Michael Smith

University of Illinois at Chicago, Chicago, IL, United States

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Publications (5)13.11 Total impact

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    ABSTRACT: OBJECTIVE: To review the clinical features and surgical outcome in patients with temporal lobe gangliogliomas associated with intractable chronic epilepsy. METHODS: The Rush University Surgical Epilepsy Database was queried to identify patients with chronic intractable epilepsy who underwent resection of temporal lobe gangliogliomas at Rush University Medical Center. Medical records were reviewed for age of seizure onset, delay to referral for surgery, seizure frequency and characteristics, pre-operative MRI results, extent of resection, pathological diagnosis, complications, length of follow-up, and seizure improvement. RESULTS: Fifteen patients were identified. Average duration between seizure onset and surgery was 14.3 years. Complex partial seizures were the most common presenting symptom. Detailed operative data was available for 11 patients - of these, 90.9% underwent complete resection of the amygdala and either partial or complete resection of the hippocampus, in addition to lesionectomy. Average follow-up was 10.4 years (range 1.6-27.5 years), with 14 patients improving to Engel's class I and one patient to Engel's class III. There were no recurrences, and permanent complications were noted in one patient. CONCLUSIONS: Long-term follow-up of patients with temporal lobe gangliogliomas associated with chronic intractable epilepsy demonstrates excellent results in seizure improvement with surgery and increasingly low incidence of complications with improvements in microsurgical techniques.
    Clinical neurology and neurosurgery 06/2012; · 1.30 Impact Factor
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    ABSTRACT: There have been only a few large series that have used a tailored temporal lobectomy. To clarify whether tailoring a temporal lobe resection will lead to equivalent epilepsy outcomes or have the same predictive factors for success when compared with standard resections. Retrospective analysis of 222 patients undergoing a tailored temporal lobe resection. Demographic measures and typical factors influencing outcome were evaluated. Pathology included 222 cases. With a mean follow-up of 5.4 years, 70% of patients achieved Engel class I outcome. A significant factor predicting Engel class I outcome on multivariate analysis was lesional pathology (P = .04). Among patients with hippocampal sclerosis, extent of lateral neocortical resection and hippocampal resection were not statistically associated with Engel class I outcome (P = .93 and P = .24). However, an analysis of Engel class subgroups a to d showed that patients who had a complete hippocampectomy in the total series were more likely to achieve an Engel class Ia outcome (P = .04). This was also true among patients with hippocampal sclerosis (P = .03). Secondarily, generalized seizure (P = .01) predicted outcome less than Engel class I. Predictive of poor outcome was the need for preoperative electrodes (P = .02). Complications included superior quadrant visual field defects, 2 cases of permanent dysphasia, and 3 wound infections. Predictors of successful seizure outcome for a tailored temporal lobectomy are similar to standard lobectomy. Patients with secondarily generalized epilepsy and cases in which preoperative subdural electrodes were thought necessary were less likely to achieve class I outcome. Among Engel class I cases, those who had a complete hippocampectomy were more likely to achieve Engel class Ia outcome.
    Neurosurgery 06/2012; 71(3):703-9; discussion 709. · 3.03 Impact Factor
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    ABSTRACT: Abnormal MRI findings localizing to the mesial temporal lobe predict a favorable outcome in temporal lobe epilepsy surgery. The purpose of this study is to summarize the surgical outcome of patients who underwent a tailored antero-temporal lobectomy (ATL) with normal 1.5 T MRI. Specifically, factors that may be associated with favorable post-surgical seizure outcome are evaluated. A retrospective analysis of the Rush University Medical Center surgical epilepsy database between 1992 and 2003 was performed. Patients who underwent an ATL and had a normal MRI study documented with normal volumetric measurements of hippocampal formations and the absence of any other MRI abnormality were selected for this study. Demographic information was collected on all patients. Seizure outcomes were evaluated using Engel's classification. A two-sided Fisher exact test with Bonferroni correction was performed in statistical analyses. Twenty-one (21) patients met the inclusion criteria of normal 1.5 T MRI and underwent a tailored temporal lobectomy. Mean age at time of surgery was 28 years (SD=8.1, range 11-44) and mean duration of the seizure disorder was 13.4 years (range 2-36). Risk factors for epilepsy included head injury (n=4), encephalitis (n=3), febrile seizures (n=2), and 12 patients had no risk factors. Pathological evaluation of resected tissue revealed no abnormal pathology in 12/21 patients (57%). After a mean 4.8 years follow-up post-surgical period, 15/21 (71%) patients were free of disabling seizures (Engel I outcome). At 8.3 years follow-up, 13/21 (62%) patients had similar results. Absence of prior epilepsy risk factors was the only statistically significant predictor of an Engel class I outcome (p<0.0022). Patients with medically intractable epilepsy and normal MRI appear to benefit from epilepsy surgery. Absence of prior epilepsy risk factors may be a positive prognostic factor.
    Seizure 03/2011; 20(6):475-9. · 2.06 Impact Factor
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    ABSTRACT: The authors undertook a study to review the clinical features and outcome in patients who underwent surgery for intractable chronic epilepsy caused by temporal lobe tumors. The Rush Surgical Epilepsy Database was queried to identify patients with chronic intractable epilepsy who underwent resection of temporal lobe tumors between 1981 and 2005 at Rush University Medical Center. Medical records were reviewed for age of the patient at seizure onset, delay to referral for surgery, seizure frequency and characteristics, preoperative MR imaging results, extent of resection, pathological diagnosis, complications, duration of follow-up period, and seizure improvement. Thirty-eight patients were identified, all with low-grade tumors. Gangliogliomas were the most common (36.8%), followed in descending order by dysembryoplastic neuroepithelial tumors (26.3%) and low-grade diffuse astrocytoma (10.5%). The mean duration between seizure onset and surgery was 15.4 years. Complex partial seizures were the most common presenting symptom. Detailed operative data were available for 28 patients; of these, 89.3% underwent complete resection of the amygdala, and 82.1% underwent partial or complete resection of hippocampus, in addition to lesionectomy. The mean follow-up duration was 7.7 years (range 1.0-23.1 years), with 78.9% of patients having seizure status that improved to Engel Class I, 15.8% to Engel Class II, and 5.3% to Engel Class III. Permanent complications were noted in 2.6% of patients. The authors' examination of the long-term follow-up data in patients with temporal lobe tumors causing chronic intractable epilepsy demonstrated excellent results in seizure improvement after surgery.
    Neurosurgical FOCUS 09/2009; 27(2):E6. · 2.14 Impact Factor
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    ABSTRACT: Twenty-three patients had magnetic resonance imaging (MRI) and computed tomography (CT) of the head prior to surgery for medically intractable epilepsy. Eleven patients had neoplasms, mostly astrocytomas. Six of the 11 tumors were seen on CT. In five of the six cases, the MRI showed a focal area of increased signal on T2-weighted images. All 11 tumors were detected by MRI. None of the non-neoplastic lesions produced an abnormal T2-weighted signal area on MRI. Only one of the non-neoplastic lesions was seen on both CT and on MRI. MRI allowed clear discrimination between tumors and non-neoplastic lesions in patients coming to surgery for intractable epilepsy.RÉSUMÉ23 patients ont bénlificié une imagerie par résonnance mag-néique (IRM) et une scannographie (TDM) cérébrales avant traitement éhirurgical une épilepsie rebelle. 11 patients prése-ntaient une néoplasie, le plus souvent un astrocytome. La TDM a permis de mettre en évidence la tumeur chez 6 patients sur 11. IRM mit en evidence la tumeur dans 10 cas sur 11, avec un aspect augmentation focale du signal en T2. Aucune des lésions non néoplasiques n'a produit image pathologique en T2 à examen par IRM. Une seule tumeur a été visible à la fois en TDM et en IRM. IRM a permis de séparer clairement les tumeurs et les lésions non néoplasiques chez les patients hospitalisés pour chirurgie une épilepsie rebelle.RESUMENAntes de practicar cirugía en 23 enfermos con epilepsyía intrat-able médicamente se practiceó una Resonancia Magnética (MRI) y una Tomograffa Computarizada (CT). Once enfermos tertían neoplasias, la mayor parte astrocitomas. Los tumores fueron visualizados mediante la CT en 6 de 11 casos. En 5 de estos 6 casos, la MRI mostró un área focal de incremento de señal en las imágenes T2. Todos los 11 tumores fueron detectados mediante la MRI. Ninguna de las lesiones no-neoplásicas produjeron señates anormales en T2 mediante la MRI. Solamente un tumor se vio en ambas técnicas, la CT y la MRI. La MRI permitió aclarar la discriminación entre tumores y lesiones no-neoplásicas en pa-cientes que se programan para cirguía de la epilepsyía m4eAdicamente incurable.ZUSAMMENFASSUNGBei 23 Patienten mit medicamentös nicht behandelbarer Epi-lepsie wurden vor dem (Epilepsie) chircurgischen Eingriff NMR und CAT durchgeführt. 11 Patienten zeigten Neoplasmen, meist Astrozytome, die im CT nur 6 mal erschienen. 11 mal stellte das NMR den Tumor las fokales Signal bei T2-Gewichtung dar, bis auf eine Ausnahme. Keine der nicht-neoplastischen Laesionen erzeugte eine abnorme T2-Gewichtung im NMR. Nur eine Lae-sion wurde sowohl im CT als auch im NMR gesehen. Das NMR erlaubt somit eine klare Unterscheidung zwischen Tumor und nicht-neoplastischen Laesionen bei Patienten, die zur EpUepsie-Chirugie kommen.
    Epilepsia 11/2007; 30(3):318 - 321. · 4.58 Impact Factor

Publication Stats

54 Citations
13.11 Total Impact Points

Institutions

  • 2012
    • University of Illinois at Chicago
      • Department of Neurosurgery (Chicago)
      Chicago, IL, United States
  • 2011–2012
    • Rush University Medical Center
      • Department of Neurosurgery
      Chicago, Illinois, United States