Limits...
Treatment of epilepsy with bipolar electro-coagulation: an analysis of cortical blood flow and histological change in temporal lobe.

Cui ZQ, Luan GM, Zhou J, Zhai F, Guan YG, Bao M - Chin. Med. J. (2015)

Bottom Line: Twenty-four patients were consecutively enrolled, and divided into three groups according to the date of admission.The regional cortical blood flow (rCBF), electrocorticography, the depth of cortex damage, and acute histological changes (H and E staining, neuronal staining and neurofilament (NF) staining) were analyzed before and after the operation.The t-test analysis was used to compare the rCBF before and after the operation.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, Sanbo Brain Hospital, Capital Medical University, Beijing 100093, China.

ABSTRACT

Background: Bipolar electro-coagulation has a reported efficacy in treating epilepsy involving functional cortex by pure electro-coagulation or combination with resection. However, the mechanisms of bipolar electro-coagulation are not completely known. We studied the acute cortical blood flow and histological changes after bipolar electro-coagulation in 24 patients with intractable temporal lobe epilepsy.

Methods: Twenty-four patients were consecutively enrolled, and divided into three groups according to the date of admission. The regional cortical blood flow (rCBF), electrocorticography, the depth of cortex damage, and acute histological changes (H and E staining, neuronal staining and neurofilament (NF) staining) were analyzed before and after the operation. The t-test analysis was used to compare the rCBF before and after the operation.

Results: The rCBF after coagulation was significantly reduced (P < 0.05). The spikes were significantly reduced after electro-coagulation. For the temporal cortex, the depth of cortical damage with output power of 2-9 W after electro-coagulation was 0.34 ± 0.03, 0.48 ± 0.06, 0.69 ± 0.06, 0.84 ± 0.09, 0.98 ± 0.08, 1.10 ± 0.11, 1.11 ± 0.09, and 1.22 ± 0.11 mm, respectively. Coagulation with output power of 4-5 W completely damaged the neurons and NF protein in the molecular layer, external granular layer, and external pyramidal layer.

Conclusions: The electro-coagulation not only destroyed the neurons and NF protein, but also reduced the rCBF. We concluded that the injuries caused by electro-coagulation would prevent horizontal synchronization and spread of epileptic discharges, and partially destroy the epileptic focus.

Show MeSH

Related in: MedlinePlus

Red and white stripes at regular intervals were clearly visible on the electro-coagulated cortex (coagulated with output power of 4 W).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC4837840&req=5

Figure 1: Red and white stripes at regular intervals were clearly visible on the electro-coagulated cortex (coagulated with output power of 4 W).

Mentions: The anterior temporal lobe was fully exposed before the surgical procedure. Electro-coagulation was performed using bipolar coagulation forceps (Company Name: B. Braun, Germany) outside the arachnoid mater, with output power of 4 W. In all cases, electro-coagulations were placed in the central portion of the planned resection. The brain surface was kept clean and moist with saline gauze. There was 45° between the forceps’ axis and the brain surface. The direction of electro-coagulation was perpendicular to the long axis of the brain gyrus. The diameter of the tip of the bipolar forceps was 2 mm, and the procedure was performed at an interval of 5 mm. The brain surface was washed immediately after electro-coagulation with room-temperature saline to lower the brain temperature because the electro-coagulation releases heat, and we could clearly see the red and white stripes at regular intervals on the electro-coagulated cortex [Figure 1].


Treatment of epilepsy with bipolar electro-coagulation: an analysis of cortical blood flow and histological change in temporal lobe.

Cui ZQ, Luan GM, Zhou J, Zhai F, Guan YG, Bao M - Chin. Med. J. (2015)

Red and white stripes at regular intervals were clearly visible on the electro-coagulated cortex (coagulated with output power of 4 W).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4837840&req=5

Figure 1: Red and white stripes at regular intervals were clearly visible on the electro-coagulated cortex (coagulated with output power of 4 W).
Mentions: The anterior temporal lobe was fully exposed before the surgical procedure. Electro-coagulation was performed using bipolar coagulation forceps (Company Name: B. Braun, Germany) outside the arachnoid mater, with output power of 4 W. In all cases, electro-coagulations were placed in the central portion of the planned resection. The brain surface was kept clean and moist with saline gauze. There was 45° between the forceps’ axis and the brain surface. The direction of electro-coagulation was perpendicular to the long axis of the brain gyrus. The diameter of the tip of the bipolar forceps was 2 mm, and the procedure was performed at an interval of 5 mm. The brain surface was washed immediately after electro-coagulation with room-temperature saline to lower the brain temperature because the electro-coagulation releases heat, and we could clearly see the red and white stripes at regular intervals on the electro-coagulated cortex [Figure 1].

Bottom Line: Twenty-four patients were consecutively enrolled, and divided into three groups according to the date of admission.The regional cortical blood flow (rCBF), electrocorticography, the depth of cortex damage, and acute histological changes (H and E staining, neuronal staining and neurofilament (NF) staining) were analyzed before and after the operation.The t-test analysis was used to compare the rCBF before and after the operation.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, Sanbo Brain Hospital, Capital Medical University, Beijing 100093, China.

ABSTRACT

Background: Bipolar electro-coagulation has a reported efficacy in treating epilepsy involving functional cortex by pure electro-coagulation or combination with resection. However, the mechanisms of bipolar electro-coagulation are not completely known. We studied the acute cortical blood flow and histological changes after bipolar electro-coagulation in 24 patients with intractable temporal lobe epilepsy.

Methods: Twenty-four patients were consecutively enrolled, and divided into three groups according to the date of admission. The regional cortical blood flow (rCBF), electrocorticography, the depth of cortex damage, and acute histological changes (H and E staining, neuronal staining and neurofilament (NF) staining) were analyzed before and after the operation. The t-test analysis was used to compare the rCBF before and after the operation.

Results: The rCBF after coagulation was significantly reduced (P < 0.05). The spikes were significantly reduced after electro-coagulation. For the temporal cortex, the depth of cortical damage with output power of 2-9 W after electro-coagulation was 0.34 ± 0.03, 0.48 ± 0.06, 0.69 ± 0.06, 0.84 ± 0.09, 0.98 ± 0.08, 1.10 ± 0.11, 1.11 ± 0.09, and 1.22 ± 0.11 mm, respectively. Coagulation with output power of 4-5 W completely damaged the neurons and NF protein in the molecular layer, external granular layer, and external pyramidal layer.

Conclusions: The electro-coagulation not only destroyed the neurons and NF protein, but also reduced the rCBF. We concluded that the injuries caused by electro-coagulation would prevent horizontal synchronization and spread of epileptic discharges, and partially destroy the epileptic focus.

Show MeSH
Related in: MedlinePlus