Epileptic Disorders


Pediatric epilepsy surgery: the widening spectrum of surgical candidacy Volume 1, issue 3, Septembre 1999


Figure 1. (a) T1- weighted axial MR image of an 8 month-old boy with recent onset of infantile spasms. There is an area of high signal abnormality in the right hippocampal formation with involvement of the middle, superior and lingual gyrus, and blurring of the gray-white matter interface. There is mild mass effect on the hippocampal formation and temporal horn of the right lateral ventricle associated with a focal rounded cystic area in the region of the right parahippocampal gyrus. (b) Post-operative T1-weighted axial MR image in the same patient. The resection extends posteriorly for 4 cm from the right temporal pole, and includes the hippocampus, parahippocampus, middle and inferior temporal gyrus, anteriorly. Pathologic analysis of the specimen revealed a grade 2 fibrillary astrocytoma. Infantile spasms ceased immediately after surgery.


Figure 2. (a) Fast spin-echo T2 coronal MR image in a five year-old girl with gelastic seizures and severe behavioral problems. There is a non-enhancing mass, presumed to be a hamartoma, involving the left hypothalamus with protrusion into the medial inferior aspect of the third ventricle, and extension inferiorly towards the tuber cinereum. The mass measures 1.3 cm. in height. (b) T1-weighted coronal MR image obtained four months after gamma knife radiofrequency lesioning. There is an area of high signal in the mass that is believed to represent gliosis. She is seizure-free and has shown dramatic improvement in her behavior.