Richard V Andrews

University of Nebraska Medical Center, Omaha, Nebraska, United States

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Publications (2)4.3 Total impact

  • Arun-Angelo Patil, Richard V Andrews
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    ABSTRACT: : The conventional procedure of hippocampectomy can impair memory. Furthermore, the hippocampus is the main source of stem cells. On the other hand, multiple hippocampal transection (MHT) can disrupt seizure circuits without loss of function or stem cells. In this presentation therefore, the authors will present long term outcomes in patients who had MHT for unilateral temporal lobe epilepsy. : There were 15 patients with a male/female ratio of 2-to-1; follow-up of 24 to 60 months (median of 41 months); and ages between 25 and 60 years. Preoperative electrocorticography (ECoG) was done using subdural and depth electrodes. All patients had multiple subpial transection (MST) on the neocortex and MHT on the hippocampus. Access to the hippocampus was gained through the middle temporal gyrus. Transverse cuts were made in the hippocampus at 4 mm intervals. The fimbria and entorhinal cortex were left intact. Amygdala was removed if it was epileptogenic (10 patients). Intraoperative ECoG was then done. If recordings showed epileptogenic activity, transections were repeated. If this activity persisted, the involved neocortex was resected. : Based on intraoperative ECoG, repeat transections were needed in every case; though the second pass was over a much smaller area. Resection of temporal tip (1-2.5 cm diameter) was needed in 11 patients. There were no permanent neurological complications. Fourteen patients (94.7%) are Seizure free (Engel's class I) and 1 (6%) has rare seizures (class II). Neuropsychological studies showed that verbal memory was preserved. : Although the series is small the long-term follow-up is adequate to draw preliminary conclusions. The results show that the seizure outcome with MHT is better than those reported with standard temporal lobectomy. The study also shows that intraoperative ECoG is important in order to conclude adequacy of the procedure. These conclusions indicate that this procedure needs to be persued as an alternate to hippocampectomy.
    Neurosurgery 08/2012; 71(2):E568. · 2.53 Impact Factor
  • Arun-Angelo Patil, Richard V Andrews
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    ABSTRACT: Clinical experience with a new surgical procedure called multiple hippocampal transections is described. In this procedure, seizure circuits within the hippocampus are disrupted by making multiple cuts parallel to the hippocampal digitations; while the vertical functional fibers are preserved. Ten patients with temporal lobe epilepsy are described. The male/female ratio is 6:4, the ages of the patients were 20-53 years, and follow-up periods were 10-34 months, with a median of 21 months. Five patients had no hippocampal sclerosis, two had minimal sclerosis, and three had significant sclerosis. Six patients had surgery on the dominant side and five had failed the Wada test. Multiple hippocampal transections were made at 4-mm intervals. The neocortex was then treated with multiple subpial transections. In addition, six patients had resections of the temporal tip. There were no permanent neurologic complications: seven patients are seizure-free, two have rare seizures, and one has 60% decrease in seizure frequency. Eight patients had both pre- and postoperative memory testing. Among these eight patients, five had improved verbal memory, three had improved visual memory, and three had a slight drop in visual memory. This is a small series with a short follow-up period. However, the results are encouraging enough to warrant further trials. In addition, this may be an effective alternative procedure for those who fail the Wada test and do not have significant temporal lobe sclerosis or who have seizures originating from the dominant side.
    World Neurosurgery 12/2010; 74(6):645-9. · 1.77 Impact Factor

Publication Stats

4 Citations
4.30 Total Impact Points

Top Journals

Institutions

  • 2010–2012
    • University of Nebraska Medical Center
      • Division of Neurosurgery
      Omaha, Nebraska, United States