Objective: The purpose of this examine was to make use of voxel-based MRI post-processing in detection of delicate FCD in drug-resistant operculoinsular epilepsy sufferers with unfavourable presurgical MRI, and by combining magnetoencephalography (MEG) to enhance the localization of epileptogenic zone.
Methods: Operculoinsular epilepsy sufferers with a unfavourable presurgical MRI had been included in this examine. MRI post-processing was carried out utilizing a Morphometric Analysis Program (MAP) on T1-weighted volumetric MRI.
Clinical data together with semiology, MEG, scalp electroencephalogram (EEG), intracranial EEG and surgical technique was retrospectively reviewed. The pertinence of MAP-positive areas was confirmed by surgical consequence and pathology.
Results: A complete of 20 sufferers had been identified with operculoinsular epilepsy had non-lesional MRI throughout 2010-2018, of which 11 sufferers with resective surgical procedures had been included. MEG confirmed clusters of single equal present dipole (SECD) in inferior frontal areas in 5 sufferers and temporal-insular/ frontal-temporal-insular/parietal-insular areas in 5 sufferers.
Four out of 11 sufferers had optimistic MAP outcomes. The MAP optimistic fee was 36.4%.
The optimistic areas had been in insular in one affected person and operculoinsular areas in three sufferers. Three of the 4 sufferers who had been MAP-positive bought seizure-free after efficiently resect the MAP-positive and MEG-positive areas (the pathology outcomes had been FCD IIb in two sufferers and FCD IIa in one affected person).
Conclusions: MAP is a useful gizmo in detection the epileptogenic lesions in sufferers with MRI-negative operculoinsular epilepsy. Notably, in order to make a proper surgical regime choice, MAP outcomes ought to all the time be interpreted in the context of the affected person’s anatomo-electroclinical presentation.
Surgery of renal artery aneurysms: A monocentric retrospective examine
To report the outcomes of standard surgical procedure for renal artery aneurysms (RAA) in our middle.We retrospectively reviewed the recordsdata of all of the sufferers operated for RAA between 2009 and 2018 in our middle. We collected demographic, organic (renal perform), morphological (CT-scan), and practical (ultrasound examination, resistance index) pre and postoperative knowledge.
Clinical and paraclinical operative knowledge had been examined. Results had been expressed as common ± customary deviation or median and extremes.26 aneurysms had been operated in 20 kidneys (10 proper kidneys) amongst 19 sufferers, together with 13 (68%) ladies with a mean age of 55 (±12) years.
Three (16%) sufferers offered an aneurysm in a single kidney. The discovery of the aneurysm was fortuitous in 14 (74%) sufferers. One Marfan affected person was operated after a postpartum rupture. The median diameter of the operated aneurysms was 22 mm (7-48), and 23 (90%) had been hilar aneurysms.
Arterial restore was carried out in situ in 16 (80%) kidneys. The surgical procedure consisted of a direct arterial restore in 21 circumstances (81%), together with 4 resections and anastomosis, 12 aneurysmorraphies, and 5 complicated reconstructions. Four arterial replacements had been carried out (one prosthetic graft, two femoral grafts, and one inner iliac graft). The common length of renal clamping was 30.5 (±17.3) min.
Postoperative renal perform was unchanged in all of the sufferers besides one (5.2%) who required two days of postoperative dialysis. The resistance index of all of the operated kidneys was regular (0.66±0.08) at discharge. Sixteen (70%) of the 23 aneurysms examined, anatomo–pathology concluded to a dysplastic origin.
At three months, a scientific CT-scan objectified the patency of 95% of the arterial reconstructions however with three stenoses > 50%. One stenosis > 80% was handled at seven months by balloon angioplasty. Only one operated kidney offered a loss of viability of its higher pole. The imply length of follow-up was 54 ± 35 months.
By the top of the follow-up, major and secondary patency charges evaluated by Doppler ultrasound had been 90 and 95%, respectively.Conventional surgical procedure usually carried out in situ stays a positive and efficient therapy for RAA. This difficult surgical procedure for a uncommon illness ought to be carried out in experimented facilities.