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Research Interests: Deep Brain Stimulation, Magnetic Resonance Imaging, Adolescent, Medicine, Brain Mapping, and 15 moreHumans, Cerebral Cortex, Female, Male, Neuronavigation, Clinical Sciences, Middle Aged, Ictal, Adult, Frontal Lobe, Brain Neoplasms, Gliosis, Functional Laterality, Neuropsychological Tests, and angioma
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BACKGROUND Glioblastoma with multiple localizations (mGBMs) can be defined as multifocal, where enhancing lesions present a connection visible on magnetic resonance imaging fluid-attenuated inversion recovery imaging, or multicentric, in... more
BACKGROUND Glioblastoma with multiple localizations (mGBMs) can be defined as multifocal, where enhancing lesions present a connection visible on magnetic resonance imaging fluid-attenuated inversion recovery imaging, or multicentric, in the absence of a clear dissemination pathway. OBJECTIVE To evaluate the role of the extent of resection (EOR) in the treatment of mGBMs and its correlation with overall survival (OS) and progression free survival (PFS). METHODS One hundred patients with mGBMs were treated at our Institution between 2009 and 2019. Clinical, radiological, and follow-up data were collected. EOR of the contrast-enhancing part of lesions was classified as gross total resection (GTR, absence of tumor remnant), subtotal resection (STR, residual tumor < 30% of the initial mass), partial resection (PR, residual tumor > 30% of the initial mass), and needle or open biopsy (residual tumor > 75% of the initial mass). RESULTS Approximately 15% of patients underwent GTR, 14% STR, 32% PR, and 39% biopsy. Median OS was 17 mo for GTR, 11 mo for STR, 7 mo for PR, and 5 mo for biopsy. Greater EOR was associated with a significantly longer OS than biopsy. GTR and STR were associated with a longer PFS in Kaplan-Meier survival analyses. After adjusting for age, Karnofsky performance status (KPS), number of lesions, and adjunctive therapy in multivariable Cox regression analyses, GTR, STR, and PR were still associated with OS, but only GTR remained associated with PFS. CONCLUSION Our study suggests that EOR may positively influence survival of patients with mGBM. Surgical resection can be a reasonable option when performance and access to adjuvant treatment can be preserved.
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Research Interests: Magnetic Resonance Imaging, Language, Medicine, Language disorders, Brain Mapping, and 15 moreHumans, Glioma, Female, Male, Incidence, Clinical Sciences, Middle Aged, Adult, Neurosciences, Brain Neoplasms, Postoperative Period, Functional Laterality, Neoplasm grading, Cerebrum, and Electric stimulation
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We describe a patient with focal epilepsy characterized by ictal asystole episodes and low-grade tumour over the left temporal neocortex. Non-invasive pre-surgical evaluation showed an epileptogenic zone extended beyond the low-grade... more
We describe a patient with focal epilepsy characterized by ictal asystole episodes and low-grade tumour over the left temporal neocortex. Non-invasive pre-surgical evaluation showed an epileptogenic zone extended beyond the low-grade tumour. This extension was confirmed by intraoperative electrocorticography. One-stage surgery with anterior temporal lobe resection was performed. The patient was seizure-free after one year of follow-up. Detailed electroclinical and therapeutic reasoning with hypotheses defining epileptogenic and symptomatogenic networks are discussed.
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BACKGROUND During surgery in the posterior fossa in the prone position, blood can sometimes fill the surgical field, due both to the less efficient venous drainage compared to the sitting position and the horizontally positioned surgical... more
BACKGROUND During surgery in the posterior fossa in the prone position, blood can sometimes fill the surgical field, due both to the less efficient venous drainage compared to the sitting position and the horizontally positioned surgical field itself. In some cases, blood clots can wedge into the cerebral aqueduct and the third ventricle, and potentially cause acute hydrocephalus during the postoperative course. OBJECTIVE To illustrate a technique that can be used in these cases: the use of a flexible scope introduced through the opened roof of the fourth ventricle with a freehand technique allows the navigation of the fourth ventricle, the cerebral aqueduct, and the third ventricle in order to explore the cerebrospinal fluid pathways and eventually aspirate blood clots and surgical debris. METHODS We report on one patient affected by an ependymoma of the fourth ventricle, for whom we used a flexible neuroendoscope to explore and clear blood clots from the cerebral aqueduct and the ...
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Resting-state functional MRI has been increasingly implemented in imaging protocols for the study of functional connectivity in glioma patients as a sequence able to capture the activity of brain networks and to investigate their... more
Resting-state functional MRI has been increasingly implemented in imaging protocols for the study of functional connectivity in glioma patients as a sequence able to capture the activity of brain networks and to investigate their properties without requiring the patients’ cooperation. The present review aims at describing the most recent results obtained through the analysis of resting-state fMRI data in different contexts of interest for brain gliomas: the identification and localization of functional networks, the characterization of altered functional connectivity, and the evaluation of functional plasticity in relation to the resection of the glioma. An analysis of the literature showed that significant and promising results could be achieved through this technique in all the aspects under investigation. Nevertheless, there is room for improvement, especially in terms of stability and generalizability of the outcomes. Further research should be conducted on homogeneous samples o...
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Purpose The definition of chronic adult hydrocephalus encompasses different pathological entities with overlapping characteristics, including long-standing overt ventriculomegaly in adults (LOVA), late-onset idiopathic aqueductal stenosis... more
Purpose The definition of chronic adult hydrocephalus encompasses different pathological entities with overlapping characteristics, including long-standing overt ventriculomegaly in adults (LOVA), late-onset idiopathic aqueductal stenosis (LIAS) and idiopathic normal pressure hydrocephalus (iNPH). The aim of our study was to identify preoperative clinical and radiological features peculiar of these diseases providing some pathophysiology inferences on these forms of hydrocephalus. Methods Clinical and radiological preoperative records, type of surgical treatment and clinical outcome of patients with chronic adult hydrocephalus who were surgically treated between 2013 and 2019 were retrospectively reviewed. Univariate and multivariate analyses were performed to evaluate the contribution of each variable to the differential diagnosis. Results In total, 105 patients were included: 18 with LOVA, 23 with LIAS and 64 with iNPH. On multivariate analysis, an enlarged cisterna magna and a mo...
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Focal cortical dysplasia (FCD) type IIb is a frequent cause of pharmacoresistant epilepsy. However, intraoperative identification of the pathological tissue still remains a challenge despite the use of neuronavigation, particularly when... more
Focal cortical dysplasia (FCD) type IIb is a frequent cause of pharmacoresistant epilepsy. However, intraoperative identification of the pathological tissue still remains a challenge despite the use of neuronavigation, particularly when it lies in eloquent areas. We here report a case of intraoperative identification of a right frontal FCD type IIB through ultrasound assisted neuronavigation during awake surgery in a patient with drug-resistant epilepsy. Intraoperative ultrasound may have a role in focal cortical dysplasia localization optimizing its resection. In selected patient submitted to epilepsy surgery the integration of disposable technologies (i.e. brain neuronavigation, fMRI and iUS) with awake surgery could improve FCD identification preventing unacceptable neurological morbidity.
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Objective The aim of the present study is to evaluate a neurocognitive outcome in patients affected by late-onset idiopathic aqueductal stenosis (LIAS) who underwent endoscopic third ventriculostomy (ETV). Materials and Methods A... more
Objective The aim of the present study is to evaluate a neurocognitive outcome in patients affected by late-onset idiopathic aqueductal stenosis (LIAS) who underwent endoscopic third ventriculostomy (ETV). Materials and Methods A prospective study was conducted between January 2015 and December 2017 in a series of 10 consecutive adult patients referred to the Neurosurgery Department of IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy. All the adult patients admitted with absence of CSF flow through the aqueduct in phase-contrast (PC)—MRI sequences or a turbulence void signal in T2—weighted images in midsagittal thin-slice MR sequences underwent a specific neuroradiological, neurological, and neurocognitive assessment pre- and postoperatively. Results All patients affected by gait and sphincter disturbances improved after ETV. Attentive and executive functions as well as visuo-spatial memory and verbal executive functions improved in several patients. Similarly, t...
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We describe a multicenter experience with VNS implantation in pediatric patients with epileptic encephalopathy. Our goal was to assess VNS efficacy and identify potential predictors of favorable outcome. This was a retrospective study.... more
We describe a multicenter experience with VNS implantation in pediatric patients with epileptic encephalopathy. Our goal was to assess VNS efficacy and identify potential predictors of favorable outcome. This was a retrospective study. Inclusion criteria were: ≤18 years at the time of VNS implantation and at least one year of follow-up. All patients were non-candidates for excisional procedures. Favorable clinical outcome and effective VNS therapy were defined as seizure reduction >50%. Outcome data were reviewed at one, two, three and five years after VNS implantation. Fisher's exact test, Kaplan-Meier and multiple logistic regression analysis were employed. Twenty-seven patients met inclusion criteria. Responder rate (seizure frequency reduction ≥ 50%) at one-year follow-up was 25.9%, and 15.3% at last follow-up visit. The only variable significantly predicting favorable outcome was time to VNS implantation, with the best outcome achieved when VNS implantation was performed within five years of seizure onset (overall response rate of 83.3% at one year of follow-up and 100% at five years). In total, 63% of patients evidenced improved QOL at last follow-up visit. Only one patient exited the study due to an adverse event at two years from implantation. Early VNS implantation within five years of seizure onset was the only predictor of favorable clinical outcome in pediatric patients with epileptic encephalopathy. Improved QOL and a very low incidence of adverse events were observed.
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Patients with hypothalamic hamartomas (HHs) located at the level of the mammillary bodies may present with a peculiar epileptic syndrome characterized by gelastic seizures and, commonly, falls.1–4 Associated symptoms can include... more
Patients with hypothalamic hamartomas (HHs) located at the level of the mammillary bodies may present with a peculiar epileptic syndrome characterized by gelastic seizures and, commonly, falls.1–4 Associated symptoms can include developmental delay, cognitive deterioration, psychiatric disorders, central precocious puberty, and sleep disturbances.1,4–6 Here, we report the case of an adult patient with HH and excessive daytime sleepiness (EDS) in whom CSF analysis disclosed low levels of hypocretin-1, a finding consistently observed in patients with type 1 narcolepsy.7
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Hippocampal sclerosis (HS) is the most common cause of drug-resistant medial temporal lobe epilepsy (MTLE). Structural abnormalities such as HS, granule cell pathology (GCP) and focal cortical dysplasia (FCD), have been... more
Hippocampal sclerosis (HS) is the most common cause of drug-resistant medial temporal lobe epilepsy (MTLE). Structural abnormalities such as HS, granule cell pathology (GCP) and focal cortical dysplasia (FCD), have been histopathologically classified possibly allowing more accurate prognostic seizure and neuropsychological outcome assessment. We correlated seizure outcome with comprehensive temporal lobe pathological findings, identified according to the most recent classification systems of HS, GCP and FCD. All the 83 patients submitted to anterior temporal lobectomy (ATL) for drug-resistant MTLE and with a proven diagnosis of HS between April 2001 and May 2014 were collected. Patients were divided in two main groups: 1) Isolated HS with/without GCP (HS +/- GCP) 2) HS associated with FCD with/without GCP (HS+FCD +/- GCP). Patients were followed up at least 1 year and seizure outcome was reported in accordance with Engel classification. Group I: HS +/- GCP: Statistical analysis conf...
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Magnetic resonance imaging (MRI) is mandatory to identify the epileptogenic zone in refractory temporal lobe epilepsy (TLE). The correct identification of lesions is essential to obtain good post-surgery seizure control. Low grade tumours... more
Magnetic resonance imaging (MRI) is mandatory to identify the epileptogenic zone in refractory temporal lobe epilepsy (TLE). The correct identification of lesions is essential to obtain good post-surgery seizure control. Low grade tumours (LGT) and focal cortical dysplasia (FCD) are common findings in symptomatic TLE, and frequently coexist. The aim of this study was to identify the MRI characteristics in the diagnosis of FCD associated with LGT. We analyzed 24 subjects with TLE who underwent tailored surgery. They all had LGTs. Two expert neuroradiologists analyzed the imaging data and compared them with histological results, hypothesizing the causes of diagnostic errors in the identification of FCD. We selected three exemplary cases to report the most important causes of errors. In the diagnosis of FCD we reported false positives and false negatives due to different causes. An incomplete MRI protocol, the large dimensions of the tumour, infiltration and related oedema were the mos...
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Focal cortical dysplasias (FCDs) represent a common architectural cortical disorder underlying pharmacoresistant focal epilepsy. The recent ILAE classification defines different types of FCDs based on their histopathological features, MRI... more
Focal cortical dysplasias (FCDs) represent a common architectural cortical disorder underlying pharmacoresistant focal epilepsy. The recent ILAE classification defines different types of FCDs based on their histopathological features, MRI imaging, and presumed pathogenesis; however, their clinical features and their prognostic significance are still incompletely defined. In addition, the combination of different histopathological abnormalities can represent "unusual" subtypes that can be difficult to classify. The aim of our study was to analyze the incidence and the significance of these "unusual" subtypes of FCDs in drug-resistant mesial temporal lobe epilepsy (MTLE). We retrospectively analyzed 133 patients consecutively submitted to tailored anteromesial temporal lobe resection for pharmacoresistant MTLE. Seizure onset, seizure duration, age at surgery, and postoperative seizure outcome were evaluated in relation to the different neuropathological groups defi...
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In recent years, increasing attention has been placed on epilepsy associated with low-grade tumors and focal cortical dysplasias. The focus has been directed to the neuropathological classification aspects [1] regarding the assessment of... more
In recent years, increasing attention has been placed on epilepsy associated with low-grade tumors and focal cortical dysplasias. The focus has been directed to the neuropathological classification aspects [1] regarding the assessment of histological types and subtypes, to the denominations used for this cluster of tumors [2–4] and to the timing of surgical treatment [5, 6]. Some considerations can be drawn from our experience in this field of epilepsy surgery [7–15]. The main key points are classification aspects, the terminology used for these tumors, and the timing of surgical treatment when faced with pharmacoresistance.
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Glioneuronal tumors (GNTs) are an increasingly recognized cause of focal epilepsies, particularly in children and young adults. GNTs consist of a mixture of glial and neuronal elements and most commonly arise in the temporal lobe,... more
Glioneuronal tumors (GNTs) are an increasingly recognized cause of focal epilepsies, particularly in children and young adults. GNTs consist of a mixture of glial and neuronal elements and most commonly arise in the temporal lobe, particularly in the temporo-anterior-basal mesial site. They are often associated with cortical dysplasia or other neuronal migration abnormalities. Epilepsy associated with GNT is poorly controlled by antiepileptic drugs in many cases; but, it is extremely responsive to surgical treatment. However, the best management strategy of tumor-related focal epilepsies remains controversial and still remain one of the contemporary issues in epilepsy surgery. Temporo-mesial GNT are associated with a widespread epileptic network, defining, therefore, a distinct anatomo-clinico-pathological group with complex epileptogenic mechanisms. By using an epilepsy surgery oriented strategy GNT associated with focal epilepsies may have an excellent seizure outcome and, therefo...
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We have read with great interest the paper of Wirrel et al. [1]. We entirely agree with the authors that the etiology is an important determinant of pharmacoresistance in nonsyndromic focal epilepsies and that a lesional group is more... more
We have read with great interest the paper of Wirrel et al. [1]. We entirely agree with the authors that the etiology is an important determinant of pharmacoresistance in nonsyndromic focal epilepsies and that a lesional group is more likely prone to pharmacoresistance. Therefore, we absolutely agree that the concept of pharmacoresistance should be used more strictly to refer specific groups of patients, such as those with lesional epilepsies. Also, as the authors properly stated, among lesional cases, it is important to consider further differences based on the lesion type and subtype [2–6]. The importance of pathological substrate on seizure outcome after epilepsy surgery has been recently underlined [2–10] with the evidence that different pathological subtypes are associated with different postsurgery seizure outcomes. In the last decade, the concept of a long-term epilepsy-associated tumor (LEAT) has been developed to describe the spectrum of lowgrade tumors identified in patients investigated for long histories of drug-resistant epilepsy [11–13]. The most common tumor subtypes are represented by glioneuronal tumors, in particular gangliogliomas (GGs) and dysembryoplastic neuroepithelial tumors (DNTs), which share relatively benign clinical behavior and long duration of epilepsy. These tumors are an increasingly recognized cause of focal refractory epilepsies, particularly in children and young adults, and are frequently associated with focal cortical dysplasia [2,13–15]; a possible pathogenetic relationship between these epileptogenic entities has been suggested [16–18]. Seizure outcome after epilepsy surgery for an epilepsy-associated tumor are very good, with more than 80–90% of patients seizure-free [2,11,13,15,19–21]. This group of tumors should be hence considered as a prototype of a “surgically remediable cause of epilepsy”. Therefore, an epilepsyassociated tumor (EAT) should be properly and quickly diagnosed by adequate imaging and neurophysiological investigations and considered early for surgical treatment, irrespective of pharmacoresistance. Afterward, surgery should be offered early to avoid psychosocial consequences of persistent seizures and/or adverse effects of pharmacological treatment and even prevent the rare risk of tumor growth and malignant transformation [2,11,13,15,19–23]. In addition, according to the authors, early epilepsy surgery may reduce the risk of sudden unexplained death (SUDEP) or seizure-related injury. Therefore, soon, the acronym “LEAT” could be changed to “EAT”, as, with early diagnosis and treatment, the misleading adjective “long-
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Research Interests: Neurosurgery, Epilepsy, Humans, Female, Male, and 3 moreClinical Sciences, Neurosciences, and Brain Neoplasms
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Object The authors retrospectively analyzed and compared seizure outcome in a series of 28 patients with temporomesial glioneuronal tumors associated with epilepsy who underwent 1 of 2 different epilepsy surgery procedures: lesionectomy... more
Object The authors retrospectively analyzed and compared seizure outcome in a series of 28 patients with temporomesial glioneuronal tumors associated with epilepsy who underwent 1 of 2 different epilepsy surgery procedures: lesionectomy or tailored resection. Methods The 28 patients were divided into 2 groups, with 14 cases in each group. In Group A, surgery was limited to the tumor (lesionectomy), whereas Group B patients underwent tailored resection involving removal of the tumor and the epileptogenic zone as identified by a neurophysiological noninvasive presurgical study. Results In Group A (10 male and 4 female patients) the interval between onset of seizures and surgery ranged from 1 to 33 years (mean 10.6 years). Patients' ages ranged from 3 to 61 years (mean 23.1 years). The epileptogenic lesion was on the left side in 6 patients and the right in 8 patients. Mean follow-up was 9.8 years (range 6.5–15 years). The Engel classification system, used to determine postoperativ...
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Object The study was performed to investigate the relation between seizure outcome after surgical treatment of mesial temporal lobe epilepsy (MTLE) and pathological findings, classified according to the recently proposed classifications... more
Object The study was performed to investigate the relation between seizure outcome after surgical treatment of mesial temporal lobe epilepsy (MTLE) and pathological findings, classified according to the recently proposed classifications of mesial temporal sclerosis (MTS), granule cell pathology (GCP), focal cortical dysplasia (FCD) and epilepsy-associated low-grade tumors (ELGT). Methods The authors analyzed data obtained in 120 consecutive cases involving patients presenting with drug-resistant MTLE, who underwent tailored anteromesial temporal lobe resection, and correlated seizure outcome with pathological findings. They identified 5 histopathological groups: Group 1—ELGT, alone or associated with other lesions (30 cases); Group 2—isolated FCD (17 cases); Group 3—MTS, with or without GCP (28 cases); Group 4—MTS associated with FCD, with or without GCP (37 cases); Group 5—other lesions (8 cases). Results Engel Class I outcome was observed in 83% of patients with ELGT (Class IA in ...
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To the Editors: We have read with great interest the article entitled Cavernoma-related epilepsy: Review and recommendations for management—Report of the Surgical Task Force of the ILAE Commission on Therapeutic Strategies, by Rosenow et... more
To the Editors: We have read with great interest the article entitled Cavernoma-related epilepsy: Review and recommendations for management—Report of the Surgical Task Force of the ILAE Commission on Therapeutic Strategies, by Rosenow et al. 1 The authors presented an interesting review of the strategies that could be adopted in case of cavernomarelated epilepsy (CRE), which is still a controversial issue. We agree with the authors about the necessity to remove, whenever possible and without causing deficits, the surrounding cortical gliotic tissue, usually stained by hemosiderin. Regarding CRE patients with dual and triple pathology, we also agree that these patients will not be rendered seizure free by the removal of a single lesion, but we think that in the majority of cases a noninvasive presurgical study (i.e., video–electroencephalography [EEG] monitoring) might be sufficient to define the epileptogenic zone. Furthermore, detection of the associated pathology, namely focal cortical dysplasia type IIIc, with magnetic resonance imaging (MRI) continues to be a challenge, and identification is more often a result of histopathologic examination. In cases of cavernoma associated with pharmacoresistant epilepsy or with a long history of epilepsy, the suspicion of a coexistent pathology hidden at MRI might arise, as in the case of glioneuronal tumors or multiple cavernomas. Therefore, we believe that a presurgical noninvasive neurophysiologic study (video-EEG monitoring) could be useful. The association of cavernoma with hippocampal sclerosis or other lesions not detected by MRI but potentially epileptogenic, such as subtle forms of malformation of cortical development, emphasizes the importance of an extensive noninvasive presurgical study (video-EEG monitoring), which might suggest a possible correlation between the lesion and the identification of the epileptogenic zone. Consequently, the surgical strategy follows a tailored procedure apt to remove both the structural lesion and the epileptogenic area. However, during surgery in eloquent areas, the possible functional significance of pericavernous cerebral tissue, the preservation of which represents one of the main factors leading to the surgical procedure, should be borne in mind. In addition, it is important to recommend a strict neuropathologic protocol that can highlight any associated pathology such as subtle forms of cortical dysplasias. Therefore, in case of focal epilepsy associated with only one cavernoma, as for patients with multiple cavernomas, we consider it unnecessary and dangerous to recommend “invasive evaluations” associated with major risks. Such considerations are particularly relevant in this field where other associated vascular malformations, such as venous angiomas, or other developmental venous anomalies and microvascular abnormalities, might be present.
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We retrospectively analyzed 29 seizure-associated temporal lobe low-grade tumors to evaluate the utility of CD34 and bcl-2 expression in clarifying the relationship of these tumors with different classes of focal cortical dysplasia (FCD).... more
We retrospectively analyzed 29 seizure-associated temporal lobe low-grade tumors to evaluate the utility of CD34 and bcl-2 expression in clarifying the relationship of these tumors with different classes of focal cortical dysplasia (FCD). CD34 immunostained 75% of gangliogliomas (GG) and 60% of pleomorphic xanthoastrocytomas. FCD type IIIb [i.e. abnormal cortical layering associated with a glioneuronal tumor, according to the new International League Against Epilepsy (ILAE) classification] presented CD34-immunopositive cells in 2/9 (22.2%) cases, whereas FCD type II in 6/7 (85.7%) cases, a difference statistically significant (p = 0.0117). Bcl-2 immunostained 9/12 (75%) gangliogliomas and 2/3 (66.6%) gangliocytomas. The cases of FCD type IIIb resulted negative for Bcl-2, whereas 4/7 cases (57.1%) of FCD type II showed immunopositive cells. These differences in Bcl-2 expression between FCD type IIIb and FCD type II resulted statistically significant (p = 0.0088). Abnormal cortical layering, overall, represents the kind of FCD more commonly associated with seizure-related low-grade tumors, whereas FCD type II is more frequently associated with GG. The profile of CD34 and Bcl-2 expression exhibited by GG is more similar to that observed in FCD type II. Such immunoprofile suggests the existence of a common pathogenesis linking glioneuronal tumors and FCD type II.
Research Interests: Immunology, Malformations of Cortical Development, Medical Microbiology, Epilepsy, Immunohistochemistry, and 15 moreAdolescent, Humans, Child, Female, Male, Young Adult, Clinical Sciences, Middle Aged, Adult, Retrospective Studies, Chi Square Distribution, Brain Neoplasms, Brain Diseases, Child preschool, and Neoplasm grading
Glioneuronal tumors (GNTs) are an increasingly recognized cause of focal epilepsies, particularly in children and young adults. These tumors consist of a mixture of glial and neuronal elements and most commonly arise in the temporal lobe,... more
Glioneuronal tumors (GNTs) are an increasingly recognized cause of focal epilepsies, particularly in children and young adults. These tumors consist of a mixture of glial and neuronal elements and most commonly arise in the temporal lobe, particularly in the temporo-anterio- basal mesial site and are often associated with cortical dysplasia or other neuronal migration abnormalities. Typically, epilepsy associated with GNT is insufficiently controlled by antiepileptic drugs. On the other hand, epilepsies associated with GNTs are extremely responsive to surgical treatment. However the best management strategy of tumor related focal epilepsy syndrome remains controversial and is one of the contemporary issues in epilepsy surgery. Temporo-mesial GNT are associated with a widespread epileptic network, defining therefore a distinct anatomo-clinico-pathological group with complex epileptogenic mechanisms. The best seizure outcome results are obtained with resection of the tumor and the adjacent epileptogenic zone as identified by non invasive presurgical neurophysiological study. By using an epilepsy surgery oriented strategy to treat temporomesial GNT associated with focal epilepsies an excellent seizure outcome can be achieved, and therefore surgical treatment can be offered early to avoid both the consequences of uncontrolled seizures as well as the side effects of prolonged pharmacological therapy and the rare risk of tumor grow or malignant transformation.
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Background: Tractography has been widely adopted to improve brain gliomas' surgical planning and guide their resection. This study aimed to evaluate state-of-the-art of arcuate fasciculus (AF) tractography for surgical planning and... more
Background: Tractography has been widely adopted to improve brain gliomas' surgical planning and guide their resection. This study aimed to evaluate state-of-the-art of arcuate fasciculus (AF) tractography for surgical planning and explore the role of along-tract analyses in vivo for characterizing tumor histopathology.Methods: High angular resolution diffusion imaging (HARDI) images were acquired for nine patients with tumors located in or near language areas (age: 41 ± 14 years, mean ± standard deviation; five males) and 32 healthy volunteers (age: 39 ± 16 years; 16 males). Phonemic fluency task fMRI was acquired preoperatively for patients. AF tractography was performed using constrained spherical deconvolution diffusivity modeling and probabilistic fiber tracking. Along-tract analyses were performed, dividing the AF into 15 segments along the length of the tract defined using the Laplacian operator. For each AF segment, diffusion tensor imaging (DTI) measures were compared w...
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The Leucine-rich glioma inactivated 1 (LGI1) protein is thought to be implicated in malignant progression of glioma tumors, and mutations in the encoding gene, LGI1, cause autosomal dominant lateral temporal epilepsy, a genetic focal... more
The Leucine-rich glioma inactivated 1 (LGI1) protein is thought to be implicated in malignant progression of glioma tumors, and mutations in the encoding gene, LGI1, cause autosomal dominant lateral temporal epilepsy, a genetic focal epilepsy syndrome. The aim of this study was to investigate the possible involvement of LGI1 in high-grade glioma-associated epilepsy by analyzing its expression in tumor specimens of patients with and without epilepsy and by searching for LGI1 autoantibodies in the sera these patients. We examined tumor tissue samples from 24 patients with high-grade gliomas (12 with and 12 without epilepsy) by immunoblot and detected variable amounts of LGI1 in tumor tissues from 9/24 (37%) patients. LGI1 was detected in 7/12 (58%) patients with epilepsy and in 2/12 (16%) patients without epilepsy (p = 0.0894; Fisher's exact test). Moreover, testing blood sera of five patients for antibodies against LGI1 revealed LGI1 autoantibodies in two patients, both suffering...