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Diffusion Tensor Imaging in Cases with Visual Field Defect after Anterior Temporal Lobectomy

Diffusion Tensor Imaging in Cases with Visual Field Defect after Anterior Temporal Lobectomy

A and B, T2-weighted image. The patient had left anterior temporal lobectomy (A), and there is a high signal intensity area in the anterior part of left sagittal stratum (B, arrow). C, Visual field. The upper quadrant visual field is completely impaired. D, Color-displayed tensor image. Sagittal strata including the optic radiation were recognized as a green area even in operated side. Regions of interest for measurement are shown as dotted lines. E, FA image. The FA value of the left sagittal strata shows a noticeably lower value as compared with the opposite side (right, 0.506; left, 0. 394). F, ADC image. No apparent difference between the optic radiations of both sides is observed (right, 6.10 ⫻ 10 ⫺4 mm 2 /s; left, 7.00 ⫻ 10 ⫺4 mm 2 /s).
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Neurosurgical Management of Intractable Temporal Lobe Epilepsy by Amygdalohippocampectomy Plus Anterior Temporal Lobectomy: Report of Initial Three Pediatric Cases with Short Literature Review

Neurosurgical Management of Intractable Temporal Lobe Epilepsy by Amygdalohippocampectomy Plus Anterior Temporal Lobectomy: Report of Initial Three Pediatric Cases with Short Literature Review

usually AEDs resistant and needs surgery. Result of surgery in these cases is excellent. In these cases combination of AEDs with adequate dose failed to control disabling epilepsy, but surgical intervention brought a significant symptomatic improvement. Literature suggests that in most of the cases surgery is curative if there is no second focus or at least good control of epilepsy can be achieved with AED. 2,3 We went for amygdalohippocampectomy with plus standard anterior temporal lobectomy in two cases and amygdalohippocampectomy with plus standard anterior temporal lobectomy with excision of arachnoid cyst in one case but selective amygdalohippo- campectomy (with lesionectomy where applicable) could be another surgical option to these lesions 2 . Size of the lesion, possibility of different pathology, narrow space through trans-sylvian route and possibility of manipulation and damage of critical vessels and neural structures and most importantly less familiarity of the approach along with less success rate of amygdalohippocampectomy in controlling epilepsy helped us to take decision in favour of trans middle temporal gyrus approach amygdalohippocampectomy with lesionectomy plus standard anterior temporal lobectomy instead of selective amygdalohippocampectomy in the hope to cure epilepsy as well as the lesion. It has been suggested that the amount of tissue resected in mesio- temporal operations is crucial for surgical success in mesial TLE 4,5,6,7 . In a randomized, prospective study
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Observations on the relationship between verbal explicit and implicit memory and neuronal density in the left and right hippocampus in temporal lobectomy patients.

Observations on the relationship between verbal explicit and implicit memory and neuronal density in the left and right hippocampus in temporal lobectomy patients.

cits ð7\ 43\ 44Ł[ Studies which measure the relationship between hippocampal morphology and verbal memory rarely emphasize implicit memory[ The distinction between explicit and implicit memory was _rst dem! onstrated in amnesic patients with bilateral cortical dam! age which includes the hippocampal formation due to alcoholism\ to Alzheimer|s disease\ or to stroke[ They had impaired explicit memory "recall or recognition# but unimpaired implicit memory "word!completion or skill learning# when performance was compared to control subjects ð07Ð19Ł[ A recent study ð56Ł has investigated the status of verbal explicit vs implicit memory in unilateral anterior temporal lobectomy "TL# patients and found asymmetrical explicit verbal memory "worse in the left than in the right# in the face of symmetrical implicit memory "which was not di}erent from normal#[ Taken together\ these studies demonstrate that memory is not a unitary function but rather is made of multiple systems ð38Ł[
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The case for a relationship between human memory, hippocampus and corpus callosum

The case for a relationship between human memory, hippocampus and corpus callosum

When we examined a large (N = 52) series of these patients (unilateral anterior temporal lobectomy) we were able to analyze the data for neuronal density with respect to sex of patient (D. Zaidel, Esiri, & Oxbury, 1994). We have used the same methods described above. On the left, there were 15 males and 15 females; on the right, there were 13 males, 9 females. The findings indicated that males had significantly more neurons in the left hippocampus than on the right for all 3 subfields sampled (CA1, CA4, and DG). In the females this asymmetry was not present. Moreover, statistical correlation among subfields on the left was consistently positive only in males while in females, only 2 (of 3 possible) comparisons was positive. In the right, the correlation between subfield
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Surgical Treatment of Dysembryoplastic Neuroepithelial Tumor

Surgical Treatment of Dysembryoplastic Neuroepithelial Tumor

determined. Neoplasm was found to be soft and dark gray with obvious boundaries between normal tissue and tumor. In 2 patients with frontal lobe epilepsy, the epileptic foci involved the lower part of the central anterior gyrus, and the contralateral oral and tongue movements were determined by cortical electrical stimulation; In 1 case of parietal lobe epilepsy, the epileptic foci involved the upper part of the central posterior gyrus, and abdominal discomfort was observed in patients with intraoperative arousal state by electrical stimulation of the cortex. All patients underwent complete resection of the tumor and epileptic foci, or low-power bipolar cortical thermal cauterization in the affected functional areas. Eclampsia discharge monitored by ECoG was located around the lesion in the operation. 9 cases of temporal lobe DNET patients underwent tumor plus hippocampal amygdala or standard anterior temporal lobectomy, and 2 cases of frontal lobe and 1 case of parietal lobe patients underwent low-power bipolarcortical thermal cauterization on the central cortex according to ECoG monitoring after tumor resection.
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Automatic labeling of the fanning and curving shape of Meyer’s loop for epilepsy surgery: an atlas extracted from high-definition fiber tractography

Automatic labeling of the fanning and curving shape of Meyer’s loop for epilepsy surgery: an atlas extracted from high-definition fiber tractography

Background: Visual field defects caused by injury to Meyer ’ s loop (ML) are common in patients undergoing anterior temporal lobectomy during epilepsy surgery. Evaluation of the anatomical shapes of the curving, fanning and sharp angles of ML to guide surgeries is important but still challenging for diffusion tensor imaging. We present an advanced diffusion data-based ML atlas and labeling protocol to reproduce anatomical features in individuals within a short time. Methods: Thirty Massachusetts General Hospital-Human Connectome Project (MGH-HCP) diffusion datasets (ultra-high magnetic gradient & 512 directions) were warped to standard space. The resulting fibers were projected together to create an atlas. The anatomical features and the tractography correspondence rates were evaluated in 30 MGH-HCP individuals and local diffusion spectrum imaging data (eight healthy subjects and six hippocampal sclerosis patients). Results: In the atlas, features of curves, sharp angles and fanning shapes were adequately reproduced. The distances from the anterior tip of the temporal lobe to the anterior ridge of Meyer ’ s loop were 23.1 mm and 26.41 mm on the left and right sides, respectively. The upper and lower divisions of the ML were revealed to be twisting. Eighty-eight labeled sides were achieved, and the correspondence rates were 87.44% ± 6.92, 80.81 ± 10.62 and 72.83% ± 14.03% for MGH-HCP individuals, DSI-healthy individuals and DSI-patients, respectively.
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Diffusion Tensor Tractography of the Meyer Loop in Cases of Temporal Lobe Resection for Temporal Lobe Epilepsy: Correlation between Postsurgical Visual Field Defect and Anterior Limit of Meyer Loop on Tractography

Diffusion Tensor Tractography of the Meyer Loop in Cases of Temporal Lobe Resection for Temporal Lobe Epilepsy: Correlation between Postsurgical Visual Field Defect and Anterior Limit of Meyer Loop on Tractography

Fig 3. Right temporal lobe epilepsy. Anterior temporal lobec- tomy was performed. A, Presurgical tractography. Tractogra- phy of the Meyer loop is shown as the green tract. T-M distance is 35.6 mm. Uncinate fascicles are shown in the yellow tract. Note that there is no gap between the 2 tractographies. B, Postsurgical spin-echo sagittal image. An anterior temporal lobectomy has been performed. The T-R distance is 38 mm (arrow). Because the T-M distance is 35.6 mm on the presurgical tractography, the M-R distance is calculated to be ⫹2.4 mm. C, For the postsurgical tractog- raphy, the Meyer loop could not be delineated; thus, only the dorsal optic radiation could be drawn. D, The visual field 2 months after the surgery. There is a complete visual field defect in the medial sector and a partial visual field defect in the lateral sector of the lateral upper quadrant visual field.
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Exploring the role of the posterior middle temporal gyrus in semantic cognition : Integration of anterior temporal lobe with executive processes

Exploring the role of the posterior middle temporal gyrus in semantic cognition : Integration of anterior temporal lobe with executive processes

Making sense of the world around us depends upon selectively retrieving information relevant to our current goal or context. However, it is unclear whether selective semantic retrieval relies exclusively on general control mechanisms recruited in demanding non- semantic tasks, or instead on systems specialised for the control of meaning. One hypothesis is that the left posterior middle temporal gyrus (pMTG) is important in the controlled retrieval of semantic (not non-semantic) information; however this view remains controversial since a parallel literature links this site to event and relational semantics. In a functional neuroimaging study, we demonstrated that an area of pMTG implicated in semantic control by a recent meta-analysis was activated in a conjunction of (i) semantic association over size judgements and (ii) action over colour feature matching. Under these circumstances the same region showed functional coupling with the inferior frontal gyrus – another crucial site for semantic control. Structural and functional connectivity analysis demonstrated that this site is at the nexus of networks recruited in automatic semantic processing (the default mode network) and executively demanding tasks (the multiple- demand network). Moreover, in both task and task-free contexts, pMTG exhibited functional properties that were more similar to ventral parts of inferior frontal cortex, implicated in controlled semantic retrieval, than more dorsal inferior frontal sulcus, implicated in domain-general control. Finally, the pMTG region was functionally correlated at rest with other regions implicated in control-demanding semantic tasks, including inferior frontal gyrus and intraparietal sulcus. We suggest that pMTG may play a crucial role within a large-scale network that allows the integration of automatic retrieval in the default mode network with executively-demanding goal-oriented cognition, and that this could support our ability to understand actions and non-dominant semantic associations, allowing semantic retrieval to be ‘shaped’ to suit a task or context.
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A Rare Middle Ear Cholesteatoma Complication behind Painless Swelling of the Temporozygomatic Region

A Rare Middle Ear Cholesteatoma Complication behind Painless Swelling of the Temporozygomatic Region

The complications of middle ear cholesteatoma can be classified into two major categories: intracranial and intratemporal. Intracranial complications include meningitis, brain abscess, multiple abscesses, sigmoid sinus thrombosis, hydrocephalus, and meningoencephalic hernia. Most of these complications require timely surgical treatment. Intratemporal complications are typically tympano-ossicular chain disruption, labyrinthine fistula, mastoid abscesses (Bezold, mastoid subperiosteal, zygomatic) [1], facial palsy or paralysis, and apicitis pyrami- dalis (Gradenigo’s syndrome). The zygomatic abscess is the rarest mastoid abscess, requiring early radical mas- toidectomy to eradicate the source of the infection [2]. When the cells of the pneumatic system of the zygomatic root and/or the foot of the temporal bone squama are well developed, cholesteatoma may reach these cells via temporozygomatic extension above the auricular pavilion and in the lower palpebral area [2] [3]. The complica- tions are often consequent to middle ear surgery. In these cases, extension of recurrent/residual middle ear cho- lesteatoma is unpredictable.
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Development of a video-assisted thoracoscopic lobectomy program in a single institution: results before and after completion of the learning curve

Development of a video-assisted thoracoscopic lobectomy program in a single institution: results before and after completion of the learning curve

Surgical data and post-operative outcomes are showed in Table 3. The operative time (detailed for each patient in Fig. 1) was statistically significantly shorter in Group B. There was a not statistically significant difference be- tween the estimated blood loss in the two groups (Fig. 2). The conversion rate was statistically significantly lower in Group B than in Group A (1 % vs 8 % respectively, p = 0,02). Conversions were due to vascular injuries in all cases of Group A: they were n = 3 (6 %) bleeding (arterial bleeding n = 2, 4 %; venous bleeding n = 1, 2 %), of which n = 2 (4 %) considered as “bleeding not safely manageable by VATS” and n = 1 (2 %) as a “life threatening bleeding”. Finally, n = 1 (2 %) conversion in Group A was due to an incorrect transection of the main left pulmonary artery instead of the upper medi- astinal branch during a left upper lobe lobectomy; after conversion, this patient was managed by an end to end anastomosis of the vascular stumps. In Group B, n = 1 (1.1 %) conversion was due to an hilar lymphadenop- athy. Complication rates were similar between the two groups. We registered n = 2 major complications, both in Group B: n = 1 acute lung injury (ALI); n = 1 acute liver failure, evolved with a multiple organ failure (MOF). This last patient represented the n = 1 case of mortality in Group B. Chest drain duration and hospital stay (Group A 6,5 ± 2,5 vs Group B 5,9 ± 1,9; range 4-12 vs 4-28) were similar between the two groups; n = 68 (46 %) patients were discharged within the fifth p.o. day. Our policy in re- moving chest tubes is to take out them when the drained is less of 200 ml in the last 24 h and this can affect directly the hospitalization.
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Particulate embolization of the anterior choroidal artery in the treatment of cerebral arteriovenous malformations

Particulate embolization of the anterior choroidal artery in the treatment of cerebral arteriovenous malformations

8, Left internal carotid injection, lateral projection, shows medial temporal lobe AVM supplied by anterior choroidal artery arrows.. C, Left anterior choroidal artery injection, latproj[r]

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Apparent atypical callosal dysgenesis: analysis of MR findings in six cases and their relationship to holoprosencephaly

Apparent atypical callosal dysgenesis: analysis of MR findings in six cases and their relationship to holoprosencephaly

In contradistinction , the fibers of the anterior commissure cross earlier and in a more rostral portion of the commissural plate; the temporal and geographic separation of the developin[r]

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Evaluation of Nasal and Temporal Anterior Chamber Angle with Four Different Techniques

Evaluation of Nasal and Temporal Anterior Chamber Angle with Four Different Techniques

This study also showed good agreement between the results obtained by gonioscopy and the AS-OCT (p = 0.09) for both nasal (p = 0.15) and temporal data (p = 0.36). In a study by Sakata et al. poor agreement between gonioscopy and AS-OCT is reported for superior and inferior angles, but the agreement for nasal and temporal angle is reported to be good [18]. They also stated that AS-OCT tends to detect more closed ACAs than gonio- scopy which can partly be seen in our study too. When comparing the mean ACA values obtained by gonio- scopy to that obtained by AS-OCT, it can be seen that AS-OCT measures the angle 0.14 nasally and 0.08 tem- porally narrower than gonioscopy.
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Embolization of arteriovenous malformations of the temporal lobe via the anterior choroidal artery

Embolization of arteriovenous malformations of the temporal lobe via the anterior choroidal artery

Preembolization angiogram shows temporal lobe arteriovenous malformation fed by dilated anterior choroidal artery AChA arrow.. 8 and C, Superselective lateral 8 and anteroposterior C ang[r]

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Preventing visual field deficits from neurosurgery

Preventing visual field deficits from neurosurgery

closely related to the anterior tip of the lateral ventricle and is at risk during the early part of surgery. However, the displacement of this landmark was minimal (max- imum 3.2 mm, mean 1.9 mm), with negligible move- ment in the antero-posterior direction, which is the most critical direction when attempting dissection anterior to the optic radiation. This small extent of brain shift explains the lack of additional benefit from correcting for intraoperative brain shift in ATLR over and above the addition of an error margin.

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Anatomical Variations of the Temporomesial Structures in Normal Adult Brain - A Cadaveric Study.

Anatomical Variations of the Temporomesial Structures in Normal Adult Brain - A Cadaveric Study.

positive correlation was found between the rhinal sulcus and posterior uncal segment. Rhinal sulcus was well defined in 81% of samples with a strong positive correlation with corresponding posterior uncal segment showing intralimbic gyrus in 77% and uncinate gyri in 81% samples. On the other hand, the band of Giacomini (38.4%), one of the parts of posterior uncal segments, showed negative correlation with rhinal sulcus (81%). A near‑positive correlation was observed among anterior uncal segment consisting of semilunar and ambiens gyri (69.2%) and semilunar sulcus (69.2%) with rhinal sulcus (81%). Similarly, uncinate gyrus (81%) showed strong positive correlation Table 1: Variability in various temporal lobe structures
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Sentence processing in anterior superior temporal cortex shows a social emotional bias

Sentence processing in anterior superior temporal cortex shows a social emotional bias

statistical map. In both cases, a whole-brain map was created and was corrected for multiple comparisons at a False Discovery Rate (FDR) of q = 0.05 (Genovese et al., 2002). The map for the main effect of Constituent Size was thresholded at 10 voxels to avoid weak, spurious activation. For all statistical maps in this report, clusters were defined as a contiguous set of voxels sharing at least one corner. A cluster was termed aSTG/STS if the peak activation was anterior to the limen insula (Insausti et al., 1998; Simmons et al., 2010; y = 3 in the left hemisphere, y = 5 in the right). Whether it was aSTG or aSTS was determined based on visual inspection in all three orientations. Any clusters posterior to the limen insula were named mid- and posterior- to differentiate them as separate from the anterior clusters. We examined the direction of the Constituent Size effect (1-word, 3-word, 6-word) within each real word Constituent Size cluster by using the approach of best-fit lines taken by Pallier et al. (2011). For each subject, we extracted the average beta weights across a cluster separately for the 1-word, 3-word, and 6-word conditions. We then fit the beta weights of these conditions with a best-fit line for each subject. Finally, to test if the grand-average best-fit line slope was positive, we used two-sided t-tests. In addition to testing the real word Constituent Size effect, we used the same approach to test for a Jabberwocky Constituent Size effect. Pallier et al. found that most best-fit lines were not linear but logarithmic, and we confirmed that logarithmic functions best fit our data as well. Plots in the figures are on a log-linear scale, so these logarithmic responses appear linear on this scale.
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TDP-43 pathology in anterior temporal pole cortex in aging and Alzheimer’s disease

TDP-43 pathology in anterior temporal pole cortex in aging and Alzheimer’s disease

TDP-43 pathology was investigated in the anterior temporal pole cortex (ATPC) and orbital frontal cortex (OFC), regions often degenerated in frontotemporal lobar degenerations (FTLD), in aging and Alzheimer ’ s disease (AD). Diagnosis of dementia in the 1160 autopsied participants from 3 studies of community-dwelling elders was based on clinical evaluation and cognitive performance tests which were used to create summary measures of the five cognitive domains. Neuronal and glial TDP-43 cytoplasmic inclusions were quantitated in 8 brain regions by immunohistochemistry, and used in ANOVA and regression analyses. TDP-43 pathology was present in 547 (49.4%) participants in whom ATPC (41.9%) was the most frequently involved neocortical region and in 15.5% of these cases, ATPC was the only neocortical area with TDP-43 pathology suggesting not only that ATPC is involved early by TDP-43 but that ATPC may represent an intermediate stage between mesial temporal lobe involvement by TDP-43 and the last stage with involvement of other neocortical areas. To better study this intermediary neocortical stage, and to integrate with other staging schemes, our previous 3 stage distribution of TDP-43 pathology was revised to a 5 stage distribution scheme with stage 1 showing involvement of the amygdala only; stage 2 showed extension to hippocampus and/or entorhinal cortex; stage 3 showed extension to the ATPC; stage 4 – showed extension to the midtemporal cortex and/ or OFC and finally in stage 5, there was extension to the midfrontal cortex. Clinically, cases in stages 2 to 5 had impaired episodic memory, however, stage 3 was distinct from stage 2 since stage 3 cases had significantly increased odds of dementia. The proportion of cases with hippocampal sclerosis increased progressively across the stages with stage 5 showing the largest proportion of hippocampal sclerosis cases. Stage 5 cases differed from other stages by having impairment of semantic memory and perceptual speed, in addition to episodic memory impairment. These data suggest that of the regions studied, TDP-43 pathology in the ATPC is an important early neocortical stage of TDP-43 progression in aging and AD while extension of TDP-43 pathology to the midfrontal cortex is a late stage associated with more severe and global cognitive impairment.
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Effects of phototherapy on muscle activity and pain in individuals with temporomandibular disorder: a study protocol for a randomized controlled trial

Effects of phototherapy on muscle activity and pain in individuals with temporomandibular disorder: a study protocol for a randomized controlled trial

temporomandibular disorder. A further aim is to determine the cumulative effect 24 and 48 hours after a single session. Methods/Design: A placebo-controlled, double-blind, randomized, clinical trial will be carried out involving 72 women between 18 and 40 years of age with a diagnosis of myogenous TMD. The participants will then be randomly allocated to four groups totaling 18 individuals per group. Three groups will be submitted to a single session of phototherapy with different light sources, and one group will receive placebo therapy: Group A (2.62 Joules); Group B (5.24 Joules); Group C (7.86 Joules); and Group D (0 Joules). The following assessment tools will be administered on four separate occasions (baseline and immediately after, 24 h after and 48 h after phototherapy). Pain intensity will be assessed using the visual analog scale for pain, while pain thresholds will be determined using algometer, and electromyographic (EMG) analysis on the masseter and anterior temporal muscles.
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Comparative Study of VDR and the Electrical Activity of the Anterior Temporal and Masseter Muscles using Physiologic rest Position, Phonetics and Swallowing methods

Comparative Study of VDR and the Electrical Activity of the Anterior Temporal and Masseter Muscles using Physiologic rest Position, Phonetics and Swallowing methods

masseter and temporal muscles [23, 24, 25]. Unsuitable VDO causes several orofacial disorders such as bruxism, masticatory muscle pain and temporomandibular joint problems (TMJ Disorders)[26]. On the other hand, increase or decrease of VDO in the area around the mouth and the face has been followed by substantial effects including beauty and masticatory force [9, 27]. Ambramicheltali(1998) compared size of vertical distance in rest position in clinic and vertical distance in rest position by means of Electromyographi and deduced that there is a millimeter difference in the distance between two vertical resting position at the clinic (phonetics and swallowing ) and EMG[28]. Further, Frenso(2007) evaluated activity of temporal muscles using EMG, Phonetics and Swallowing methods and deduced that there is no significant difference between measured VDR via different methods[29].
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