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Vision After Occipital Lobectomy and Related Surgeries

Vision After Occipital Lobectomy and Related Surgeries. Monika Jones, JD Visionary Founder and CEO The Brain Recovery Project: Childhood Epilepsy Surgery Foundation Board Member, Council of Parent Attorneys and Advocates. OVERVIEW. Why remove an occipital lobe (or more)?

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Vision After Occipital Lobectomy and Related Surgeries

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  1. Vision After Occipital Lobectomy and Related Surgeries Monika Jones, JD Visionary Founder and CEO The Brain Recovery Project: Childhood Epilepsy Surgery Foundation Board Member, Council of Parent Attorneys and Advocates

  2. OVERVIEW • Why remove an occipital lobe (or more)? • What are the resulting vision implications and how do they impact a child? • Instruction methods, accommodations, modifications, and compensatory mechanisms to help these children succeed in school.

  3. Why remove an occipital lobe (or more) on purpose?

  4. INCIDENCE OF PEDIATRIC EPILEPSY SURGERY IN THE U.S.

  5. WHEN TO HAVE A SURGICAL EVALUATION Cross, H. Proposed Criteria for Referral and Evaluation of Children for Epilepsy Surgery: Recommendations of the Subcommission for Pediatric Epilepsy Surgery. Epilepsia, 47(6):952–959, 2006 Failure of two appropriate anti-epileptic drugs … OR Diagnosed with a “catastrophic” epilepsy … OR Diagnosed with a condition known to be drug resistant

  6. CATASTROPHIC EPILEPSIES Shields, Catastrophic Epilepsy In Childhood Epilepsia, 41(Suppl. 2):SZ-S6, 2000 Otahara syndrome *Infantile spasms (IQ drop 4 points; CVI) Dravet syndrome Lennox-Gastaut syndrome Doose syndrome Sturge-Weber syndrome Rasmussen’s encephalitis

  7. DRUG RESISTANT BRAIN CONDITIONS Hemispheric malformations (hemimegalencephaly) Rasmussen’s encephalitis In utero or post-natal stroke Cortical dysplasia Polymicrogyria Tuberous sclerosis complex Hypothalmic hamartoma Electrical status epilepticus in sleep (ESES) Cross, H. Proposed Criteria for Referral and Evaluation of Children for Epilepsy Surgery: Recommendations of the Subcommission for Pediatric Epilepsy Surgery. Epilepsia, 47(6):952–959, 2006

  8. cerebrum cerebellum

  9. GRAY MATTER WHITE MATTER (CORTEX) (AXONS

  10. Axon = white matter Neuron cell body = gray matter

  11. Self Reflected in Blues 22K gilded microetching under multicolored light 2014-2016 Greg Dunn and Brian Edwards

  12. Ventricles ‘sit” in the white matter

  13. Tailored 50-60% of the occipital lobe is devoted to central field Goal is to preserve central vision Complete/Multi-Lobar Entire occipital lobe removed or disconnected (white matter tracts) or gray matter removed (corticectomy) Hemispherectomy Posterior quadrantic resection/disconnection Occipital lobectomy (w/ or w/o other lobes) What type of resection did your student have? Hydrocephalus?

  14. Case study C-section @ 35 weeks hemimegalencephaly seizures in utero/at birth infantile spasms 5 anti-epileptic drugs by three months old Uncontrolled seizures

  15. Hemispherectomy “+” Hemiparesis Auditory processing Speech (left v. right) Executive function/processing Proprioception/touch Hydrocephalus (periventricular damage?) Seizures (71%) Medications IQ CVI (dense homonymous hemianopia and…?) Oculomotor control Strabismus/Exotropia (corrected?) Nystagmus? Optic nerve damage?

  16. parafoveal

  17. Fovea is only 2-5 degrees of the total visual field - about the size of two times the thumbnail viewed at arms length • Fovea represents 50% of the visual cortex (occipital lobe) • Views detail. Only part of the retina where 20/20 vision possible. • If object large, eyeballs must move around to view the object in detail. Krantz, John H. (1 October 2012). "Chapter 3: The Stimulus and Anatomy of the Visual System" (PDF). Experiencing Sensation and Perception. Pearson Education. ISBN978-0-13-097793-9. Fairchild, Mark. (1998), Color Appearance Models. Reading, Mass.: Addison, Wesley, & Longman, p.7. ISBN0-201-63464-3

  18. Your field of vision peripheral Central (fovea) parafoveal

  19. Does the child see black in the lost visual field?

  20. ORIENTATION AND MOBILITY CHALLENGES bump into people and objects trip and fall/stairs pouring beverages reduced participation in social life, sports, recess 50% states prohibit driving visual neglect INTERVENTIONS/TRAINING Comprehensive eval (static/dynamic/familiar/unfamiliar) spontaneous saccades to the blind side mark crucial features consistent furniture placement Hemianopsia.net Perkins/New England cane?

  21. READING EXPERIMENT • On the next slide, focus ONLY on the redword. Don’t move your eyes to try to read any other word but the red word. • FOCUS ONLY ON THE RED WORD! • Now, read the entire paragraph while focusing only on the red word.

  22. October arrived, spreading a damp chill over the grounds and into the castle. Madam Pomfrey, the nurse, was kept busy by a sudden spate of colds among the staff and students. Her Pepperup potion worked instantly, though it left the drinker smoking at the ears for several hours afterward. Ginny Weasley, who had been looking pale, was bullied into taking some by Percy. The steam pouring from under her vivid hair gave the impression that her whole head was on fire. Even aside from the rain and wind it hadn't been a happy practice session. Fred and George, who had been spying on the Slytherin team, had seen for themselves the ...

  23. alpine

  24. “Reading into nothingness…”

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