詳細検索結果
以下の条件での結果を表示する:
全文: "Corpus callosotomy"
41件中 1-20の結果を表示しています
  • Kamran Ali SALAYEV, Nobukazu NAKASATO, Mamiko ISHITOBI, Hiroshi SHAMOTO, Akitake KANNO, Teiji TOMINAGA, Kazuie IINUMA
    Neurologia medico-chirurgica
    2006年 46 巻 3 号 136-142
    発行日: 2006年
    公開日: 2006/03/24
    ジャーナル オープンアクセス
    Interhemispheric time difference (ITD) measured by electroencephalography (EEG) and magnetoencephalography (MEG) was compared to seizure outcome after callosotomy. Two patients with frequent drop attacks underwent simultaneous EEG and MEG before and after total callosotomy. ITDs in 30 bilateral synchronized (BS) discharges were calculated independently by EEG and MEG. As minimum transcallosal conduction time was suggested to be approximately 20 msec, BS discharges were classified into five categories according to ITD and side: left- or right-leading long (300 to 80 msec), left- or right-leading moderate (80 to 20 msec), and negligible (<20 msec). In Case 1 before callosotomy, EEG detected 77% negligible and 23% right-leading moderate BS discharges, whereas MEG detected 30% and 63%, respectively. After callosotomy, drop attacks reduced remarkably and EEG and MEG detected no BS discharges. In Case 2 before callosotomy, EEG detected 77% negligible and 23% moderate BS discharges, whereas MEG detected 80% and 20%, respectively. After callosotomy, drop attacks recurred 2 months later and EEG and MEG detected left- and right-leading long BS discharges (63% by EEG and 56% by MEG). MEG detected a large number of BS discharges with moderate ITD before surgery in Case 1, suggesting that the transcallosal pathway was the main pathway for the synchronization, whereas the negligible ITD in Case 2 excludes transcallosal propagation. BS discharges with longer ITD after surgery in Case 2 suggest a persistent poly-synaptic non-transcallosal pathway. MEG with higher spatial resolution than EEG may provide surgical indications for callosotomy.
  • Haruhiko KISHIMA, Satoru OSHINO, Naoki TANI, Yomoyuki MARUO, Shayne MORRIS, Hui Ming KHOO, Takufumi YANAGISAWA, Kuriko SHIMONO, Takeshi OKINAGA, Masayuki HIRATA, Amami KATO, Toshiki YOSHIMINE
    Neurologia medico-chirurgica
    2013年 53 巻 11 号 814-820
    発行日: 2013年
    公開日: 2013/11/25
    [早期公開] 公開日: 2013/10/21
    ジャーナル オープンアクセス
    Children with unilobar or multilobar pathology issuing in refractory epilepsy are potential candidates for surgical treatment. Extensive surgery results in good seizure control, but it also increases the risk of neurological deficits as well as motor and mental problems. We reviewed the cases of 19 children with refractory epilepsy treated surgically at Osaka University Hospital. Four of the 19 patients underwent temporal disconnection, 2 underwent occipital lobectomy, 4 underwent temporoparietooccipital disconnection, 6 underwent functional hemispherotomy, and 3 underwent corpus callosotomy. A good surgical outcome, i.e., Engel’s class I or II, was achieved in 12 (63%) of the 19 patients. Excellent surgical outcomes and satisfactory motor and mental development were achieved in 4 patients who underwent temporoparietooccipital disconnection. The outcomes of functional hemispherectomy were also satisfactory. The outcomes of temporal disconnection and corpus callosotomy were poor in comparison to outcomes of the other procedures. We believe that better surgical outcomes would have been achieved with temporoparietooccipital disconnection in some cases treated by temporal disconnection or occipital resection. Adequate extensive surgical procedures should be considered for refractory childhood epilepsy arising from unilobar or multilobar pathology.
  • Anannit Visudtibhan, Atthaporn Boongird, Chaiyos Khongkhatithum, Lunliya Thampratankul, The Ramathibodi Epilepsy Surgery Group
    Epilepsy & Seizure
    2008年 1 巻 1 号 47-56
    発行日: 2008年
    公開日: 2008/10/14
    ジャーナル フリー

    Purpose: To demonstrate the preliminary result of surgical treatment in a university-based hospital in Thailand.
    Methods: The medical records of children and adolescents who received surgical treatment for epilepsy at Ramathibodi Hospital, Bangkok, Thailand from October 2005 till July 2007 were reviewed.
    Results: 38 children and adolescents (21 males and 17 females; ages ranged from 14 months to 18 ½ years, mean 9.5 years, median 9.75 years) were included in this study. 18 and 20 were classified into symptomatic and cryptogenic/idiopathic groups, respectively. Lennox-Gastaut syndrome, West syndrome, tuberous sclerosis and Sturge-Weber syndrome were diagnosed in 10, 3, 2 and 1 patients, respectively. Presurgical evaluation consisted of ictal/interictal video-monitored EEG recording, MRI of brain and ictal/interictal SPECT scans. Surgical treatment were lesionectomy, lobectomy, corpus callosotomy, corpus callosotomy with lobectomy, anterior temporal lobectomy with amydalohippocampectomy, functional hemishperectomy and hemispherotomy in 11, 9, 8, 2, 5, 2 and 1 patients, respectively. Follow-up durations ranged from 1 to 19 months. The outcomes were freedom from seizure, significant seizure reduction, minimal seizure reduction, and no frequency change in 22, 11, 3 and 2 patients, respectively. One antiepileptic drug was removed from the treatment regimen in 11 patients. No patient deteriorated after treatment. The majority of parents reported improvement of social interaction and motor functions.
    Conclusion: Although this is a report of a small number of patients with short follow-up duration, the preliminary result is in favor of surgery as an option for the treatment of childhood and adolescent intractable epilepsy in Thailand.
  • 木村 清次, 斎藤 義朗, 田邉 豊
    てんかん研究
    2005年 23 巻 2 号 131-136
    発行日: 2005年
    公開日: 2005/09/06
    ジャーナル 認証あり
    Periodic spasms(PS)はWest症候群類似のシリーズ形成性spasmを示す発作型である。発作時脳波は速波が重なる全般性高振幅徐波を特徴とし、脳波所見のみから判断すると全般性高振幅徐波は非てんかん性放電と間違えやすく、発作時の観察またはビデオ脳波同時記録が必要である。PSは抗てんかん薬に反応しにくく治療に難渋する。今回の症例は1歳6カ月からPSが発症し、経過中に複雑部分発作、全般性多棘律動に伴う単発性の強直発作、および転倒発作を合併した。種々の抗てんかん薬が無効で、転倒発作による外傷の機会が多くなり15歳で全脳梁離断を行った。術後約2年を経過するが、全ての型の発作の再発を認めず、またPS時や強直発作時にみられた全般性放電も消失している。脳梁離断が本例に有効であった理由の説明は難しいが、脳梁は単なるてんかん性放電の伝播経路ではなく、多焦点性てんかん発射の両側同期化をコントロールしている可能性が示唆される。
  • 岩崎 真樹, 植松 貢, 中山 東城, 福與 なおみ, 萩野谷 和裕, 神 一敬, 大沢 伸一郎, 中里 信和, 冨永 悌二
    脳と発達
    2013年 45 巻 3 号 195-198
    発行日: 2013年
    公開日: 2014/10/11
    ジャーナル フリー
     【目的】小児の難治全般てんかんに対する脳梁離断術の有効性と, 発作予後に関連する臨床的因子を探る.
     【方法】発作軽減を目的に一期的全脳梁離断術を施行した乳幼児期あるいは小児早期に発症した難治てんかん連続13例を対象に, 発作予後と術前の臨床的特徴の関連を後方視的に検討した.
     【結果】13例中4例で術後1年以上の発作消失を達成した. 発作が残った9例中8例で転倒に至る発作が消失した. 術前MRIが正常であった5例中4例で発作が消失し, 統計学的に有意な関連があった.
     【結論】乳幼児期あるいは小児早期に発症した難治全般てんかんのうち, 明らかな病因がなく正常MRIを呈する群は脳梁離断術によって長期の発作寛解を得る例が多い.
  • 荒木 寛, 長岡 京子, 本田 涼子
    日本臨床麻酔学会誌
    2016年 36 巻 5 号 523-527
    発行日: 2016/09/15
    公開日: 2016/11/05
    ジャーナル フリー

    MECP2重複症候群の脳梁離断術における麻酔を経験したので,報告する.症例は5歳の男児で,胎児期から子宮内発育遅延,小頭症を指摘されておりMECP2重複症候群と診断された.3歳時に全身のミオクロニー発作が出現し,抗てんかん薬の内服加療を行ったがコントロール困難であったため,脳梁離断術が行われた.術後,TOFR 70%の時点でスガマデクスを投与したが,TOFR 100%になるまで約10分を要した.抜管後は喉頭浮腫が疑われヒドロコルチゾンを投与した.MECP2重複症候群は非常にまれな疾患ではあるが,筋弛緩の遷延および周術期の気道トラブルに注意する必要がある.

  • Ayataka FUJIMOTO, Tohru OKANISHI, Sotaro KANAI, Keishiro SATO, Mitsuyo NISHIMURA, Hideo ENOKI
    Neurologia medico-chirurgica
    2017年 57 巻 9 号 496-502
    発行日: 2017年
    公開日: 2017/09/15
    [早期公開] 公開日: 2017/08/01
    ジャーナル オープンアクセス

    Stereoelectroencephalography (SEEG) is an invasive surgical procedure used to identify epileptogenic zones. The combination of both subdural grids and depth electrodes (DEs) is currently used for invasive intracranial monitoring in many epilepsy centers. To perform DE implantation, some centers use frame-based stereotactic techniques and others use stereotactic robotic techniques. However, not all epilepsy centers have access to these tools. We hypothesized that DE implantation using a neuronavigation system can be utilized for subsequent epilepsy surgery. Between April 2016 and April 2017, we performed invasive monitoring for 26 patients. Among these, 17 patients (8 females, 9 males; mean age, 21.2 years; range, 3–51 years) underwent DE implantation. We divided patients into three groups: Group 1 (7 patients), a free-hand implantation group; Group 2 (7 patients), a frameless stereotactic implantation group; and Group 3 (3 patients), a computed tomography (CT)-guided auto image registration system with the stereotactic implantation group. Group 3 showed the closest distance from planned target to DE tip, followed by Group 2. Fourteen of the 17 patients underwent subsequent epilepsy surgery referring to the results of DE studies. DE placement using a neuronavigation system without stereotactic robotic equipment or frame-based stereotactic techniques can be utilized for subsequent epilepsy surgery.

  • P. David Adelson
    脳神経外科ジャーナル
    2010年 19 巻 4 号 311-320
    発行日: 2010/04/20
    公開日: 2017/06/02
    ジャーナル フリー
    Epilepsy is the most common neurologic disorder in childhood. In cases where a reasonable trial of several antiepileptic medications fails to provide adequate seizure control, neurosurgical options include both diagnostic techniques as well as innovative treatments. For that reason, pediatric neurosurgeons often involve themselves early in the evaluation and management of these children. Although full seizure control may be impossible, improved neurologic development and avoidance of injuries from ictal events may be worthy, alternative outcomes. Recently developed techniques in neuromodulation, like vagal nerve stimulation and deep brain stimulation, provide potential improved seizure control for those patients who would be unlikely to benefit from resective surgery for cure.
  • James T. Rutka
    脳神経外科ジャーナル
    2006年 15 巻 4 号 320-
    発行日: 2006/04/20
    公開日: 2017/06/02
    ジャーナル フリー
  • 中里 信和, 社本 博, 岩崎 真樹, Kamran A Salayev, 冨永 悌二
    脳神経外科ジャーナル
    2006年 15 巻 4 号 320-
    発行日: 2006/04/20
    公開日: 2017/06/02
    ジャーナル フリー
  • 馬場 好一, 三原 忠紘
    脳神経外科ジャーナル
    2006年 15 巻 4 号 320-
    発行日: 2006/04/20
    公開日: 2017/06/02
    ジャーナル フリー
  • 清水 弘之
    脳神経外科ジャーナル
    2004年 13 巻 4 号 328-
    発行日: 2004/04/20
    公開日: 2017/06/02
    ジャーナル フリー
  • 堀 智勝, 山根 文孝, 落合 卓
    脳神経外科ジャーナル
    2004年 13 巻 4 号 328-
    発行日: 2004/04/20
    公開日: 2017/06/02
    ジャーナル フリー
  • 馬場 啓至
    脳神経外科ジャーナル
    2004年 13 巻 4 号 328-
    発行日: 2004/04/20
    公開日: 2017/06/02
    ジャーナル フリー
  • 河島 雅到, 萩原 宏之, 中山 賢司, 植村 研一, 北原 孝雄, 遠藤 昌孝, 藤井 清孝
    脳卒中の外科
    2008年 36 巻 4 号 298-305
    発行日: 2008年
    公開日: 2009/08/25
    ジャーナル フリー
    Most distal anterior cerebral artery (ACA) aneurysms arise at the pericallosal-callosomarginal (PC-CM) junction, which is usually located in the A3 segment of the ACA around the genu of the corpus callosum. PC-CM aneurysms are divided into 2 types according to their location: supracallosal and infracallosal. Infracallosal distal ACA aneurysms are defined as those located in the lower half of A3, thus making it more difficult to gain proximal control. In this study, we examined the microsurgical anatomy of the distal ACA region, focusing especially on the relationship between the pericallosal and callosomarginal arteries located in the lower half of the A3 (infracallosal) segment, and present the surgical strategy for dealing with distal ACA aneurysms.
    The microsurgical anatomy of the distal ACA region was examined in 22 adult cadaveric cerebral hemispheres after perfusion of the arteries and veins with colored silicone. The relationships of the infracallosal segment of the pericallosal to the callosomarginal was examined. The distance between the nasion and the site at which a parallel line directed along the long axis of the infracallosal peri-
    callosal artery just proximal to the origin of the callosomarginal artery crosses the forehead (PC point) was also measured. Surgical approaches to distal ACA aneurysms were examined in stepwise dissections and applied to 2 clinical cases.
    The PC-CM junctions were located in the supracallosal and infracallosal segments of A3 in 36% and 55% of cases, respectively. In the infracallosal region, it is difficult to identify the proximal pericallosal artery and to establish proximal control of the vessel. The infracallosal part of the proximal pericallosal artery courses almost parallel to the frontal cranial base, and the PC point was 42.2±15.9 mm from the nasion. These findings indicate that there is only a limited space to access an infracallosal distal ACA aneurysm below the PC point and establish proximal control by the anterior interhemispheric approach. When the approach is made above the PC point, an anterior callosotomy prior to final aneurysm dissection and clipping may be necessary to establish proximal control. The PC point is an important surgical landmark in planning the surgical strategy for infracallosal distal ACA aneurysms.
  • Hidenori SUGANO, Hajime ARAI
    Neurologia medico-chirurgica
    2015年 55 巻 5 号 399-406
    発行日: 2015年
    公開日: 2015/05/15
    [早期公開] 公開日: 2015/04/28
    ジャーナル オープンアクセス
    Pediatric epilepsy has a wide variety of etiology and severity. A recent epidemiological study suggested that surgery might be indicated in as many as 5% of the pediatric epilepsy population. Now, we know that effective epilepsy surgery can result in seizure freedom and improvement of psychomotor development. Seizure control is the most effective way to improve patients neurologically and psychologically. In this review, we look over the recent evidence related to pediatric epilepsy surgery, and try to establish the optimal surgical timing for patients with intractable epilepsy. Appropriate surgical timing depends on the etiology and natural history of the epilepsy to be treated. The most common etiology of pediatric intractable epilepsy patients is malformation of cortical development (MCD) and early surgery is recommended for them. Patients operated on earlier than 12 months of age tended to improve their psychomotor development compared to those operated on later. Recent progress in neuroimaging and electrophysiological studies provide the possibility of very early diagnosis and comprehensive surgical management even at an age before 12 months. Epilepsy surgery is the only solution for patients with MCD or other congenital diseases associated with intractable epilepsy, therefore physicians should aim at an early and precise diagnosis and predicting the future damage, consider a surgical solution within an optimal timing.
  • 馬場 啓至, 小野 智憲, 戸田 啓介, 馬場 史郎
    脳神経外科ジャーナル
    2007年 16 巻 3 号 177-183
    発行日: 2007/03/20
    公開日: 2017/06/02
    ジャーナル フリー
    脳梁離断術は発作の二次性全般化を防止する目的で1940年Van WagenenとHerrenにより報告された.しかしながらその後,全般発作に対する有効性が確認され,過去30年多くの症例に行われた.特に脱力発作,強直発作,全般性強直間代発作に有効で,複雑部分発作についてはその効果が一定していない.手術適応を含め,手術時期,離断範囲など未解決の点も多い.切除外科とは異なり,脳梁離断術はあくまで緩和手術であるため,発作消失率は低いが,術後発作軽減が得られ,ADL改善につながる.脳梁離断術の歴史,脳梁のてんかんにおける役割,発作抑制機序について考察した.
  • Joo Hee Seo, Kum Ok Choi, Joon Soo Lee, Heung Dong Kim
    Epilepsy & Seizure
    2008年 1 巻 1 号 1-10
    発行日: 2008年
    公開日: 2008/02/19
    ジャーナル フリー
    Twenty to thirty percent of children with epilepsy continue to have seizures despite anti-epileptic drugs (AEDs) treatment and are defined as medically intractable epilepsy. Intractable epilepsy frequently has developmental impact, causing permanent neurodevelopmental deficits in children. Recently developed neurodiagnostic studies and treatment modalities have substantially altered the management of patients with intractable epilepsy. The newly developed AEDs are frequently used for the treatment of patients unresponsive to conventional AEDs. Nonpharmacologic options for intractable epilepsy include dietary therapy such as ketogenic diet and modified Atkins diet, epilepsy surgery, and neuromodulatory treatments such as vagus nerve stimulation. Ketogenic diet is an effective and safe treatment for epilepsy in children; increasing use has led to modification of protocol for higher efficacy and better tolerability. When epilepsy is intractable to medical treatment, epilepsy surgery including surgical resection of epileptogenic area, or palliative surgery can be considered. Vagal Nerve Stimulation is recommended for patients who are not candidates for resective surgery. These nonpharmcologic treatments could result in resumption of developmental progress in patients with childhood intractable epilepsy.Active application of newly developed medical and surgical treatments could provide better outcome in seizure control and developmental progress in patients with intractable epilepsy.
  • 清水 弘之
    脳神経外科ジャーナル
    2001年 10 巻 3 号 148-154
    発行日: 2001/03/20
    公開日: 2017/06/02
    ジャーナル フリー
    てんかん外科には切除手術と遮断手術がある.遮断手術には, 脳梁離断術, MST, 半球離断術などが含まれる.脳梁離断術は転倒発作にきわめて有効で, 全離断の方が部分離断よりも有効性が高い.小児では術後に認知機能の改善がみられることが多いが, 成人では精神的, 社会的適応障害が観察されることがある.MSTは大脳のcritical areaの焦点に対する治療法として開発されたが, 播種性広範囲てんかん焦点に対しても有効な手段である.術中皮質脳波を反復し, てんかん性異常波の消失を確認すれば良好な手術結果が期待できる.手術操作による永久的脱落症状はみられない.
  • 石橋 秀昭, 小川 博司, 田村 有希恵, 広島 覚, 鎌田 恭輔
    脳神経外科ジャーナル
    2016年 25 巻 2 号 112-127
    発行日: 2016年
    公開日: 2016/02/25
    ジャーナル フリー
     ペンフィールドのhomunculusが報告されてから機能的脳局在を重視した脳神経外科手術が進歩してきた. てんかん外科においては発作の減少と術後神経機能脱落の回避を目的に, 従来の脳表電極・硬膜下電極によるてんかん原生域同定に加え, 医用技術進歩により種々の非侵襲的・補助的診断機器, 覚醒下手術などが積極的に導入されてきたが, これらは単にてんかんに留まらず, glioma手術を含めた脳神経外科手術の根幹をなすものと思われる. 同時にてんかん関連・皮質機能関連ネットワークの解明にも利用され, 新たな大脳皮質機能地図が明らかになりつつある.
     この稿では医用技術進歩に伴う検査と侵襲的・非侵襲的治療法に焦点をあて, 概説を試みた.
feedback
Top