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  • 1
    ISSN: 1433-0407
    Keywords: Schlüsselwörter Epilepsiechirurgie ; Prächirurgische Diagnostik ; Nichtinvasives Protokoll ; Key words Epilepsy surgery ; Presurgical evaluation ; Noninvasive protocol
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Summary We present a non-invasive epilepsy surgery protocol, which includes EEG-video-monitoring, magnetic resonance imaging (MRI), interictal positron emission tomography (PET) and ictal single photon emission computerized tomography (SPECT). According to this non-invasive protocol 50 of 173 patients with medically intractable focal epilepsy underwent resective surgery. The localization of the epileptogenic zone was based on the congruence of the localizing results of EEG-video-montoring, MRI, interictal PET and ictal SPECT. 46 (92%) of the patients had temporal and 4 (8%) had extratemporal epilepsies. 78% (n=39) of all patients operated according to our non-invasive protocol were postoperatively completely or almost seizure free. Extramesiotemporal resections could be carried out without invasive EEG-recording if the epileptogenic zone was not adjacent to the eloquent cortex. We conclude from our results that in a considerable number of patients with medically intractable particularly temporal focal epilepsies, resective epilepsy surgery can be based on non-invasive EEG-evaluations and the risk of invasive recordings can be avoided.
    Notes: Zusammenfassung Wir stellen ein nichtinvasives Protokoll für die epilepiechirurgische Diagnostik vor, demzufolge bei 50 von 173 Patienten mit pharmakoresistenten fokalen Epilepsien ein resektiver epilepsiechirurgischer Eingriff durchgeführt wurde. Die lokalisatorische Übereinstimmung von Befunden des nichtinvasiven EEG-Video-Monitorings, der Magnet-Resonanz-Tomographie (MRT), der interiktalen Positronen-Emissions-Tomographie (PET) und der iktalen SPECT (Single-Photon-Emissions-Computer-Tomographie) bildete die Grundlage der Fokuslokalisation. Bei 46 (92%) der Patienten lagen temporale und bei 4 (8%) extratemporale Epilepsien vor. 78% (n=39) aller 50 Patienten wurden anfallsfrei oder hatten nur noch sehr selten Anfälle. Extratemporale Resektionen konnten ohne invasive EEG-Untersuchungen erfolgen, wenn umschriebene MRT-Läsionen vorlagen und die Resektionen in ausreichendem Abstand vom eloquenten Kortex durchgeführt werden konnten. Anfallsfreiheit konnte so bei insgesamt 3 der 4 extratemporalen Patienten erreicht werden. Wir folgern aus unseren Ergebnissen, daß bei einer Reihe von ausgewählten Patienten mit pharmakoresistenten fokalen, insbesondere temporalen Epilepsien nichtinvasive EEG-Ableitungen in der prächirurgischen Diagnostik ausreichen und so das Risiko invasiver EEG-Untersuchungen vermieden werden kann.
    Type of Medium: Electronic Resource
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  • 2
    ISSN: 1432-1459
    Keywords: Key words CADASIL ; Cerebrovascular disease ; Skin biopsy ; Muscle biopsy ; Electron microscopy
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is a microangiopathic syndrome. Although the defective gene has been identified, genetic analysis may be effort some due to its large size and various mutations. Providing a reliable diagnostic marker would therefore be helpful. Electron microscopy has revealed characteristic electron-dense granular deposits in the basal lamina of vessels of patients with CADASIL. We investigated the sensitivity of skin and muscle biopsies for diagnosing CADASIL. We examined 30 family members of three unrelated German families affected by CADASIL. In 14 of the 21 affected individuals we performed skin and muscle biopsies; two patients were clinically asymptomatic. Under electron microscopy all muscle and skin biopsy specimens showed patches of granular and electron-dense material in the basal layer of both arterioles and capillaries. These findings confirm that general microangiopathy is a typical feature of this syndrome and is present in the early phase of the disease with or without clinical manifestation. Thus, as electron microscopy of skin biopsy specimens can establish the diagnosis of CADASIL with high certainty, it may be considered the method of first choice.
    Type of Medium: Electronic Resource
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