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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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(a-b) The superficial neurons were found sparingly in the electrocoagulated areas (arrow, neuronal [NeuN], original magnification ×40), while the density of deep cortical structures was almost normal (NeuN, original magnification ×100). (c-d) The neurofilament proteins (NFs) in electrocoagulated areas were completely destroyed and could not be stained (arrow) while NeuN and axonal morphology in the deep cortex were normal (NF, original magnification ×200).
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Figure 4: (a-b) The superficial neurons were found sparingly in the electrocoagulated areas (arrow, neuronal [NeuN], original magnification ×40), while the density of deep cortical structures was almost normal (NeuN, original magnification ×100). (c-d) The neurofilament proteins (NFs) in electrocoagulated areas were completely destroyed and could not be stained (arrow) while NeuN and axonal morphology in the deep cortex were normal (NF, original magnification ×200).

Mentions: Histological analysis (H and E) demonstrated that the thermal necrosis was localized within the layers of the electro-coagulated cortex, and did not reach the white matter. After the procedure with output power of 4–5 W, there was no subarachnoid hemorrhage. The arachnoid showed slight changes with a mild shrinkage, the capillaries under the arachnoid disappeared, and those out of the coagulated areas were normal. The larger arteries under the arachnoid and vessel located in the sulci showed no damage. The depth of damage reached the superficial layers of the external pyramidal layer, the neurons showed disintegration, vacuolization, morphological structure deformation, and the pyramidal cells in the deep layers showed normal morphology. No scorched-like tissue was seen in the whole region of electro-coagulation [Figure 3c and d]. Immunohistochemical analysis showed that the neurons and NF proteins in the molecular layer, external granular layer, and external pyramidal layer were completely damaged in the coagulated cortex. The superficial neuron density in the electrocoagulated areas appeared sparse, while the neuron density in the deep cortex and noncoagulated superficial cortex was almost normal [Figure 4a and b]. The NF proteins in electrocoagulated areas were completely destroyed and could not be stained, while NeuN and axonal morphology in the deep cortex and noncoagulated superficial cortex were normal [Figure 4c and d]. However, after the procedure with output power of more than 5 W, the depth of damage reached to the internal granular layer (fourth layer), and even the internal pyramidal layer (fifth layer), while the neurons and NF proteins were correspondingly damaged.


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-b) The superficial neurons were found sparingly in the electrocoagulated areas (arrow, neuronal [NeuN], original magnification ×40), while the density of deep cortical structures was almost normal (NeuN, original magnification ×100). (c-d) The neurofilament proteins (NFs) in electrocoagulated areas were completely destroyed and could not be stained (arrow) while NeuN and axonal morphology in the deep cortex were normal (NF, original magnification ×200).
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 4: (a-b) The superficial neurons were found sparingly in the electrocoagulated areas (arrow, neuronal [NeuN], original magnification ×40), while the density of deep cortical structures was almost normal (NeuN, original magnification ×100). (c-d) The neurofilament proteins (NFs) in electrocoagulated areas were completely destroyed and could not be stained (arrow) while NeuN and axonal morphology in the deep cortex were normal (NF, original magnification ×200).
Mentions: Histological analysis (H and E) demonstrated that the thermal necrosis was localized within the layers of the electro-coagulated cortex, and did not reach the white matter. After the procedure with output power of 4–5 W, there was no subarachnoid hemorrhage. The arachnoid showed slight changes with a mild shrinkage, the capillaries under the arachnoid disappeared, and those out of the coagulated areas were normal. The larger arteries under the arachnoid and vessel located in the sulci showed no damage. The depth of damage reached the superficial layers of the external pyramidal layer, the neurons showed disintegration, vacuolization, morphological structure deformation, and the pyramidal cells in the deep layers showed normal morphology. No scorched-like tissue was seen in the whole region of electro-coagulation [Figure 3c and d]. Immunohistochemical analysis showed that the neurons and NF proteins in the molecular layer, external granular layer, and external pyramidal layer were completely damaged in the coagulated cortex. The superficial neuron density in the electrocoagulated areas appeared sparse, while the neuron density in the deep cortex and noncoagulated superficial cortex was almost normal [Figure 4a and b]. The NF proteins in electrocoagulated areas were completely destroyed and could not be stained, while NeuN and axonal morphology in the deep cortex and noncoagulated superficial cortex were normal [Figure 4c and d]. However, after the procedure with output power of more than 5 W, the depth of damage reached to the internal granular layer (fourth layer), and even the internal pyramidal layer (fifth layer), while the neurons and NF proteins were correspondingly damaged.

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