OBJECTIVE: The objective of this study was to evaluate the role of resective pediatric epilepsy surgery for Lennox-Gastaut syndrome (LGS). METHODS: We analyzed clinical data of 27 children and adolescents who had LGS and underwent resective epilepsy surgery despite abundant (>30% of preoperative interictal and/or ictal epileptiform discharges) generalized or generalized contralateral maximal and multiregional electroencephalogram abnormalities. RESULTS: On high-resolution MRI, cerebral lesions were noted in 23 (85.2%) patients but not in 4 (14.8%) patients. The age of patients at the time of surgery was between 1.7 and 17.3 years (mean: 7.8 years). Surgeries were lobar or multilobar resection in 21 (77.8%) patients and hemispherotomy in 6 (22.2%). At a mean of 33.1 months9 postoperative follow-up, 16 (59.3%) patients had no seizures and 4 (14.8%) had infrequent seizures. Of 4 patients without brain abnormalities found on MRI, 2 patients became seizure-free after resective surgery was performed on the basis of electrophysiologic studies and concordant results in other multimodal neuroimages. Malformation of cortical development was the most common pathology and was seen in 20 (74.1%) patients, but 2 (7.4% patients) did not show any abnormal pathology. Sixteen (72.7%) patients, including 14 who had no seizures and 2 who had infrequent seizures after surgery, showed an increase in developmental quotient. No clinical profile was significantly associated with postoperative seizure-free rate. CONCLUSIONS: Resective epilepsy surgery should be considered for children with LGS, despite abundant generalized and multiregional electroencephalogram abnormalities.

Resective pediatric epilepsy surgery in Lennox-Gastaut syndrome.

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Advances in magnetic resonance.

BACKGROUND AND PURPOSE: Diffusion tensor imaging (DTI) will show abnormal fractional anisotropy (FA) in the normal-appearing brain after prophylactic cranial irradiation (PCI). These abnormalities will be more accentuated in patients with underlying vascular risk factors.

MATERIALS AND METHODS: A prospective study by use of DTI and conventional T2-weighted MR images was performed with a 1.5T unit with 16 patients with small cell lung cancer and undergoing PCI. All of the T2-weighted images were evaluated with respect to abnormalities in signal intensity of white matter as markers of radiation damage. Measurements of FA were performed before, at the end of, and 6 weeks after radiation therapy. On the FA maps, the bifrontal white matter, the corona radiata, the cerebellum, and the brain stem were evaluated. FA values were compared with respect to age, demographic, and vascular risk factors. Statistical analyses (Friedman test, Wilcoxon test, and Mann-Whitney U test) were performed.

RESULTS: Fractional anisotropy decreased significantly in supratentorial and infratentorial normal-appearing white matter from the beginning to the end of PCI ( P < .01). A further decline in FA occurred 6 weeks after irradiation ( P < .05). A stronger reduction in FA was observed in patients with more than 1 vascular risk factor. There was an age-related reduction of white matter FA. Patients 65 years and older showed a trend toward a stronger reduction in FA.

CONCLUSION: During the acute phase, after PCI, patients with many vascular risk factors showed stronger damage in the white matter compared with patients with only 1 risk factor.

http://www.ajnr.org/content/ajnr/29/2/379.full.pdf

Diffusion tensor imaging screening of radiation-induced changes in the white matter after prophylactic cranial irradiation of patients with small cell lung cancer: first results of a prospective study.

Object The authors report on the use of stereoelectroencephalography (stereo-EEG) in the presurgical electroclinical evaluation of infants and very young children with focal drug-resistant epilepsy. Methods Fifteen patients (9 girls and 6 boys, mean age 34.1 ± 7.3 months, range 21–45 months), potentially candidates to receive surgical treatment for their focal drug-resistant epilepsy, were evaluated using stereo-EEG recording for a detailed definition of the epileptogenic zone. Stereoelectroencephalography was indicated because neuroradiological (brain MRI) and video-EEG data failed to adequately localize the epileptogenic zone. Stereotactic placement of multicontact intracerebral electrodes was preceded by the acquisition of all pertinent anatomical information from structural and functional MRI and from brain angiography, enabling the accurate targeting of desired structures through avascular trajectories. Stereoelectroencephalography monitoring attempted to record habitual seizures; electrical stimulat...

Stereoelectroencephalography in the presurgical evaluation of focal epilepsy in infancy and early childhood.

The structures of polydisulfide-based biodegradable macromolecular Gd(III) complexes were modified to improve their in vivo retention time and MRI contrast enhancement. Steric hindrance was introduced around the disulfide bonds to control their access to free thiols in order to alter the degradation rate of the copolymers. Two new macromolecular agents, (Gd-DTPA)-cystine copolymers (GDCP) and (Gd-DTPA)-cystine diethyl ester copolymers (GDCEP), were prepared. Both agents were readily degraded in vitro and in vivo by the disulfide-thiol exchange reaction, but at a slow rate. The introduction of COOH and COOEt groups slowed down the degradation of the copolymers in the incubation with 15 μM cysteine. Metabolic degradation products were identified by matrix-assisted laser desorption/ionization time-of-flight (MALDI-TOF) mass spectrometry in the urine samples from rats injected with the agents. The T1 relaxivity (r1) was 5.43 mM−1s−1 for GDCP, and 5.86 mM−1s−1 for GDCEP, respectively, at 3T. MRI contrast enhancement of both agents was studied in nude mice bearing MDA-BM-231 human breast carcinoma xenografts, on a Siemens Trio 3T scanner. The modified agents resulted in more significant contrast enhancement in the blood pool and tumor periphery than (Gd-DTPA)-cystamine copolymers (GDCC) and a low-molecular-weight control agent, Gd-(DTPA-BMA), at a dose of 0.1 mmol-Gd/kg. The results demonstrate that the structural modification of the biodegradable macromolecular Gd(III) complexes resulted in a relatively slow degradation of the macromolecules and significantly improved in vivo contrast enhancement. The modified agents show promise for use in investigations of blood pool and cancer by contrast-enhanced (CE) MRI. Magn Reson Med 53:835–842, 2005. © 2005 Wiley-Liss, Inc.

Contrast-enhanced MRI with new biodegradable macromolecular Gd(III) complexes in tumor-bearing mice.

Rationale and Objectives:To compare enhancement patterns of gadomer-17 with those of gadopentetate dimeglumine in VX2 carcinomas after irradiation on rabbits.Methods:Twelve rabbits with VX2 carcinoma in the thigh underwent dynamic contrast-enhanced magnetic resonance (MR) imaging with gadopentetate

Dynamic contrast-enhanced MR imaging of VX2 carcinomas after X-irradiation in rabbits: comparison of gadopentetate dimeglumine and a macromolecular contrast agent.

The aim of this study was to reveal the clinical and encephalographic (EEG) features of infantile spasms (IS) with malformations of cortical development (MCDs). The clinical features, EEG findings, neuroimaging studies and outcomes of various therapeutic modalities for 27 patients with IS and MCDs were reviewed. Background activities of EEG on the MCDs, i.e. asymmetric hypsarrhythmia, localized persistent polymorphic slowing, asymmetric slowing and diffuse fast activities, were shown in 22, 15, 9 and 2 patients, respectively. Partial epileptiform discharges such as localized paroxysmal fast activities, spindle-shaped fast activities and subclinical seizures were shown in 15, 8 and 10 patients, respectively, and the lateralized prominence of generalized paroxysmal fast activities and generalized sharp and wave discharges in 4 and 5 patients, respectively. MCDs were suspected in 5 patients, as revealed by EEG and/or functional neuroimagings without distinct magnetic resonance imaging lesions, and confirmed by pathologic findings. Of the 11 patients treated with surgical resection, 8 became seizure free. EEG features can be very useful in the identification of underlying cortical dysgenesis in patients with IS. However, in one patient who underwent epilepsy surgery in early infancy, we observed easy bleeding and difficult hemostasis from friable vascular and parenchymal tissues. Various EEG features can be very useful in screening underlying MCDs. In addition, epilepsy surgery can be an effective therapeutic modality in many patients with otherwise medically intractable IS with MCDs. However, surgical intervention in extremely young infants should be performed with caution.

Clinical and electroencephalographic features of infantile spasms associated with malformations of cortical development.

Bifid inferior nasal turbinates—two inferior turbinates with a single root observed in the nasal cavity—are an extremely rare anatomical variation, especially when they are observed bilaterally and exist with other variations. We report a case of bilateral bifid inferior nasal turbinates with bilateral secondary middle turbinates. We discuss the findings of this rare condition and suggest an appropriate term—accessory inferior turbinate—to replace bilateral inferior turbinate by reason of its embryology.

Bilateral accessory inferior turbinates and secondary middle turbinates

The left brachiocephalic vein usually passes superior and anterior to the aortic arch. In rare cases, this vein follows an anomalous course; for example, a circumaortic left brachiocephalic vein. We present the case of a circumaortic left brachiocephalic vein in a 53-year-old male with lung cancer. A multidetector CT showed that the two branches of the left brachiocephalic vein circumscribed the aortic arch. The anterior branch was above and the posterior branch was below the aortic arch. Both branches drained into the superior vena cava.

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Circumaortic Left Brachiocephalic Vein: CT Findings

A 53-year-old man presented at our outpatient department complaining of paraparesis over the previous 7 months. The patient had a traffic accident 7 months ago and did not have a history of lumbar puncture. Neurologic examination revealed decreased lower limb reflexes to grade 2-4 and decreased ankle and toe reflexes to grade 1. The patient suffered hypoesthesia over the lumbar spinal level and experienced dysuresis and dyschezia. Plain radiography of the spine showed no abnormality. MR imaging of the spine showed an intradural and extramedullary mass, measuring 4.7 cm, at the junction of conus medullaris and cauda equine located between T12 and L1 levels. The mass exhibited hetergenous and relatively high signal intensity on a T1-weighted image (T1-WI) (Fig. 1A, B) and high signal intensity relative to the spinal cord on a T2-weighted image (T2-WI) (Fig. 1C, D). After IV administration of contrast material, the mass showed minimal peripheral enhancement (Fig. 1E, F). At surgery, the tumor mass was covered with a glistening, white capsule that was located in the subdural area, which compressed the spinal cord (Fig. 2A). The tumor capsule adhered to the spinal cord (Fig. 2B), and brownish contents within the capsule were noted (Fig. 2C). The tumor may be an extramedullary tumor, which invades the intramedullary space, or not. On Case Report pISSN 1738-2637 J Korean Soc Radiol 2012;66(2):113-116

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Woo Ho Cho

Papers

Dynamic contrast-enhanced MR imaging of VX2 carcinomas after X-irradiation in rabbits: comparison of gadopentetate dimeglumine and a macromolecular contrast agent.

Clinical and electroencephalographic features of infantile spasms associated with malformations of cortical development.

Bilateral accessory inferior turbinates and secondary middle turbinates

Circumaortic Left Brachiocephalic Vein: CT Findings

Intradural Epidermoid Cyst at Conus Medullaris and Cauda Equina of the Spine: A Case Report