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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.

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Related in: MedlinePlus

(a) The areas of the cortex after electro-coagulation showed semilunar or arcuated damage (output power of 4 W, arrow). (b) The H and E smear showed that the arcuated damage located in the superficial layers of the cortex (output power of 4 W, arrow). (c) The depth of damage only reached the superficial layers of the external pyramidal layer. The pyramidal cells in the deep layers had normal morphology (output power of 4 W, H and E, original magnification ×100). (d) Histological analysis showed electrocoagulated neural necrosis in the superficial layers and adjacent tissue edema. The deep cortical structures in the electro-coagulated areas were almost normal (output power of 4 W, H and E, original magnification ×40).
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Figure 3: (a) The areas of the cortex after electro-coagulation showed semilunar or arcuated damage (output power of 4 W, arrow). (b) The H and E smear showed that the arcuated damage located in the superficial layers of the cortex (output power of 4 W, arrow). (c) The depth of damage only reached the superficial layers of the external pyramidal layer. The pyramidal cells in the deep layers had normal morphology (output power of 4 W, H and E, original magnification ×100). (d) Histological analysis showed electrocoagulated neural necrosis in the superficial layers and adjacent tissue edema. The deep cortical structures in the electro-coagulated areas were almost normal (output power of 4 W, H and E, original magnification ×40).

Mentions: The cortical sections showed semilunar damage after fixation for at least 3 days in 20% buffered formalin [Figure 3a]. The shape of the damaged cortex after electro-coagulation was consistent with the arc current released by bipolar coagulation forceps [Figure 3b].


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)

(a) The areas of the cortex after electro-coagulation showed semilunar or arcuated damage (output power of 4 W, arrow). (b) The H and E smear showed that the arcuated damage located in the superficial layers of the cortex (output power of 4 W, arrow). (c) The depth of damage only reached the superficial layers of the external pyramidal layer. The pyramidal cells in the deep layers had normal morphology (output power of 4 W, H and E, original magnification ×100). (d) Histological analysis showed electrocoagulated neural necrosis in the superficial layers and adjacent tissue edema. The deep cortical structures in the electro-coagulated areas were almost normal (output power of 4 W, H and E, original magnification ×40).
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 3: (a) The areas of the cortex after electro-coagulation showed semilunar or arcuated damage (output power of 4 W, arrow). (b) The H and E smear showed that the arcuated damage located in the superficial layers of the cortex (output power of 4 W, arrow). (c) The depth of damage only reached the superficial layers of the external pyramidal layer. The pyramidal cells in the deep layers had normal morphology (output power of 4 W, H and E, original magnification ×100). (d) Histological analysis showed electrocoagulated neural necrosis in the superficial layers and adjacent tissue edema. The deep cortical structures in the electro-coagulated areas were almost normal (output power of 4 W, H and E, original magnification ×40).
Mentions: The cortical sections showed semilunar damage after fixation for at least 3 days in 20% buffered formalin [Figure 3a]. The shape of the damaged cortex after electro-coagulation was consistent with the arc current released by bipolar coagulation forceps [Figure 3b].

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