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The article presents the discussion on case study of 30-year-old overseas-born male with tonic–clonic seizure with no other systemic symptoms or head trauma. Topics include consulted his general practitioner, who prescribed a short course of oral cephalexin without further investigation; and lesion was discrete, appeared separate from adjacent brain tissue, and came away uniformly enbloc.

Simple Summary: There is growing evidence that the extent of resection of low-grade glioma is directly correlated with patients' outcomes. Preservation of function must be the other goal in brain tumor surgery. Only little is known about the organization of the face in the primary motor area (M1). New findings emphasize different motor projections to the facial motor nuclei. The aim of this retrospective study was to analyze the impact of tumor resection within the M1 face area on transient and permanent neurological deficits. Based on 12 patients, we were able to demonstrate that tumor resection within the non-dominant face motor cortex might be safe and, even in the dominant hemisphere, is only associated with transient impairment. We believe that this retrospective analysis can help identify eloquent brain areas and can lead to a change in the treatment paradigm for this disease, affecting many patients and informing many physicians worldwide. Objective: During surgery on low-grade gliomas (LGG), reliable data relevant to the primary motor cortex (M1) for the face area are lacking. We analyzed the impact of tumor removal within the M1 face area on neurological deficits. Methods: We included LGG patients with resection within the M1 face area between May 2012 and November 2019. The primary endpoint was postoperative facial motor function. Secondary endpoints were postoperative aphasia, dysarthria, and dysphagia. Surgery was performed either with the awake protocol or under anesthesia with continuous dynamic mapping. The alarm criteria were speech arrest or a mapping threshold of 3 mA or less. Resection was completed in five patients. The resection was stopped due to the alarm criteria in three patients and for other reasons (vascular supply, patient performance) in four patients. A total of 66.7% (n = 8) presented with new-onset facial paresis (62.5% left LGG) and 41.7% (n = 5) with aphasia (all left LGG) postoperatively. After one year, all eight patients had recovered from the facial paresis. Tumor removal within the M1 face area was not associated with permanent facial motor deficits. [ABSTRACT FROM AUTHOR]

Malformation of cortical development is an important cause of drug-resistant epilepsy in young children. Mild malformation of cortical development with oligodendroglial hyperplasia in epilepsy (MOGHE) has been added to the last focal cortical dysplasia (FCD) classification and commonly involves the frontal lobe. The semiology at the onset of epilepsy is dominated by non-lateralizing infantile spasm; the boundaries of the malformation are usually difficult to determine by magnetic resonance imaging (MRI) and positron emission tomography (PET), and electroencephalography (EEG) findings are often widespread. Therefore, the traditional concept and strategy of preoperative evaluation to determine the extent of the epileptogenic zone by comprehensive anatomo-electro-clinical methods are difficult to implement. Frontal disconnection is an effective surgical method for the treatment of epilepsy, but there are few related reports. A total of 8 children with histo-pathologically confirmed MOGHE were retrospectively studied. MOGHE was located in the frontal lobe in all patients, and frontal disconnection was performed. The periinsular approach was used in the disconnective procedures, divided into several surgical steps: the partial inferior frontal gyrus resection, the frontobasal and intrafrontal disconnection, and the anterior corpus callosotomy. One patient presented with a short-term postoperative speech disorder, while another patient exhibited transient postoperative limb weakness. No long-term postoperative complications were observed. At 2 years after surgery, 75% of patients were seizure-free, with cognitive improvement in half of them. This finding suggested that frontal disconnection is an effective and safe surgical procedure for the treatment of MOGHE instead of extensive resection in the frontal lobe.

Background: In adults, moyamoya disease (MMD) often presents with slight neurocognitive impairment, which may result from frontal lobe hemodynamic insufficiency., Methods: In this study, we performed revascularization surgery by superficial temporal artery-anterior cerebral artery (ACA) direct bypass in 20 adults with MMD with poor anterograde ACA flow (Group M). The pre- and postoperative neurocognitive test results of these patients were retrospectively analyzed. The comparative group (Group C) included 23 patients with unruptured aneurysms or brain tumors who underwent craniotomy, as well as the same neurocognitive tests as Group M. We calculated the compositive frontal lobe function index (CFFI) based on the results of seven neurocognitive tests for each patient, and the difference between the pre- and postoperative CFFI values (CFFI Post - Pre) was compared between the two groups., Results: Frontal perfusion improved postoperatively in all patients in Group M. The CFFI Post - Pre was significantly higher in Group M than in Group C (0.23 ± 0.44 vs. - 0.20 ± 0.32; p < 0.001). After adjusting for postoperative age, sex, preoperative non-verbal intelligence quotient, and preoperative period of stress, Group M had a significantly higher CFFI Post - Pre than Group C in the multiple regression analysis (t value = 4.01; p < 0.001)., Conclusion: Improving frontal lobe hemodynamics might be the key for improving neurocognitive dysfunction in adults with MMD. The surgical indication and method should be considered from the perspective of both stroke prevention and neurocognitive improvement or protection., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Background: Frontal lobe epilepsy is pharmacoresistant in 30% of cases, constituting 10-20% of epilepsy surgeries. For cases of no lesional epilepsy (negative MRI), frontal lobectomy is a crucial treatment, historically involving Frontal Anatomical Lobectomy (AFL) with a 33.3% complication risk and 55.7% seizure control., Methods: We describe Frontal Functional Lobectomy (FFL), in which the boundaries are defined on the patient's functional cortico-subcortical areas, recognized with advanced intraoperative technologies such as tractography and navigated transcranial magnetic stimulation (nTMS)., Conclusions: The FFL allows for a broader resection with a lower rate of postoperative complications than the AFL., (© 2024. The Author(s).)

Arteriovenous malformations (AVMs) are complex vascular lesions that can pose significant risk for spontaneous hemorrhage, seizures, and symptoms related to ischemia and venous hypertension. 1 Microsurgical management of AVMs requires a deep understanding of the surrounding anatomy and precise identification of the lesion characteristics. We demonstrate the use of augmented reality in the localization of arterial feeders and draining veins in relation to bordering normal structures (Video 1). A 66-year-old man presented with several episodes of severe right frontal headaches. Magnetic resonance imaging revealed an AVM along the right frontal pole. Subsequent computed tomography angiography demonstrated arterial supply from the right anterior cerebral artery with venous drainage to the superior sagittal sinus. Due to the size, noneloquent location, and superficial pattern of venous drainage, the patient elected to proceed with microsurgery. A virtual planning platform was used in preparation for surgery. Augmented reality integrated with neuronavigation was used during microsurgical resection. Postoperative angiography showed complete resection of the AVM. The patient was discharged home on postoperative day 3 with no complications. He remains neurologically well at 4 months of follow-up., (Copyright © 2024. Published by Elsevier Inc.)

Objective: We investigated neuropsychological outcome in patients with pharmacoresistant pediatric-onset epilepsy caused by focal cortical dysplasia (FCD), who underwent frontal lobe resection during adolescence and young adulthood., Methods: Twenty-seven patients were studied, comprising 15 patients who underwent language-dominant side resection (LDR) and 12 patients who had languagenondominant side resection (n-LDR). We evaluated intelligence (language function, arithmetic ability, working memory, processing speed, visuo-spatial reasoning), executive function, and memory in these patients before and two years after resection surgery. We analyzed the relationship between neuropsychological outcome and resected regions (side of language dominance and location)., Results: Although 75% of the patients showed improvement or no change in individual neuropsychological tests after surgical intervention, 25% showed decline. The cognitive tests that showed improvement or decline varied between LDR and n-LDR. In patients who had LDR, decline was observed in Vocabulary and Phonemic Fluency (both 5/15 patients), especially after resection of ventrolateral frontal cortex, and improvement was observed in WCST-Category (7/14 patients), Block Design (6/15 patients), Digit Symbol (4/15 patients), and Delayed Recall (3/9 patients). In patients who underwent n-LDR, improvement was observed in Vocabulary (3/12 patients), but decline was observed in Block Design (2/9 patients), and WCST-Category (2/9 patients) after resection of dorsolateral frontal cortex; and Arithmetic (3/10 patients) declined after resection of dorsolateral frontal cortex or ventrolateral frontal cortex. General Memory (3/8 patients), Visual Memory (3/8 patients), Delayed Recall (3/8 patients), Verbal Memory (2/9 patients), and Digit Symbol (3/12 patients) also declined after n-LDR., Conclusion: Postoperative changes in cognitive function varied depending on the location and side of the resection. For precise presurgical prediction of neuropsychological outcome after surgery, further prospective studies are needed to accumulate data of cognitive changes in relation to the resection site., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Inc. All rights reserved.)

We present a protocol for the rapid postmortem bedside procurement of selected tissue samples using an endoscopic endonasal surgical technique that we adapted from skull base surgery. We describe steps for the postmortem collection of blood, cerebrospinal fluid, a nasopharyngeal swab, and tissue samples; the clean-up procedure; and the initial processing and storage of the samples. This protocol was validated with tissue samples procured postmortem from COVID-19 patients and can be applied in another emerging infectious disease. For complete details on the use and execution of this protocol, please refer to Khan et al. (2021) 1 and Khan et al. (2022). 2 ., Competing Interests: Declaration of interests The authors declare no competing interests., (Copyright © 2023 The Author(s). Published by Elsevier Inc. All rights reserved.)

Patients with diffuse frontal gliomas often present with post-operative apathy after tumour removal. However, the association between apathy and tumour removal of gliomas from the frontal lobe remains unknown. This study aimed to investigate the factors influencing post-operative apathy after tumour removal in patients with diffuse frontal gliomas. We compared the demographics and clinical characteristics of patients with and without post-operative apathy in a cohort of 54 patients who underwent awake brain mapping for frontal gliomas. The frequency of clinical parameters such as left-sided involvement, high-grade tumour types (WHO grades III, IV), main tumour location in the anterior cingulate gyrus (ACC) and/or dorsolateral prefrontal cortex (DLPFC) and orbitofrontal cortex (OFC) was significantly greater in the apathetic group compared to the non-apathetic group. The apathetic group scored significantly lower on neuropsychological assessments such as the Letter Fluency Test among the Word Fluency Tests than the non-pathetic group (p = .000). Moreover, the scores of Parts 3, and 3-1 of the Stroop test were significantly lower in the apathetic group than those in the non-apathetic group (p = .023, .027, respectively). Multivariate model analysis revealed that the appearance of post-operative apathy was significantly related to side of the of lesion [left vs. right, hazard ratio (HR) = 8.00, 95% confidence interval (CI) = 1.36-46.96, p = .021], location of the main tumour in the frontal lobe (ACC/DLPFC/OFC vs. others, HR = 7.99, 95% CI = 2.16-29.59, p = .002), and the Letter Fluency Test (HR = .37, 95% CI = .15-.90, p = .028). Post-operative apathy is significantly associated with ACC and/or DLPFC and OFC in the left hemisphere of diffuse frontal gliomas. Apathy in frontal gliomas is correlated with a decline in the Letter Fluency Test scores. Therefore, this instrument is a potential predictor of post-operative apathy in patients with diffuse frontal gliomas undergoing awake brain mapping., (© 2023 The British Psychological Society.)

Objective: Traditionally, resection of nondominant hemisphere brain tumors was performed under general anesthesia. An improved understanding of right-lateralized neural networks has led to a paradigm shift in recent decades, where the right or nondominant hemisphere is no longer perceived as "functionally silent." There is an increasing interest in awake brain mapping for nondominant hemisphere resections. The objective of this study was to perform a comprehensive review of the existing brain mapping paradigms for patients with nondominant hemisphere gliomas undergoing awake craniotomies., Methods: In accordance with PRISMA guidelines, systematic searches of the Medline, Embase, and American Psychological Association PsycInfo databases were undertaken from database inception to July 1, 2023. Studies providing a description of the intraoperative mapping paradigm used to assess cognition during an awake craniotomy for resection of a nondominant hemisphere glioma were included., Results: The search yielded 1084 potentially eligible articles. Thirty-nine unique studies reporting on 788 patients were included in the systematic review. The most frequently tested cognitive domains in patients with nondominant hemisphere tumors were spatial attention/neglect (17/39 studies, 43.6%), speech-motor/language (17/39 studies, 43.6%), and social cognition (9/39 studies, 23.1%). Within the frontal lobe, the highest number of positive mapping sites was identified for speech-motor/language, spatial attention/neglect, dual tasking assessing motor and language function, working memory, and social cognition. Within the parietal lobe, eloquence was most frequently found upon testing spatial attention/neglect, speech-motor/language, and calculation. Within the temporal lobe, the assessment of spatial attention/neglect yielded the highest number of positive mapping sites., Conclusions: Cognitive testing in the nondominant hemisphere is predominantly focused on evaluating two domains: spatial attention/neglect and the motor aspects of speech/language. Multidisciplinary teams involved in awake brain mapping should consider testing an extended range of functions to minimize the risk of postoperative deficits and provide valuable information about anatomo-functional organization of cognitive networks.

The frontal aslant tract (FAT) connects the supplementary motor area (SMA) with the pars opercularis. Its role in language and its implications in glioma surgery remain under discussion. We present an anatomosurgical study of three cases with surgical resolution. Three patients with gliomas in the left frontal lobe were operated on using an awake patient protocol with cortical and subcortical mapping techniques, conducting motor and language evaluations. Tractography was performed using DSI Studio software. All three patients showed intraoperative language inhibition through subcortical stimulation of the FAT. Resection involving the FAT correlated with language deficits in all cases and movement initiation deficits in two cases. All patients recovered from their deficits at six months postoperatively. In conclusion, the tract has been successfully reconstructed, showing both anatomical and functional complexity, supporting the idea of its mapping and preservation in glioma surgery. Future interdisciplinary studies are necessary to determine the transient or permanent nature of the deficits.

Thinking about the chronology of the introduction of leucotomy in Germany sheds new light on the hypothesis of a special 'radical' approach of German psychiatry to the treatment of the mentally ill during the period of National Socialism. Moreover, it offers new insights into the transnational and interdisciplinary conditions of the introduction of leucotomy in early divided post-war Germany. [ABSTRACT FROM AUTHOR]

Background: The preoperative evaluation of drug-resistant focal epilepsy patients considered for epilepsy surgery provides a unique setting to evaluate cortical function and corresponding networks. Aims: Whereas there is a wealth of data on cortical language localization using electrical stimulation with subdural electrodes, there is much less experience with stimulation of depth electrodes in the white matter and an effect on language function via electric stimulation of the corpus callosum has not been demonstrated so far. Methods & Procedures: We report on a 29-year-old epilepsy patient with bilateral language representation who underwent pre-surgical EEG-video-monitoring for drug-resistant, non-lesional right frontal lobe epilepsy. Outcomes & Results: Electric stimulation of a stereotactically implanted depth electrode in the right anterior corpus callosum elicited paraphasia and anomia. The precise mechanism could be an inhibition of cortical language areas in the left hemisphere, the right hemisphere or interference with transcallosal connectivity. Conclusions: This is the first report on language dysfunction through electric stimulation in the corpus callosum, most likely through an inhibition of cortical language areas in the left frontal lobe. [ABSTRACT FROM AUTHOR]

Brain abscess is a rare disease in childhood requiring prompt medical and/or surgical treatment. The objective was to review presentation, management, and outcome of brain abscess in children. We reviewed the clinical and radiological features and outcomes of 18 children (10 females, 8 males), with a median age of 48 months (range 1-182), that presented with brain abscesses and admitted to a tertiary pediatric infectious department between December 2010 and January 2017. One (5.5%) patient underwent craniotomy and 14 (77.7%) had burr hole aspirations. The most common localization was the frontal lobe (33.3%). The survival rate was 94.4%, and long-term neurological sequelae affected 27.7% of the patients. Empiric treatment choices require knowledge of common pathogens and local resistance. The most predominant infections were still upper respiratory infections. Clinicians may treat the children with appropriate choice and duration of antibiotic treatment for upper respiratory tract infections. [ABSTRACT FROM AUTHOR]

We aimed to elicit emotion in patients with surgically circumscribed lesions of the prefrontal cortex (PFC) in order to elucidate the precise functional roles in emotion processing of the discrete subregions comprising the ventromedial PFC, including the medial PFC and orbitofrontal cortex (OFC). Three components of emotional reactivity were measured: subjective experience, behaviour, and physiological response. These included measures of self‐reported emotion, observer‐rated facial expression of emotion and measurements of heart rate and heart rate variability (HRV) during film viewing, and a measure of subjective emotional change since surgery. Patients with lesions to the ventromedial PFC demonstrated significant differences compared with controls in HRV during the film clips, suggesting a shift to greater dominance of sympathetic input. In contrast, patients with lesions restricted to the OFC showed significant differences in HRV suggesting reduced sympathetic input. They also showed less facial expression of emotion during positive film clips, and reported more subjective emotional change since surgery compared with controls. This human lesion study is important for refining theoretical models of emotion processing by the ventromedial PFC, which until now have primarily been based on anatomical connectivity, animal lesion, and human functional neuroimaging research. Such theories have implications for the treatment of a wide variety of emotional disorders. [ABSTRACT FROM AUTHOR]

Purpose: The sulci constituting the structure of the pars triangularis and opercularis, considered as 'Broca's area', present wide anatomical and morphological variations between different hemispheres. The boundaries are described differently from one another in various studies. The aim of this study was to explore the topographical anatomy, confirm the morphological asymmetry and highlight anatomical variations in Broca's area. Methods: This study was performed with 100 hemispheres to investigate the presence, continuity, patterns and connections of the sulcal structures that constitute the morphological asymmetry of Broca's area. Results: Considerable individual anatomical and morphological variations between the inferior frontal gyrus and related sulcal structures were detected. Rare bilateralism findings supported the morphological asymmetry. The inferior frontal sulcus was identified as a single segment in 54 % of the right and two separate segments in 52 % of the left hemispheres, which was the most common pattern. The diagonal sulcus was present in 48 % of the right and 54 % of the left hemispheres. It was most frequently connected to the ascending ramus on both sides. A 'V' shape was observed in 42.5 % of the right hemispheres and a 'Y' shape in 38.3 % of the left hemispheres, which was the most common shape of the pars triangularis. Moreover, the full results are specified in detail. Conclusions: Knowledge of the anatomical variations in this region is indispensable for understanding the functional structure and performing safe surgery. However, most previously published studies have aimed to determine the anatomical asymmetry of the motor speech area without illuminating the topographical anatomy encountered during surgery. [ABSTRACT FROM AUTHOR]

Background: Stereoelectroencephalography (SEEG) is an established and safe methodology for extra-operative invasive monitoring in patients with medical refractory epilepsy. SEEG has several advantages such as the ability to record deep cortical structures, mapping the epileptogenic zone in a three-dimensional manner, and analyze bihemispheric regions without the need for bilateral craniotomies. In patients with bilateral hemispheric hypotheses, especially the mesial surface of frontal lobes, bilateral lead placement is compulsory to further define and localize the epileptogenic zone. In this particular cohort of patients, bilateral monitoring may be accomplished from a single entry point using trans-interhemispheric placement of the electrodes. The use of trans-interhemispheric monitoring offers several advantages including sparing the need for additional leads., Objective: To test the hypothesis that, given the lack of the falx as a limiting structure in the ventral and mesial frontal lobe regions, trans-interhemispheric SEEG placement is feasible and a potential benefit for the SEEG method., Methods: We report on 6 patients who underwent bilateral monitoring using trans-interhemispheric SEEG lead placement and discuss the operative technique., Results: Six patients underwent trans-interhemispheric monitoring, with a median of 3 leads per patient (19 total). Trajectory error was minimal (<0.3 mm), and operating room time was comparable with that in previous reports. All leads were placed without adverse events, mislocalization, electrode hemorrhages, or any other complications. All patients had successful localization of the epileptogenic zone., Conclusion: Trans-interhemispheric SEEG to monitor the mesial wall of frontal lobe regions is technically feasible. No adverse events were observed, suggesting a favorable safety profile., (Copyright © Congress of Neurological Surgeons 2023. All rights reserved.)

Background and Importance: Medial orbital access through a transcaruncular corridor has yet to be fully characterized as a potential approach to intradural lesions within the skull base. Transorbital approaches present unique potential in the management of complex neurological pathologies and require subspecialty collaboration across multiple disciplines., Clinical Presentation: A 62-year-old man presented with progressive confusion and mild left-sided weakness. He was found to have a right frontal lobe mass with significant vasogenic edema. A comprehensive systemic workup was otherwise unremarkable. A multidisciplinary skull base tumor board conference recommended a medial transorbital approach through transcaruncular corridor, which was performed by neurosurgery and oculoplastics services. Postoperative imaging demonstrated gross total resection of the right frontal lobe mass. Histopathologic evaluation was consistent with amelanotic melanoma with BRAF (V600E) mutation. At his last follow-up visit, 3 months after surgery, the patient did not experience any visual symptoms and had an excellent cosmetic outcome after surgery., Conclusion: The transcaruncular corridor through a medial transorbital approach provides a safe and reliable access to the anterior cranial fossa., (Copyright © Congress of Neurological Surgeons 2023. All rights reserved.)

Background: The frontal aslant tract (FAT) is a bilateral tract located within each frontal lobe. It connects the supplementary motor area in the superior frontal gyrus with the pars opercularis in the inferior frontal gyrus. There is a new and broader conceptualization of this tract called the extended FAT (eFAT). The eFAT tract role is believed to be related to several brain functions, including verbal fluency as one of its main domains., Methods: Tractographies were performed by using DSI Studio software on a template of 1065 healthy human brains. The tract was observed in a three-dimensional plane. The Laterality Index was calculated based on the length, volume, and diameter of fibers. A t test was performed to verify the statistical significance of global asymmetry. The results were compared with cadaveric dissections performed according to the Klingler technique. An illustrative case enlightens the neurosurgical application of this anatomic knowledge., Results: The eFAT communicates the superior frontal gyrus with the Broca area (within the left hemisphere) or its contralateral homotopic area within the nondominant hemisphere. We measured the commisural fibers, traced cingulate, striatal, and insular connections and showed the existence of new frontal projections as part of the main structure. The tract did not show a significant asymmetry between the hemispheres., Conclusions: The tract was successfully reconstructed, focusing on its morphology and anatomic characteristics., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Purpose: Decision-making is crucial to daily life and can impact our society as well as economic conditions. Although the frontal lobes have been identified as important for decision-making, this capacity has only been studied to a limited extent in frontal lobe epilepsy and not at all after frontal lobe resection (FLR) for epilepsy. This study aimed to explore decision-making under ambiguity after FLR for epilepsy., Methods: Fourteen patients having undergone FLR for epilepsy completed the Iowa Gambling Task (IGT) which is a widely used tool to measure decision-making under ambiguity. Iowa Gambling Task scores included in the analysis were: total net score, separate scores from five blocks across the test, and a change score (last block of IGT minus first block). A group of healthy controls (n = 30) was used as a comparison. Associations between IGT and standardized neuropsychological methods for assessment of executive functions, self-rating questionnaires of mental health, fatigue, and behavior linked to frontal lobe dysfunction were also investigated., Results: The patient group performed inferior to controls at the final block of the IGT (p =.001).A group difference in IGT change scores was found (p =.005), reflectingthe absence of a positive change in performance over time for the FLR group compared to the control group. Correlations with tests of executive functions as well as self-rating scales were mainly statistically nonsignificant., Conclusions: This study shows that patients having undergone FLR for epilepsy have difficulties with decision-making under ambiguity. The performance illustrated a failure to learn throughout the task. Executive as well as emotional deficits may impact decision-making processes in this patient group and need to be considered in further studies. Prospective studies with larger cohorts are needed., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Objectives: We present a case series of patients who underwent perirolandic resection for medically refractory focal epilepsy due to focal cortical dysplasia (FCD). Our aim was to specifically evaluate the outcome of a surgical strategy intended for seizure freedom while preserving primary motor cortex function.Materials and Methods: Thirteen patients undergoing perirolandic resection for pharmacoresistant focal epilepsy between 2010 and 2015 who demonstrated histological evidence of FCD were selected from a prospectively maintained database. Presurgical evaluation included video EEG telemetry and 3T MRI brain for all patients. Eight patients underwent interictal FDG PET scan. Intracranial EEG monitoring was done for 8 patients - six by conventional subdural grid and depth electrodes and two by Stereo EEG. Additional techniques included extraoperative cortical stimulation mapping, intraoperative electrocorticography (ECoG), intraoperative motor cortex mapping and awake surgery in various combinations. In all cases (lesional and nonlesional), resection was intentionally limited for anatomic preservation of the primary motor cortex.Results: Amongst the thirteen patients with age ranging 14-44 years (mean 26.8 ± 9.2) 62% of them had daily seizures. MRI abnormalities were identified in 8 patients (62%), PET showed concordant findings in 7 patients (88%). When utilized, the mean duration of intracranial EEG recordings was 8.0 ± 7.2 days (range 2-23 days). All patients underwent a primary motor cortex-sparing resection of the suspected epileptogenic cortex. The mean postoperative follow up period was 23 months (range 7.5-62 months). Twelve out of 13 (92%) were seizure free (Engel 1) outcome at the last follow-up assessment; one patient had Engel 2a outcome at 28 months. Six patients (46%) had immediate new focal neurological deficits, however all six patients had recovered completely within three months.Conclusion: The surgical strategy of a primary motor cortex-sparing resective surgery for perirolandic FCD is associated with an excellent early seizure-freedom rate and no permanent neurological deficits. Since the ultimate goal of resective epilepsy surgery is seizure freedom with simultaneous functional preservation, similar long term outcome studies should ultimately guide the resection strategy. [ABSTRACT FROM AUTHOR]

Deep Brain Stimulation (DBS) is a neurosurgical procedure that can reduce symptoms in medically intractable obsessive-compulsive disorder (OCD). Conceptually, DBS of the ventral capsule/ventral striatum (VC/VS) region targets reciprocal excitatory connections between the orbitofrontal cortex (OFC) and thalamus, decreasing abnormal reverberant activity within the OFC-caudate-pallidal-thalamic circuit. In this study, we investigated these connections using diffusion magnetic resonance imaging (dMRI) on human connectome datasets of twenty-nine healthy young-adult volunteers with two-tensor unscented Kalman filter based tractography. We studied the morphology of the lateral and medial orbitofrontothalamic connections and estimated their topographic variability within the VC/VS region. Our results showed that the morphology of the individual orbitofrontothalamic fibers of passage in the VC/VS region is complex and inter-individual variability in their topography is high. We applied this method to an example OCD patient case who underwent DBS surgery, formulating an initial proof of concept for a tractography-guided patient-specific approach in DBS for medically intractable OCD. This may improve on current surgical practice, which involves implanting all patients at identical stereotactic coordinates within the VC/VS region. [ABSTRACT FROM AUTHOR]

Background: Postoperative cognitive dysfunction (POCD) is a known complication after intracranial surgery. Impaired hippocampal neurogenesis has been associated with cognitive dysfunction in animal models. Methods: In order to assess hippocampal changes after brain surgery, a frontal lobe corticectomy was performed in ten adult Wistar rats (group 4). Three different control groups ( n = 10 each) included no treatment (G1), general anesthesia alone (G2), and craniectomy without dural opening (G3). Twenty-four hours after surgery, half of the animals were killed, and the mRNA levels for IL-6, TNF-α, and brain-derived growth factor (BDNF) in the contralateral hippocampus were assessed by qPCR. Seven days later, the remaining animals underwent anxiety and memory testing. Afterwards, the number of immature neurons in the hippocampal cortex was measured by doublecortin (DCX) staining. Results: Twenty-four hours after surgery, mRNA levels of IL-6 and TNF-α increased and BDNF decreased in both surgical groups G3 and G4 ( p = 0.012). Cognitive tests demonstrated an increase in anxiety levels and memory impairment in surgical groups compared with non-surgical animals. These changes correlated with an inhibition of hippocampal neurogenesis evidenced by a decreased number of new neurons (mean ± SD for G1-4: 66.4 ± 24; 57.6 ± 22.2; 21.3 ± 3.78; 5.7 ± 1.05, p < 0.001, non-parametric ANOVA). Conclusions: Intracranial surgery was demonstrated to induce an inflammatory reaction within the hippocampus that compromised neurogenesis and impaired normal cognitive processing. Corticectomy had a greater effect than craniotomy alone, indicating a central trigger for hippocampal inflammatory changes. POCD after craniotomy may originate from a central inflammatory response resulting from surgical trauma to the brain parenchyma. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the ability of semiology alone in localising the epileptogenic zone (EZ) in people with frontal lobe epilepsy (FLE) who underwent resective surgery., Methods: We examined data on all individuals who had FLE surgery at our centre between January 01, 2011 and December 31, 2020. Descriptions of ictal semiology were obtained from video-EEG telemetry reports and presurgical multidisciplinary meeting summaries. The putative EZ was represented by the final site of resection. We assessed how well initial and combined set-of-semiologies correlated anatomically with the EZ, using a semiology visualisation tool to generate probabilistic cortical heatmaps of involvement in seizures., Results: Sixty-one individuals had FLE surgery over the study period. Twelve months following surgery, 28/61 (46%) were completely seizure-free, with a further eight experiencing only auras. Comparing the semiology database with the putative EZ, combined set-of-semiology correctly lateralised in 77% (95% CI: 69-85%), localised to the frontal lobe in 57% (95% CI: 48-67%), frontal lobe subregions in 52% (95% CI: 43-62%), and frontal gyri in 25% (95% CI: 16-33%). No difference in degree of correlation was seen comparing those with ongoing seizures 12 months after surgery to those seizure free., Significance: Semiology alone was able to correctly lateralize the putative EZ in 77%, and localise to a sublobar level in approximately half of individuals who had FLE surgery. Semiology is not adequate alone and must be combined with imaging and EEG data to identify the epileptogenic zone., Competing Interests: Conflict of Interests None., (Copyright © 2023 British Epilepsy Association. Published by Elsevier Ltd. All rights reserved.)

Background: Surgery for lesions located in the medial frontal and parietal lobes can be quite challenging for neurosurgeons because of morbidities that may arise from damage to critical midline structures or intact neural tissue that need to be crossed to reach the lesion. In our anatomic studies, the cingulate sulcus was observed as an alternative access route for lesions located in medial frontal and parietal lobes., Objective: To explain the microsurgical anatomy of the medial hemisphere and cingulate sulcus and to demonstrate the interhemispheric transcingulate sulcus approach (ITCSA) with 3 clinical cases., Methods: Five formalin-fixed brain specimens, which were frozen at -18 °C for at least 2 weeks and then thawed under tap water, were gradually dissected from medial to lateral. Diffusion fiber tracking performed using DSI Studio software in data was provided by the Human Connectome Project. Clinical data of 3 patients who underwent ITCSA were reviewed., Results: Cingulate sulcus is an effortlessly identifiable continuous sulcus on the medial surface of the brain. Our anatomic dissection study revealed that the lesions located in the deep medial frontal and parietal lobes can be reached through the cingulate sulcus with minor injury only to the cingulum and callosal fibers. Three patients were treated with ITCSA without any neurological morbidity., Conclusion: Deep-seated lesions in the medial frontal lobe and parietal lobe medial to the corona radiata can be approached by using microsurgical techniques based on anatomic information. ITCSA offers an alternative route to these lesions besides the known lateral transcortical/transsulcal and interhemispheric transcingulate gyrus approaches., (Copyright © Congress of Neurological Surgeons 2023. All rights reserved.)

There is a lack of studies assessing executive functions (EF) using ecologically valid tests in children with frontal lobe lesions. This study aimed to (1) evaluate EF in children, adolescents and young adults treated for childhood frontal lobe tumours, (2) identify factors influencing performance, such as age at diagnosis or type of treatment, and (3) examine correlations between intellectual ability and classical and ecological tests of EF. Twenty-one patients, aged 8–27 years, treated for a childhood benign or malignant frontal lobe tumour, and 42 healthy controls (matched for gender, age and socio-economic status) were assessed using classical tests of EF, and the BADS-C ecological battery. Patients also underwent assessment of intellectual ability and parent and teacher ratings of the BRIEF questionnaire. IQ scores ranged from 45 to 125 (mean FSIQ = 84) and were lower in case of epilepsy, hydrocephalus and lower parental education. Patients displayed deficits in most, but not all measures of EF. Most classical and ecological measures of EF were strongly correlated to IQ. This study confirms the frequency of EF deficits in this population; it also highlights the utility of ecological measures of EF and some limitations of classical tests of EF in children. [ABSTRACT FROM PUBLISHER]

Brain cognitive functions affect patient quality of life. The frontal lobe plays a crucial role in advanced cognitive functions, including executive function, meta-cognition, decision-making, memory, emotion, and language. Therefore, frontal tumors can lead to serious cognitive impairments. Currently, neurosurgical treatment is the primary method to treat brain tumors; however, the effects of the surgical treatments are difficult to predict or control. The treatment may both resolve the effects of the tumor to improve cognitive function or cause permanent disabilities resulting from damage to healthy functional brain tissue. Previous studies have focused on the influence of frontal lesions and surgical treatments on patient cognitive function. Here, we review cognitive impairment caused by frontal lobe brain tumors. [ABSTRACT FROM AUTHOR]

Study Design: Retrospective descriptive study of an innovative surgical technique. Objective: To assess the feasibility and success of repair of transfrontal sinus cerebrospinal fluid (CSF) rhinorrhea through pterional transcranial extradural approach using endoscope. Summary of Background Data: Repair of CSF rhinorrhea has seen advancement with the evolution of endoscopic transnasal techniques. However, leaks from defect in the posterior wall of frontal sinus still remain a challenge for the skull base surgeons and requires conventional craniotomy more often. We describe a novel technique to repair these leaks by purely endoscopic pterional extradural (PEPE) approach thereby avoiding complications associated with conventional craniotomy and endoscopic transnasal approaches. Materials and Methods: Thirty-five patients with traumatic CSF rhinorrhea from the posterior wall of frontal sinus underwent repair with the present technique. They were followed up for 6-18 months and were evaluated for feasibility of procedure, recurrence of leak, and occurrence of the fresh neurological deficit. Results: Thirty-five patients underwent CSF rhinorrhea repair using the above technique. The procedure was accomplished in all patients without any intraoperative complications. There was no requirement of blood transfusion in any case. All patients had a cessation of CSF leak in the postoperative period, and there was no recurrence. There was no evidence of frontal lobe retraction injury in any of these patients, and no fresh neurological deficit was observed. Conclusion: This PEPE approach to repair CSF leak through the posterior wall of the frontal sinus is a novel technique in which we can avoid disadvantages associated with both conventional craniotomy as well as transnasal endoscopic approaches. [ABSTRACT FROM AUTHOR]

Background and Objective: Supplementarymotor area (SMA) syndrome, an executive disorder with motor and speech dysfunctions, is rather unpredictable with typically a complete or almost complete functional recovery within weeks or months. Compensatory mechanisms are associated with contralateral cortical recruitment of the lateral premotor circuitry. We sought to investigate the role of healthy SMA formotor recovery following surgery in the medial frontal lobe. Methods: A 48-year-old right-handed man presented with focal motor seizures. The diagnostic work-up revealed a low-grade glioma at the superior frontal gyrus. The patient was operated on with intraoperative monitoring of motor pathways, and resection was taken to the functional boundaries. Results: Postoperatively, the patient experienced a typical SMA syndrome that almost completely resolved in the long term. Motor recovery occurred concurrently with a shift of SMA activation to the healthy hemisphere together with an increased lateral premotor circuitry, especially for the hand map. Conclusion: Our results confirm brain remodeling of the lateral premotor cortex, as previously described, and indicate that functional improvement is also paralleled with a shift of SMA activation toward the healthy hemisphere. [ABSTRACT FROM AUTHOR]

Background: Focal status epilepticus and catastrophic epilepsy are not rare in infants. Epilepsy surgery can be safely done in selected infants to cure epilepsy. Patient description: We report on an infant who began having drug-resistant status epilepticus at 2 weeks of age and developed epileptic spasms. We discuss in detail how the clinical and electroencephalographic data were used to reach a consensus for epilepsy surgery and why a particular surgical approach was preferred over other alternatives. Method: Presurgical evaluation consisted of 32-channel scalp video EEG using the standard 10–20 system of electrodes, 3-Tesla brain magnetic resonance imaging, and 18 F-fluorodeoxyglucose positron emission tomography. The surgery consisted of resection of the extensive epileptogenic lesion, in addition to disconnection of the left frontal lobe anterior to the motor strip. Result: The infant underwent epilepsy surgery at three months of age. At two-year follow up, she remained seizure free, with no focal motor deficit and the epileptic encephalopathy resolved. The disconnected left frontal lobe shows epileptiform discharges restricted to the disconnected tissue. Conclusion: We highlight the importance of epilepsy surgery in selected infants to achieve seizure freedom and to reverse epileptic encephalopathy. In the process, we demonstrate how epileptic spasms, although clinically and electrographically generalized, resolved after disconnecting the epileptogenic zone. [ABSTRACT FROM AUTHOR]

Objective Children with epilepsy have elevated rates of behavior problems. Research findings on the impact of epilepsy surgery on children's behavior have been mixed, with some studies showing improvements in behavior 3 to 18 months after surgery and other studies finding no change within this time interval. We examined behavior in a large surgical sample and in a nonsurgical comparison group. We also examined for potential effects of epilepsy-related and cognitive/linguistic variables. Methods Behavior was assessed by parent report in 147 children who underwent epilepsy surgery and 40 children who did not, using the Child Behavior Checklist (CBCL). For the surgical group, the CBCL was completed prior to surgery (baseline) and approximately 1 year after surgery (follow-up); ratings of the nonsurgical group were also conducted twice, at comparable intervals. Results At baseline, the groups did not differ on age, sex, age at seizure onset, antiepileptic drugs (AEDs), or intelligence quotient (IQ). Baseline Social and Attention Problems were higher in the nonsurgical group. At follow-up, 65% of the surgical group and 20% of the nonsurgical group were seizure-free. Behavioral change was not related to surgical status or seizure outcome. Children with temporal lobe seizure focus had more Externalizing Behaviors compared to those with frontal or multilobar foci. Attention was poorer in children who underwent frontal lobe excisions relative to temporal or multilobar excisions. Baseline IQ did not predict behavioral change. Significance Our results suggest that surgery and seizure outcome do not affect behavior in the first year following surgery; it may be the abnormal neural substrate and not seizure control that influences behavior in children with epilepsy. If changes are to occur due to seizure freedom, they may require a longer time to emerge. Some behaviors may be resistant to change in children with epilepsy or may require even longer intervals for improvement. [ABSTRACT FROM AUTHOR]

Impaired social cognition, including emotion recognition, may explain dysfunctional emotional and social behaviour in patients with lesions to the ventromedial prefrontal cortex (VMPFC). However, the VMPFC is a large, poorly defined area that can be sub-divided into orbital and medial sectors. We sought to investigate social cognition in patients with discrete, surgically circumscribed prefrontal lesions. Twenty-seven patients between 1 and 12 months post-neurosurgery were divided into groups based on Brodmann areas resected, determined by post-surgical magnetic resonance imaging. We hypothesised that patients with lesions to the VMPFC ( n =5), anterior cingulate cortex ( n =4), orbitofrontal cortex ( n =7) and dorsolateral prefrontal cortex (DLPFC, n =11) would perform worse than a control group of 26 extra-cerebral neurosurgery patients on measures of dynamic facial emotion recognition, theory of mind (ToM) and empathy. Results indicated the VMPFC-lesioned group performed significantly worse than the control group on the facial emotion recognition task overall, and for fear specifically, and performed worse on the ToM measure. The DLPFC group also performed worse on the ToM and empathy measures, but DLPFC lesion location was not a predictor of performance in hierarchical multiple regressions that accounted for other variables, including the reduced estimated verbal IQ in this group. It was concluded that isolated orbital or medial prefrontal lesions are not sufficient to produce impairments in social cognition. This is the first study to demonstrate that it is the combination of lesions to both areas that affect social cognition, irrespective of lesion volume. While group sizes were similar to other comparable studies that included patients with discrete, surgically circumscribed lesions to the prefrontal cortex, future large, multi-site studies are needed to collect larger samples and confirm these results. [ABSTRACT FROM AUTHOR]

Despite being associated with high-order neurocognitive functions, the frontal lobe plays an important role in core neurological functions, such as motor and language functions. The aim of this study was to present a neurosurgical perspective of the cortical and subcortical anatomy of the frontal lobe in terms of surgical treatment of intraaxial frontal lobe lesions. We also discuss the results of direct brain mapping when awake craniotomy is performed. Ten adult cerebral hemispheres were prepared for white matter dissection according to the Klingler technique. Intraaxial frontal lobe lesions are approached with a superior or lateral trajectory during awake conditions. The highly eloquent cortex within the frontal lobe is identified within the inferior frontal gyrus (IFG) and precentral gyrus. The trajectory of the approach is mainly related to the position of the lesion in relation to the arcuate fascicle/superior longitudinal fascicle complex and ventricular system. Knowledge of the cortical and subcortical anatomy and its function within the frontal lobe is essential for preoperative planning and predicting the risk of immediate and long-term postoperative deficits. This allows surgeons to properly set the extent of the resection and type of approach during preoperative planning., (© 2022. The Author(s).)

The sylvian fissure stem and its deep cisternal part (SDCP) consist mainly of the orbital gyrus (OG) and anterior medial portion of the temporal lobe. SDCP's adhesion has been found to make a trans-sylvian approach difficult due to the various patterns of adhesion. Thus, in this study, we aim to clarify the morphological features of the SDCP, and to guide a safe trans-sylvian approach. We retrospectively classified the morphology of the SDCP in 81 patients into 3 types (tight, moderate, loose type) according to the degree of adhesion of the arachnoid membrane and analyzed the morphological features of the OG and the temporal lobe using intraoperative video images. In addition, we have retrospectively measured each width of the SDCP's subarachnoid space at the three points (Point A, lateral superior portion; Point B, downward portion; Point C, medial inferior portion of SDCP) and analyzed their relationship to the degree of adhesion using the preoperative coronal three-dimensional computed tomography angiography (3D-CTA) images of 44 patients. As per the results, SDCP's adhesions were determined to be significantly tighter in cases with large OG and young cases. The temporal lobe had four surfaces (posterior, middle, anterior, and medial) that adhered to the OG in various patterns. The tighter the adhesion between the OG and each of the three distal surfaces of the temporal lobe, the narrower the width of the subarachnoid space at each point (A, B, C). Understanding of the morphological features of the SDCP, and estimating its adhesion preoperatively are useful in developing a surgical strategy and obtaining correct intraoperative orientation in the trans-sylvian approach.

Levetiracetam may induce serious behavioral disturbances, especially after surgical resection of frontal lobe low-grade glioma. Two patients, treated with levetiracetam, developed serious psychiatric complications postoperatively which completely resolved after switching to valproate. We aim to create awareness for this serious but reversible adverse effect of levetiracetam in this specific patient category. [ABSTRACT FROM PUBLISHER]

Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht.

Abstract: Executive dysfunction occurs in a variety of patients who have sustained damage to the frontal lobes. In individuals with frontal lobe epilepsy (FLE) or after unilateral frontal lobe resection (FLR), a unique neuropsychological profile linking executive functions (EF) with the frontal lobe has been elusive, with conflicting findings in the literature. Some studies show greater risk of executive impairment with left-sided FLE or FLR, while others report greater risk for right-sided patients. Some studies report no relationship between FLE and EF impairment, while others show EF impairment regardless of side of seizure foci or surgery. In patients with temporal lobe epilepsy, executive dysfunction is associated with depressed mood possibly reflecting disruption of cortical-limbic pathways and/or frontal–striatal circuitry. Although not previously examined, depression level may affect executive functioning in those with FLE or FLR. We hypothesized that FLE patients with poor mood state would show greater executive dysfunction than FLE patients without poor mood state. The relationship among EF, side of surgery and depressed mood before and 8 months after unilateral FLR was evaluated in 64 patients using validated measures of EF and mood state (Beck Depression Inventory-II). Results indicated that individuals with depressed mood before surgery had greater difficulty on a task of mental flexibility compared to patients without preoperative depressed mood. Further, individuals with depressed mood before surgery had significant increases in perseverative responding and completed fewer categories on a card-sorting task after surgery compared to patients without preoperative depressed mood. Regression analyses showed that among side of surgery, seizure freedom status after surgery and depression status, only pre-surgical depression status explained a significant amount of variance in executive functioning performance after surgery. Results suggest that clinically elevated depressive symptoms before surgery are a risk factor for moderate declines in EF after surgery. Results may be attributable to reduced cognitive reserve in patients with depressive symptoms, or may reflect a common cause attributable to damage to unilateral dorsal and ventral lateral frontal lobe. [Copyright &y& Elsevier]

Clinical cases of frontal lobe lesions have been significantly associated with acquired aggressive behaviour. Restoring neuronal and cognitive faculties of aggressive individuals through invasive brain intervention raises ethical questions in general. However, more questions have to be addressed in cases where individuals refuse surgical treatment. The ethical desirability and permissibility of using intrusive surgical brain interventions for involuntary or voluntary treatment of acquired aggressiveness is highly questionable. This article engages with the description of acquired aggressiveness in general, and presents a rare clinical case to illustrate the difficulties of treating this population. To expand the debate further, this article explores the ethics related to invasive brain surgery in three parts: a) it examines coercive involuntary invasive brain surgery for the benefit of protecting others on individuals suffering from acquired aggressiveness who lack decision-making capacities to consent; b) it addresses voluntary psychosurgery on individuals suffering from acquired aggressiveness who are competent to consent; and, c) it questions whether acquired aggressive individuals, who are legally competent, have a duty to consent to invasive brain surgery, in order to maintain their autonomy by reducing or even eliminate their aggressive drives. Ensuring the safety and efficacy of surgical brain interventions could increase the ethical permissibility of voluntary treatment, but it would not necessarily entail ethical justification for proceeding with invasive brain surgery for treatment of intractable acquired aggressive behaviour. [ABSTRACT FROM AUTHOR]

Background: Morphometric data of the frontal lobe are important for surgical planning of lesions in the frontal lobe and its surroundings. Magnetic resonance imaging (MRI) techniques provide suitable data for this purpose. Objectives: In our study, the morphometric data of mid-sagittal MRI of the frontal lobe in certain age and gender groups of children have been presented. Patients and Methods: In a normal age group of 6-17-year-old participants, the length of the line passing through predetermined different points, including the frontal pole (FP), commissura anterior (AC), commissura posterior (PC), the outermost point of corpus callosum genu (AGCC), the innermost point of corpus callosum genu (IGCC), tuberculum sella (TS), AGCC and IGCC points parallel to AC-PC line and the point such line crosses at the frontal lobe surface (FCS) were measured in three age groups (6-9, 10-13 and 14-17 years) for each gender. Results: The frontal lobe morphometric data were higher in males than females. Frontal lobe measurements peak at the age group of 10-13 in the male and at the age group of 6-13 in the female. In boys, the length of FP-AC increases 4.1% in the 10-13 age group compared with the 6-9-yearold group, while this increase is 2.3% in girls. Conclusion: Differences in age and gender groups were determined. While the length of AGCC-IGCC increases 10.4% in adults, in children aged 6-17, the length of AC-PC is 11.5% greater than adults. These data will contribute to the preliminary assessment for developing a surgical plan in fine interventions in the frontal lobe and its surroundings in children. [ABSTRACT FROM AUTHOR]

Background: Craniofacial surgery is the standard treatment for children with moderate to severe trigonocephaly. The added value of surgery to release restriction of the frontal lobes is unproven, however. In this study, the authors aim to address the hypothesis that the frontal lobe perfusion is not restricted in trigonocephaly patients by investigating cerebral blood flow., Methods: Between 2018 and 2020, trigonocephaly patients for whom a surgical correction was considered underwent magnetic resonance imaging brain studies with arterial spin labeling to measure cerebral perfusion. The mean value of cerebral blood flow in the frontal lobe was calculated for each subject and compared to that of healthy controls., Results: Magnetic resonance imaging scans of 36 trigonocephaly patients (median age, 0.5 years; interquartile range, 0.3; 11 female patients) were included and compared to those of 16 controls (median age, 0.83 years; interquartile range, 0.56; 10 female patients). The mean cerebral blood flow values in the frontal lobe of the trigonocephaly patients (73.0 ml/100 g/min; SE, 2.97 ml/100 g/min) were not significantly different in comparison to control values (70.5 ml/100 g/min; SE, 4.45 ml/100 g/min; p = 0.65). The superior, middle, and inferior gyri of the frontal lobe showed no significant differences either., Conclusions: The authors' findings suggest that the frontal lobes of trigonocephaly patients aged less than 18 months have a normal cerebral blood flow before surgery. In addition to the very low prevalence of papilledema or impaired skull growth previously reported, this finding further supports the authors' hypothesis that craniofacial surgery for trigonocephaly is rarely indicated for signs of raised intracranial pressure or restricted perfusion for patients younger than 18 months., Clinical Question/level of Evidence: Risk, II., (Copyright © 2022 by the American Society of Plastic Surgeons.)

Germinoma is rare in peripheral lobar locations in the brain, with only 10 cases of primary frontal lobe germinoma having been reported in the previous literature. Epilepsy is a rare manifestation of germinomas. We describe an unusual case of a primary frontal germinoma in a 21-year-old man who presented with epilepsy. A presumptive diagnosis of abscess or cystic glioma was made, and then, we performed microsurgery under magnetic resonance imaging (MRI) neuronavigation guidance. Postoperative histopathologic examination identified the tumour as a rare germinoma. Subsequently, adjuvant radiotherapy and chemotherapy programmes were adopted in the present case, and there were no recurrence and postoperative seizure symptoms observed in the follow-up 6 months after operation.

Abstract: This study aimed at investigating psychological features before and two years after epilepsy surgery. Fifty patients, 39 with temporal lobe epilepsy (TLE) and 11 with frontal lobe epilepsy (FLE), were assessed at baseline and two years postoperatively with the Karolinska Scales of Personality (KSP). Baseline group level outcome was normal while individual level analyses delineated some mild to moderate degrees of psychological problems exceeding the normal range in subsets of patients. Features of hostility characterized half of the FLE and one-fourth of the TLE patients. Above 1/3 in each group had dependency features. About 1/3 of the TLE patients suffered from psychasthenia. In conclusion, even though group levels were normal, several patients had psychological problems. The main longitudinal result was that the personality features were stable and did not change after epilepsy surgery. [Copyright &y& Elsevier]

Summary Purpose: Anterior temporal lobe resection (ATLR) controls seizures in up to 70% of patients with intractable temporal lobe epilepsy (TLE) but, in the language dominant hemisphere, may impair language function, particularly naming. Functional reorganization can occur within the ipsilateral and contralateral hemispheres. We investigated reorganization of language in left-hemisphere-dominant patients before and after ATLR; whether preoperative functional magnetic resonance imaging (fMRI) predicts postoperative naming decline; and efficiency of postoperative language networks. Methods: We studied 44 patients with TLE due to unilateral hippocampal sclerosis (24 left) on a 3T GE-MRI scanner. All subjects performed language fMRI and neuropsychological testing preoperatively and again 4 months after left or right ATLR. Key Findings: Postoperatively, individuals with left TLE had greater bilateral middle/inferior frontal fMRI activation and stronger functional connectivity from the left inferior/middle frontal gyri to the contralateral frontal lobe than preoperatively, and this was not observed in individuals with right TLE. Preoperatively, in left and right TLE, better naming correlated with greater preoperative left hippocampal and left frontal activation for verbal fluency (VF). In left TLE, stronger preoperative left middle frontal activation for VF was predictive of greater decline in naming after ATLR. Postoperatively, in left TLE with clinically significant naming decline, greater right middle frontal VF activation correlated with better postoperative naming. In patients without postoperative naming decline, better naming correlated with greater activation in the remaining left posterior hippocampus. In right TLE, naming ability correlated with left hippocampal and left and right frontal VF activation postoperatively. Significance: In left TLE, early postoperative reorganization to the contralateral frontal lobe suggests multiple systems support language function. Postoperatively, ipsilateral recruitment involving the posterior hippocampal remnant is important for maintaining language, and reorganization to the contralateral hemisphere is less effective. Preoperative left middle frontal activation for VF was predictive of naming decline in left TLE after ATLR. [ABSTRACT FROM AUTHOR]

The article presents a case study of a previously healthy eight-year-old boy with a generalized tonic-seizure episode. It mentions that the post-contrast magnetic resonance imaging (MRI) scan that was conducted on the patient revealed that the frontal lobe mass of the patient had a mild heterogeneous enhancement. It says that right frontal craniotomy was conducted on the patient for tumor resection. It discusses the association of extraventricular neurocytoma to the case of the patient.