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Introduction and Aims: Interdisciplinary research made by neuropsychologist, neurologists and radiologists is making possible descriptions of the anatomic bases of memory. The hippocampus is one of the main structures related to memory processing. The aim of the present study was to study the relationship between verbal and visual memory, and the volumetry and relaxometry of the., Patients and Methods: 36 patients with temporal lobe epilepsy and mesial temporal sclerosis (MTS). Fist, a neuropsychological assessment of was made the verbal and visual memory. Second, hippocampal structure were studied by magnetic resonance image (hippocampal volumetry and relaxometry)., Results and Conclusions: Reactive gliosis measured by T2 relaxation time predicted poorer visual memory in patients with right or left MTS. These results indicate that structural damage in right hippocampus implies worse performance in visual memory. Moreover, MTS was found to have negative effects on contralateral memory (poorer verbal memory in right MTS, and poorer visual memory in left MTS). These results could be due to memory compensation. Thus, the memory function associated with the sclerotic hippocampus is adopted by the contralateral structure. Therefore, the more damage there is to the latter, the poorer is the memory functioning.

Introduction: Temporal lobectomy (TL) is an effective treatment for drug refractory temporal lobe epilepsy. The main neuropsychological consequences of the intervention are changes in episodic and semantic memory. Aim. To study the consequences of right temporal lobectomy (RTL) and left temporal lobectomy (LTL) on episodic and semantic mnemonic functioning., Patients and Method: 27 patients who had undergone TL in the Hospital Universitario Virgen de las Nieves in Granada were submitted to pre and post surgical evaluation by means of a battery of neuropsychological tests that included episodic and semantic memory tests for both verbal and visual material., Results and Conclusions: ANOVA analysis was employed to analyse the pre and post surgical changes for the whole group of patients, and Student s t and Wilcoxon s non parametric test were used for each group of RTL and LTL. No deterioration was found in ipsilateral memory after the intervention, that is to say, in the verbal memory of the patients submitted to LTL and in the visual memory of RTL patients. With regard to contralateral memory, that is, the visual memory of patients submitted to LTL and the verbal memory of RTL patients, the ANOVA analyses of the whole group revealed a statistically significant improvement. The analyses performed for the whole group (LTL and RTL), however, did not reveal any statistically significant changes.

Introduction: Temporal lobe epilepsy is the most frequent of the epilepsies related with localization and one of the most refractory to pharmacological treatment. Temporal lobectomy curbs seizures in many of these patients, which improves their quality of life., Case Report: Patient aged 45 who, during early infancy, started to suffer simple partial seizures that later went on to become generalised. These were well under control by adolescence but at 23 they became complex partial seizures that were resistant to different antiepileptic drugs. The patient was submitted to a complete presurgical evaluation and a left anterior temporal lobectomy was performed at the age of 44. After surgery he evolved favourably. The final diagnosis was that he was suffering from mesial temporal sclerosis, associated with a subcortical neuronal heterotopy of the parahippocampal region. We discuss the semiology and the aetiology with regard to this patient and in a general sense, and we also define the foundations upholding the decision to perform surgery, the areas that make up the epileptogenic zone, and the neurophysiological and neuropsychological tests, and the structural and functional neuroimaging that are used to measure those areas. Likewise, the different techniques that can be used in resection of the temporal lobe are analysed. We also set out an etiopathogenic hypothesis according to the histopathological results and comment on a number of related general aspects., Conclusions: Progress in physiopathological knowledge, the development of diagnostic and surgical techniques, and its high efficiency and low morbidity have consolidated temporal lobectomy as a radical form of treatment for temporal lobe epilepsy that should be performed as early as possible once resistance to medication has been observed.

Introduction: Intracranial lipomas make up approximately 0.1% of all cerebral tumours. They are considered to be congenital malformations, caused by poor differentiation and abnormal persistence of the primitive meninges, which has become adipose tissue during the development of the subarachnoid space. They are usually found in the midline, often in the cisterna pericallosa. It is very unusual for them to be in the fissure of Sylvius and cerebral convexity. Most cerebral lipomas are aymptomatic. Epileptic seizures are the commonest symptom, and are sometimes refractory to treatment., Case Report: A 20 year old man with no previous clinical history. From the age of three years he had frequent senso-motor seizures of the lower half of the right side of his body, which were resistant to anti-epileptic drugs. On magnetic resonance there was an extra axial lesion in the left posterior parietal and parasagittal convexity. This was hyperintense in T(1) sequences, not seen in STIR sequences, and was compatible with fatty tissue. Subtotal removal of the tumour was carried out and the histopathological diagnosis was lipoma. The patient had no seizures in the year after operation., Conclusions: Lipomas of the cerebral hemispheres are very uncommon. The usual symptoms are focal epileptic seizures, as a result of the cortical irritation caused by close adherence of the lipoma to the cerebral cortex or associated cortical or vascular dysplasias. They have easily recognized characteristics on computerized axial tomography and magnetic resonance. Treatment should be conservative unless it is associated with refractory epilepsy, in which case careful resection may be considered, although this is rarely complete.

Introduction: Focal cortical dysplasia (FCD) is an unusual cause of refractory epilepsy, in which the morbid anatomy is characterized by cortical laminar dysplasia and the presence of balloon like cells., Clinical Case: A 36 year old woman who had had drug-resistant epilepsy since the age of 9 years old, with daily complex partial seizures and seizures in which she fell to the ground. After many therapeutic trials, at the age of 29 years she had a callostomy as palliative treatment for the seizures in which she fell and was completely cured of these. The complex partial seizures increased in frequency, in spite of high doses of multiple drugs, so the possibility of resective surgery was considered. A surface EEG with predominant lateralization and localization to the left temporal lobe, ictal and interictal cerebral SPECT, PET and MR were done. The findings were comparable with two foci of dysplasia in the left cerebral hemisphere, one superior parietal and the other posterior basal temporal in situation. Finally, video-EEG monitoring with foramen ovale electrodes showed ictal activity starting in the left posterior temporal regions and with rapid homolateral anteromesial diffusion. A left temporal lobectomy and amigdalohippocampectomy was done with resection of a posterior basal temporal lesion. This reduced the number of seizures by 90%, with minimal dysnomy as a sequel. The findings on morbid anatomical study were compatible with a FCD., Conclusions: FCD is a cause of refractory epilepsy which may benefit from surgical treatment, with excellent results, after suitable pre-operative surgical evaluation and planning, including hippocampal evaluation since there is a high incidence of associated mesial sclerosis.

Introduction: Mesial temporal sclerosis (MTS) is a progressive drug-resistant epileptic syndrome which requires rapid, effective diagnosis and treatment. Histologically there is atrophy and gliosis of the hippocampus., Objective: To establish magnetic resonance (MR) imaging guidelines for correct diagnosis., Patients and Methods: We made a prospective study of 78 patients with drug-resistant temporal lobe epilepsy (44 women and 34 men; age 6-66 years, mean 31 years). Using a magnet of 1.5 Teslas paracoronal sections were made of the hippocampus with T1 volumetric with inversion-recovery, FLAIR (fluid-attenuated inversion-recovery) and T2 relaxometry. A control group of 30 healthy volunteers was established. The reduction in volume and hippocampal T2 hyperintensity were considered to be MTS diagnosed on MR., Results: No hippocampal differences were observed among the healthy volunteers. The confidence intervals (mean +/- 1.96 SD) were: right volume: 4.169-5.911 mm3; left volume: 4.097-5.940 mm3; time of T2 relaxation: 98-113 ms. MTS was observed in 42 patients (54%): 24 left, 14 right and four asymmetrical bilateral. The results of the diagnostic validity (sensitivity/specificity) were: T1 volumetric 91/92%, FLAIR 93.5/98% and T2 relaxometry 91/92%. There was atrophy of other extrahippocampal structures in five cases of MTS; 10 patients with MTS (23.5%) had another extrahippocampal lesion associated (dual pathology), particularly migration disorders; 21 patients (27%) had lesions without MTS (tumors, alterations of migration, nonspecific gliosis) and in 15 cases (19%) there were no abnormal findings. A total of 27 patients were operated on: 22 with MTS (21 had diagnostic MR, one case had no abnormal findings), four cases had tumors and one had cortical dysplasia., Conclusion: The combination of quantitative techniques (T1 volumetric with inversion-recovery and T2 relaxometry) and FLAIR optimize MTS diagnosis using MR.