurgie   MeSH
• kraniotomie metody   MeSH
• lidé středního věku MeSH
• lidé MeSH
• mikrochirurgie metody   MeSH
• mozek anatomie a histologie   MeSH
• nádory mozku * chirurgie   MeSH
• neurochirurgické výkony * metody   MeSH
• postura těla MeSH
• spánkový lalok * chirurgie   MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• Publikační typ
• kazuistiky MeSH
• práce podpořená grantem MeSH

The aim of this retrospective study was to analyze invasive EEG findings, histopathology, and postoperative outcomes in patients with MRI-negative, PET-positive temporal lobe epilepsy (TLE) (MRI-/PET+TLE) who had undergone epilepsy surgery. We identified 20 patients with MRI-/PET+TLE (8.4% of all patients with TLE who had undergone surgery; 11 men, 9 women). Of the 20 patients, 16 underwent invasive EEG. The temporal pole and hippocampus were involved in the seizure onset zone in 62.5% of the patients. We did not identify a lateral temporal or extratemporal seizure onset in any patient. Of the 20 patients, 17 had follow-up periods >1 year (mean follow-up=3.3 years). At the final follow-up, 70.6% patients were classified as Engel I, 5.8% of patients as Engel II, and 11.8% of patients as Engel III and IV (11.8%). Histopathological evaluation showed no structural pathology in any resected hippocampus in 58% of all evaluated temporal poles. The most common pathology of the temporal pole was focal cortical dysplasia type IA or IB. MRI-/PET+TLE should be delineated from other "nonlesional TLE." The ictal onset in these patients was in each case in the temporal pole or hippocampus, rather than in the lateral temporal neocortex. Standard surgery produced a good postoperative outcome, comparable to that for patients with lesional TLE. Histopathological findings were limited: the most common pathology was focal cortical dysplasia type I.

• MeSH
• dospělí MeSH
• epilepsie temporálního laloku diagnóza   chirurgie   MeSH
• fluorodeoxyglukosa F18 diagnostické užití   MeSH
• lidé středního věku MeSH
• lidé MeSH
• longitudinální studie MeSH
• magnetická rezonanční tomografie metody   MeSH
• mladý dospělý MeSH
• neurochirurgie metody   MeSH
• pozitronová emisní tomografie metody   MeSH
• retrospektivní studie MeSH
• spánkový lalok patologie   chirurgie   MeSH
• výsledek terapie MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladý dospělý MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH

High-frequency activity has been described as having a role in the initiation of epileptic seizures. The case of a patient with refractory bitemporal epilepsy is presented. Extraoperative monitoring with depth and subdural electrodes revealed an ictal pattern with a build-up of high-frequency (> 80 Hz) activity originating in the cortex, with spread to both hippocampi. This observation was only revealed with the use of high-pass filtering, and represented crucial information that significantly influenced the decision about the side, localization and extent of resection. Removal of the cortex generating high-frequency activity, led to cessation of seizures in this patient. Current knowledge about the role of high-frequency activity and the case presented here support the importance of recording with equipment capable of detecting fast activity during the presurgical invasive monitoring. An active search for a high-frequency seizure onset zone in patients with structurally-unaffected hippocampi may improve the outcome beyond that possible with conventional bandwidth, invasive EEG recordings.

• MeSH
• elektroencefalografie MeSH
• epilepsie temporálního laloku chirurgie   patofyziologie   patologie   MeSH
• hipokampus patofyziologie   patologie   MeSH
• implantované elektrody MeSH
• lidé středního věku MeSH
• lidé MeSH
• magnetická rezonanční tomografie MeSH
• mozková kůra patofyziologie   patologie   MeSH
• neurochirurgické výkony MeSH
• pozitronová emisní tomografie MeSH
• spánkový lalok chirurgie   patofyziologie   patologie   MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• ženské pohlaví MeSH
• Publikační typ
• kazuistiky MeSH
• práce podpořená grantem MeSH