Search Results (13)

Background/Objectives: Intrapulmonary metastasis (IPM) after an initial single primary lung cancer (SPLC) is an adverse follow-up pattern; however, when studying population-based longitudinal records, the determinants remain unclear. We aimed to identify factors associated with subsequent IPM after initial SPLC using artificial intelligence (AI)-driven analytical approaches. Methods: We used Surveillance, Epidemiology, and End Results (SEER) lung cancer records from 2000 to 2019. Adults with at least two records were restricted to those with SPLC at the first record. Outcome at the second record was registry-classified IPM versus persistent SPLC. A machine learning framework based on random forest models was developed using baseline variables, first record characteristics, and the interval between records. Temporal validation was performed by training on cases from 2000 to 2013 and testing on cases from 2014 to 2019. A dynamic Bayesian network (DBN) supported simulated intervention (SI) analyses to estimate model-implied risk ratios (RRs) with 95% confidence intervals (CIs). Results: Among 3450 patients, 361 had registry-classified IPM at the second record. The random forest model achieved an area under the curve (AUC) of 0.852 in internal validation and 0.929 in temporal validation. Surgery and record timing were the leading predictors. The DBN retained surgery as the only direct parent and achieved an AUC of 0.779. SI analyses showed higher IPM probability for pleural invasion level (PL) 3 versus PL 0, RR 1.378 (95% CI, 1.080–1.657). Lobectomy with mediastinal lymph node dissection versus wedge resection lowered the IPM probability, RR 0.378 (95% CI, 0.219–0.636). Conclusions: AI-based time-sequence modeling integrating machine learning and a DBN allowed for the identification of surgery, pleural invasion, and record timing as key factors associated with subsequent IPM classification after initial SPLC. This framework demonstrates the potential of combining predictive and probabilistic dependency modeling to investigate registry-based disease classification patterns, and may support hypothesis generation for future prospective studies. Full article

Background/Objectives: The extent of initial surgical resection for low-risk papillary thyroid carcinoma (PTC) remains debated. Traditionally, total thyroidectomy (TT) has been the standard approach, although the 2015 American Thyroid Association (ATA) guidelines endorsed a more conservative strategy. The real-world adoption of these recommendations, however, is unclear. This study evaluated changes in the surgical management of low-risk PTC in a high-volume center following the implementation of the ATA guidelines and analyzed the impact on postoperative outcomes. Methods: We conducted a retrospective study of 1644 patients who underwent surgery for localized low-risk PTC < 4 cm between 2014 and 2023. Temporal trends in the initial surgical procedure (TT vs. thyroid lobectomy [TL]) were analyzed overall and by tumor size and patient demographics. The need for completion thyroidectomy after TL and postoperative outcomes were also assessed. Results: The use of TL increased from 0% in 2014 to 59.4% in 2023 (p < 0.001). For microcarcinomas, TL rose from 17.5% in 2016 to 78% in 2023, with similar but less pronounced trends for 1–2 cm tumors. TT remained predominant for nodules > 2 cm. The completion thyroidectomy rate declined from 32% in 2016 to 4% in 2022. Patients undergoing TT experienced higher rates of postoperative complications (12.4% vs. 3.0%), particularly transient hypoparathyroidism (8.9% vs. 0%), and permanent hypoparathyroidism (1.8% vs. 0%), as well as longer operative time and hospital stay (all p < 0.001). The incidence of hypoparathyroidism decreased over time as TL use increased. Conclusions: Adoption of the 2015 ATA guidelines has progressively increased the use of TL in the management of low-risk PTC. This shift in surgical practice is associated with a reduction in the overall postoperative complication burden at the population level, largely driven by decreased hypoparathyroidism. Although guideline uptake has been gradual, current trends suggest increasing acceptance of less aggressive surgical strategies in routine clinical practice. Full article

Background and Objectives: Evidence on epilepsy surgery from Central Asia is limited, reflecting the real-world challenges of developing this service in low- and middle-income settings. We evaluated one-year seizure outcomes after resective surgery for drug-resistant focal epilepsy at a single center in Kazakhstan, and we assessed whether the use of advanced presurgical imaging was associated with seizure freedom. Materials and Methods: A retrospective cohort study was conducted, including consecutive adults who underwent curative-intent resective epilepsy surgery from 2017 to 2023. Outcomes at 12 months or more post-surgery were classified using the Engel criteria. Logistic regression was used to examine associations between the advanced presurgical diagnostic tool and achieving an Engel class I outcome. Crude and adjusted risk ratios (RRs) for not achieving Engel I were estimated using modified Poisson regression with robust SEs. Results: Among 112 patients (median age 31 years; median epilepsy duration 19 years), 76% underwent temporal lobe procedures and 71% had lobectomies. At one year, 74 patients were seizure-free (Engel II: 15.2%, III: 11.6%, IV: 7.1%). Year-to-year Engel I rates varied without a significant linear trend from 2018 to 2023. In bivariable analyses, MRI-defined atrophy (RR, 3.14) and mixed lesions (RR, 2.62) were associated with a higher risk of not achieving Engel I, whereas longer epilepsy duration was linked to a lower risk (RR, 0.97 per year). In adjusted models, predictors of not achieving Engel I included generalized tonic–clonic seizures (aRR, 1.96), atrophy (aRR, 2.98), mixed lesions (aRR, 2.45), and undergoing any advanced diagnostic test (aRR, 3.38). Longer epilepsy durations remained protective (aRR 0.95 per year). In modality-specific logistic models, fMRI use was associated with higher odds of Engel I (aOR 3.39), and MR spectroscopy was associated with lower odds (aOR 0.33). Conclusions: In this Central Asian single-center cohort, about two-thirds of adults achieved complete seizure freedom one year after resective surgery—comparable to international benchmarks. Advanced imaging modalities showed divergent associations with outcomes, likely reflecting confounding by indication. These findings support the feasibility of effective epilepsy surgery in a low-resource context and the value of targeted use of advanced imaging. Full article

Background/Objectives: For patients with medically refractory temporal lobe epilepsy (TLE), surgery is an effective strategy. However, post-operative seizure recurrence occurs in 20–30% of patients, and it remains challenging to predict outcomes solely based on clinical variables. Here, we ask to what extent differences in gene expression in epileptic tissue can predict the outcome after resective epilepsy surgery. Methods: We performed RNAseq on hippocampal tissue resected from eight patients who underwent anterior temporal lobectomy with amygalohippocampectomy (ATL/AH), half of whom became seizure free (SF) or non-seizure free (NSF). Results: Bioinformatic analyses revealed 1548 differentially expressed genes and statistical enrichment analyses identified a distinct set of pathways in NSF and SF cohorts that were associated with neuroinflammation, neurotransmission, synaptic plasticity, and extracellular matrix (ECM) reorganization. Resected tissue exhibiting strong pro-inflammatory processes are associated with better post-surgery seizure outcomes than patients exhibiting cellular signaling processes related to ECM reorganization, autoantibody production, and neural circuit formation. Conclusions: The results suggest that post-operative targeting of both inhibitory aspects of the ECM remodeling and the autoimmune/inflammatory components may be helpful in promoting repair and preventing the recurrence of seizures. Full article

Background: About 65 million people worldwide are affected by epilepsy, with temporal lobe epilepsy being the most common type resistant to drugs and often requiring surgical treatment. Although open surgical approaches, such as temporal lobectomy, have been the method of choice for decades, minimally invasive MRgLITT has demonstrated promising results. However, it remains unknown whether patients who underwent one of these two approaches would show better performance on vestibulo-spatial tasks. Methods: Twenty-seven patients were included in three different groups: (1) MRgLITT (37.0 ± 15.1 years, two females), (2) R-OP (44 ± 15.7 years, five females) and (3) No-OP (43 ± 11.2 years, three females)—with no significant differences in age, disease duration and number of medications. Groups were compared on their performance in three vestibular-dependent tests: (1) clinical balance test (CBT), (2) triangle completion test (TCT) and (3) rotational memory (RM) test. Results: Significantly better performance of MRgLITT patients, in comparison to the other two groups (R-OP and No-OP), was found for the TCT. The other tests revealed no significant differences between the groups. Conclusions: Patients who underwent MRgLITT performed significantly better on the vestibular-dependent spatial orientation task (TCT) compared to those who underwent temporal lobectomy (R-OP) and non-operated patients. Speculations about reasons for such an effect—including minimal invasiveness with less “collateral damage”, influence of operated side, timing of surgery, sample heterogeneity and others—need to be assessed in detail in larger-scale, prospective longitudinal studies. Full article

Introduction: Refractory epilepsy is common in children with Autism Spectrum Disorder (ASD), significantly affecting their cognitive development and quality of life. Surgical interventions provide a therapeutic option, but it remains unclear which technique offers the best outcomes for this population. Objective: To compare the efficacy and safety of four surgical techniques—lesionectomy, temporal lobectomy, extratemporal cortical resection, and functional hemispherectomy—in children with refractory epilepsy, both with and without ASD, and evaluate their impact on cognitive and behavioral development and quality of life. Methodology: A retrospective study was conducted with 120 children diagnosed with refractory epilepsy, equally divided between those with and without ASD. Patients were assigned to one of four surgical groups (n = 15 per group) based on the intervention performed. Data on demographic and clinical characteristics, as well as one-year postoperative outcomes—including seizure control (Engel classification), intelligence quotient (WISC-V), adaptive behavior (Vineland-II), and quality of life (PedsQL)—were collected. Statistical analyses were applied to compare the results among groups, and logistic regression was used to identify the predictors of seizure freedom. Results: Lesionectomy and temporal lobectomy groups showed significantly higher rates of seizure freedom (80% and 73%, respectively) compared to extratemporal resection (60%) and functional hemispherectomy (67%). These groups also presented significant improvements in intelligence quotient, adaptive behavior, quality of life, and reductions in ASD symptoms (p < 0.01). Perioperative complications were notably lower in the lesionectomy and temporal lobectomy groups (7%) compared to extratemporal resection and functional hemispherectomy (40%; p = 0.007). Significant predictors of seizure freedom included the presence of structural anomalies on neuroimaging and a shorter duration of epilepsy before surgery (p < 0.05). Conclusions: Lesionectomy and temporal lobectomy are highly effective and safer surgical techniques for managing refractory epilepsy in children with ASD, providing significant benefits in seizure control, cognitive development, and quality of life. Importantly, the outcomes observed are not exclusive to children with ASD but likely reflect broader efficacy across pediatric epilepsy populations. The early identification of surgical candidates and comprehensive preoperative evaluations are essential for optimizing outcomes, emphasizing the importance of individualized treatment planning and further comparative research to validate these findings. Full article

Background: Positive correlations between low- and high-frequency spectra from stereotactic electroencephalogram (SEEG) recordings have been implicated in pathological brain activity interictally and have been used for ictal detection in both focal and network models. Objective: We evaluated SEEG signals in patients who ultimately underwent temporal lobectomy to evaluate their utility in seizure localization and prediction of seizure freedom post-resection. Methods: We retrospectively analyzed cross-frequency correlations between beta and high gamma (HG) interictal SEEG signals from 22 patients. We compared signals based on temporal versus extra-temporal locations, seizure-free (SF) versus non-seizure-free (NSF) outcomes, and mesial (M) versus mesial temporal-plus (M+) onset. Results: Positive cross-correlations were increased in temporal areas. NSF patients showed a higher proportion of positive electrodes in temporal areas. SF patients had a greater proportion of significant channels in mesial versus lateral temporal areas. HG/Beta correlations in mesial versus lateral temporal areas predicted seizure freedom better than ictal SEEG seizure onset localization to M or M+ locations. Conclusions: We present preliminary data that local HG/Beta correlations may predict epilepsy focus and surgical outcome and may have utility as adjunct methods to conventional SEEG analysis. Further studies are needed to determine strategies for prospective studies and clinical use. Full article

Neuropsychological outcomes following temporal lobe resection for drug-resistant epilepsy (DRE) are well established. For instance, left anterior temporal lobectomy (LATL) is associated with a greater risk for cognitive morbidity compared to right (RATL). However, the impact of neuromodulatory devices, specifically responsive neurostimulation (RNS), remains an area of active interest. There are currently no head-to-head comparisons of neuropsychological outcomes after surgical resection and neuromodulation. This study reports on a cohort of 21 DRE patients with the RNS System who received comprehensive pre- and post-implantation neuropsychological testing. We compared both cognitive and seizure outcomes in the RNS group to those of 307 DRE patients who underwent LATL (n = 138) or RATL (n = 169). RNS patients had higher seizure rates pre-intervention. While fewer in the RNS group achieved Class I Engel outcomes compared to the ATL cohorts, RNS patients also showed seizure frequency declines from pre- to post-intervention that were similar to those who underwent resective surgery. Moreover, the RNS and RATL groups were similar in their neuropsychological outcomes, showing no significant cognitive decline post-intervention. In contrast, the LATL group notably declined in object naming and verbal list learning. Direct comparisons like this study may be used to guide clinicians in shared decision making to tailor management plans for patients’ overall treatment goals. Full article

(1) Objective: This study aimed to explore the efficacy of conventional invasive techniques in confirming unilateral seizure onset localization in mesial temporal lobe epilepsy with hippocampal sclerosis (MTLE-HS) and to investigate the association between electrode type and intracranial electroencephalography (EEG) pattern. (2) Methods: This retrospective study encompasses patients diagnosed with MTLE-HS who underwent an invasive study prior to an anterior temporal lobectomy (ATL). Intracranial EEG features were assessed for 99 seizure events from 25 selected patients who achieved seizure remission with ATL after an invasive study using bilateral combined depth and subdural electrodes. Their findings were compared to those of 21 seizure events in eight patients who exhibited suboptimal seizure outcomes. (3) Results: For the distribution of electrodes that recorded the ictal onset, hippocampal depth electrodes recorded 96% of all seizure events, while subdural electrodes recorded 52%. Among the seizures recorded in subdural electrodes, 49% were localized in medial electrodes, with only 8% occurring in lateral electrodes. The initiation of seizures exclusively detected in hippocampal depth electrodes was associated with successful seizure remission, whereas those solely recorded in the lateral strip electrodes were often linked to refractory seizures after ATL. (4) Conclusions: These findings emphasize the importance of employing a combination of depth and subdural electrodes in invasive studies for patients with MTLE-HS to enhance the accuracy of lateralization. This also cautions against sole reliance on subdural electrodes without depth electrodes, which could lead to inaccurate localization. Full article

The insula is involved in a wide variety of functions, including social and emotional processing. Despite the numerous connections it shares with brain structures known to play a role in autobiographical memory (AM), little is known on the contribution of the insula to AM processing. The aim of the study was to examine emotional AM retrieval in patients with insular resection for drug-resistant epilepsy. Ten patients who underwent partial or complete insular resection (IR) were matched on age, sex, and education, to fifteen patients who underwent temporal lobectomy (TL), and to fifteen healthy controls. Participants were asked to recall four positive, four negative, and four neutral memories from their past using the autobiographical interview procedure. The results suggest that AM for emotional and neutral events after IR was comparable to that of healthy controls, whereas deficits were observed after TL. However, an independent examiner judged IR patients’ memories as poorer than those of healthy controls on the episodic richness scale, suggesting a lack of some aspects of rich and vivid remembering. Furthermore, analysis on subjective self-rated scales revealed that, contrary to healthy controls, patients with IR judged their neutral memories as more emotional. This study suggests that AM is generally preserved after IR. However, given the small sample size and varied lesion location, one cannot totally exclude a potential role of specific insular sub-regions on some aspects of autobiographical memory. In addition, IR patients showed poor emotional judgment for neutral memories, which is congruent with previous findings of altered emotional processing in this population. Full article

Auditory and visual pathways may be affected as a consequence of temporal lobe epilepsy surgery because of their anatomical relationships with this structure. The purpose of this paper is to correlate the results of the auditory and visual evoked responses with the parameters of tractography of the visual pathway, and with the state of connectivity between respective thalamic nuclei and primary cortices in both systems after the surgical resection of the epileptogenic zone in drug-resistant epileptic patients. Tractography of visual pathway and anatomical connectivity of auditory and visual thalamus-cortical radiations were evaluated in a sample of eight patients. In general, there was a positive relationship of middle latency response (MLR) latency and length of resection, while a negative correlation was found between MLR latency and the anatomical connection strength and anatomical connection probability of the auditory radiations. In the visual pathway, significant differences between sides were found with respect to the number and length of tracts, which was lower in the operated one. Anatomical connectivity variables and perimetry (visual field defect index) were particularly correlated with the latency of P100 wave which was obtained by quadrant stimulation. These results demonstrate an indirect functional modification of the auditory pathway and a direct traumatic lesion of the visual pathway after anterior temporal lobectomy in patients with drug resistant epilepsy. Full article

The neurosurgical treatment of skull base temporal encephalocele for patients with epilepsy is variable. We describe two adult cases of temporal lobe epilepsy (TLE) with spheno-temporal encephalocele, currently seizure-free for more than two years after anterior temporal lobectomy (ATL) and lesionectomy sparing the hippocampus without long-term intracranial electroencephalogram (EEG) monitoring. Encephaloceles were detected by magnetic resonance imaging (MRI) and confirmed by maxillofacial head computed tomography (CT) scans. Seizures were captured by scalp video-EEG recording. One case underwent intraoperative electrocorticography (ECoG) with pathology demonstrating neuronal heterotopia. We propose that in some patients with skull base temporal encephaloceles, minimal surgical resection of herniated and adjacent temporal cortex (lesionectomy) is sufficient to render seizure freedom. In future cases, where an associated malformation of cortical development is suspected, newer techniques such as minimally invasive EEG monitoring with stereotactic-depth EEG electrodes should be considered to tailor the surrounding margins of the resected epileptogenic zone. Full article

The study of emotion had been relegated to the fringes of neuroscience until quite recently because it was too subjective and irrational for the intellectual stiffness of modern science. Since about thirty years, the studies relating to emotions and underlying neural mechanisms have considerably multiplied utilising behavioural paradigms with normal subjects, clinical evaluation of patients suffering from neurological or psychic disorders, observations of patients with definite brain lesions and finally, using the most advanced and noninvasive technology available to capture revealing images of the living brain responding to emotions: functional brain neuroimaging. In this paper we describe the famous historical contributions to the comprehension of the links between brain and emotions. The oldest experimental demonstration of these links was carried out at the beginning of the twentieth century by Cannon and Bard who showed that the surgical ablation of a cat’s neocortex induced nonmotivated aggressive behaviour called “sham rage”. Klüver and Bucy described behavioural modifications generated by the ablation of portions of temporal lobes in monkeys. After lobectomy, animals developed a submissive and docile behaviour and hypersexuality as well as hyperorality. The case of Phineas Gage first described by Dr Harlow is also very famous as first description of personality changes after prefrontal damage. These case studies carried out on man and animal lead to the establishing of assumptions on the anatomical basis of emotions. Researchers such as Papez, Broca, MacLean and more recently Mesulam have successively contributed to the construction of the current neuroanatomical models of emotions where the cortico-limbic system constitutes the essential substrate of the emotional processes. The main anatomical structures of this system, namely the amygdala, the septal area, the hypothalamus and the prefrontal regions are then reviewed. The most relevant data supported the implication of the septal area being involved in pleasure and the amygdala in fear-related emotion. As interface between cognition and emotion, the prefrontal area has a more complex role, particularly in the regulation of social emotions.The contribution of both cerebral hemispheres is also discussed with the classical opposition “happy” left hemisphere and “pessimistic” right hemisphere. The final paragraphs provide recent data on the relations between emotional states and specific patterns of regional brain activity seized with the help of the various functional neuroimaging techniques. These techniques, which allow to study the emotional processes in healthy subjects “in vivo”, challenge the hypothesis that specific brain regions have strictly specialised functions for the generation of emotions (e.g. the critical role of amygdala in fear-related processing). It is indeed likely that separate brain regions are involved in different aspects of emotion (e.g. the amygdala may not exclusively respond to threaten stimuli but to any emotionally relevant stimuli, regardless of valence). As in other domains of neurocognition we are moving from a localisationist perspective toward approaches where the mental functions are underlain by distributed neural networks. Although our knowledge of emotional mechanisms and their anatomical substrates is still fragmentary, the study of emotions constitutes a promising field of investigation. A particular interest is attached to the role of emotion in attentional functions, memory and decision making as well as the implication of cortico-limbic circuits in motivation. Full article