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![[A]: A coronal section of the resected hippocampus shows pyramidal cell loss in the CA1 region (original magnification 20×, H&E staining). [B]: Cell loss is also noted in the dentate hilus (original magnification 10×, H&E staining). [C]: Histology of the resected lateral temporal lobe demonstrates prominent astrogliosis (original magnification 40×, glial fibrillary acidic protein staining).](profile/Takato-Morioka/publication/236655151/figure/fig4/AS:299287960408076@1448367219173/A-A-coronal-section-of-the-resected-hippocampus-shows-pyramidal-cell-loss-in-the-CA1.png)
[A]: A coronal section of the resected hippocampus shows pyramidal cell loss in the CA1 region (original magnification 20×, H&E staining). [B]: Cell loss is also noted in the dentate hilus (original magnification 10×, H&E staining). [C]: Histology of the resected lateral temporal lobe demonstrates prominent astrogliosis (original magnification 40×, glial fibrillary acidic protein staining).
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![Fig. 3. [A]: An intraoperative photograph shows the cloudy arachnoid...](profile/Takato-Morioka/publication/236655151/figure/fig2/AS:299287960408071@1448367218763/A-An-intraoperative-photograph-shows-the-cloudy-arachnoid-membrane-on-the-Sylvian_Q320.jpg)
![Fig. 4. [A]: An intraoperative photograph shows the exposed hippocampus...](profile/Takato-Morioka/publication/236655151/figure/fig3/AS:299287960408073@1448367218922/A-An-intraoperative-photograph-shows-the-exposed-hippocampus-following-resection-of_Q320.jpg)
![Fig. 5. [A]: A coronal section of the resected hippocampus shows...](profile/Takato-Morioka/publication/236655151/figure/fig4/AS:299287960408076@1448367219173/A-A-coronal-section-of-the-resected-hippocampus-shows-pyramidal-cell-loss-in-the-CA1_Q320.jpg)
Although there is no universally accepted definition, traumatic medial temporal lobe ep-ilepsy (traumatic MTLE) can be generally de-fined as a type of post-traumatic epilepsy with medial temporal epileptogenicity. Previous studies have demonstrated that patients with traumatic MTLE frequently have hippocampal sclerosis (HS) coexisting with traumati...
Citations
Vagal nerve stimulation(VNS)is an effective adjunctive therapy for medically intractable epilepsy. However, VNS is a palliative therapy, and craniotomy should preferably be performed when complete seizure remission can be expected after craniotomy. We report here three patients who were referred for VNS therapy, but underwent craniotomy instead of VNS based on the results of a comprehensive preoperative evaluation, and achieved good seizure control. Case 1 was a 48-year-old woman with left temporal lobe epilepsy and amygdalar enlargement. Even though no left hippocampal sclerosis was observed on magnetic resonance imaging, she underwent left anterior temporal lobectomy and hippocampectomy. Case 2 was a 36-year-old woman with multiple bilateral subependymal nodular heterotopias, who underwent resection of the left medial temporal lobe including subependymal nodular heterotopias adjacent to the left inferior horn. Case 3 was a 25-year-old man with posttraumatic epilepsy. As the right hemisphere was most affected, multiple subpial transections were performed on the left frontal convexity. These three patients were referred to us for VNS therapy because there was a dissociation between the interictal electroencephalogram and magnetic resonance imaging findings, or because they had multiple or extensive epileptogenic lesions. Comprehensive preoperative evaluation including ictal electroencephalography can help to identify patients who are suitable candidates for craniotomy.
