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Related Concept Videos

Endoscopic Procedures III: Video Capsule Endoscopy01:28

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Capsule endoscopy, or wireless or video capsule endoscopy, is a diagnostic procedure for examining the entire gastrointestinal tract. Patients swallow a capsule about the size of a vitamin tablet. The capsule is equipped with a transmitter, a battery, an LED light source, and a color video camera to capture images throughout the gastrointestinal tract. This procedure is particularly useful for diagnosing conditions such as Crohn's disease, ulcerative colitis, tumors, polyps, ulcers,...
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Completion Posterior Quadrant Disconnection After Failed Temporal Lobectomy: 2-Dimensional Operative Video.

Saarang Patel1, Christopher Markosian2, Jose F Dominguez3

  • 1Department of Neurosurgery, Hackensack University Medical Center, Hackensack, New Jersey, USA.

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|August 25, 2021
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Summary
This summary is machine-generated.

Posterior quadrant disconnection (PQD) is a safe and effective surgical option for medically refractory epilepsy (MRE) when medications fail. This procedure can be used initially or after other surgeries, offering seizure freedom.

Keywords:
Drug-resistant epilepsyMedically resistant epilepsyPQDSeizure

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Area of Science:

  • Neurosurgery
  • Epileptology
  • Neurology

Background:

  • Epilepsy affects 1% of the global population, with medically refractory epilepsy (MRE) occurring when antiseizure medicines (ASMs) fail.
  • Posterior quadrant disconnection (PQD) is an effective surgical treatment for MRE localized to the temporal, parietal, and/or occipital lobes.

Purpose of the Study:

  • To demonstrate the technical nuances of a right-sided completion PQD in a pediatric patient with focal MRE.
  • To highlight PQD as a viable treatment option for MRE, even after prior failed surgical interventions.

Main Methods:

  • The study details a right-sided posterior quadrant disconnection (PQD) in an 8-year-old female with medically refractory epilepsy (MRE).
  • Technical steps included revising the scalp incision, using a subdural strip to identify the central sulcus, disconnecting the parietal and occipital lobes, extending the corticectomy, and performing a posterior corpus callosum disconnection.
  • Postoperative management involved monitoring for complications and cerebrospinal fluid (CSF) drainage via an external ventricular drain (EVD).

Main Results:

  • The patient experienced transient left-arm weakness and central fever, which resolved postoperatively.
  • Cerebrospinal fluid (CSF) drainage via external ventricular drain (EVD) cleared within 3-4 days.
  • At 3-month follow-up, the patient remained seizure-free with no complications.

Conclusions:

  • Posterior quadrant disconnection (PQD) is a safe and effective surgical treatment for medically refractory epilepsy (MRE).
  • PQD can be considered as an initial surgical approach or as a salvage procedure following previous failed surgeries.
  • This technique offers a potential pathway to seizure freedom for patients with specific types of refractory epilepsy.