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1.
Numerous studies of the electrophysiology and neuropathology of temporal lobe epilepsy have demonstrated the mesial temporal structures to be the site of seizure origin in the majority of cases. This is the rationale for a transcortical selective approach, first introduced by Niemeyer, for removal of the hippocampus and amygdala. Series from a number of centers have demonstrated the efficacy of selective amygdalohippocampectomy compared to a more traditional resection. The technique described here and used at the Montreal Neurological Institute (MNI) utilizes a strictly endopial resection of the hippocampal formation and amygdala in addition to computer image guidance to perform the procedure. Ninety-five percent of patients at the MNI who underwent selective amygdalohippocampectomy realized a cessation of seizures, or greater than 90% reduction, with minimal risk of complications.  相似文献   

2.
目的观察前颞叶切除术和选择性海马、杏仁核切除术对颞叶内侧癫痫的发作控制效果是否有差别。方法 2009年1月至2010年12月在我科行前颞叶切除术的67例颞叶内侧患者为A组;2011年6月至2013年5月在我科行选择性海马、杏仁核切除术的46例颞叶内侧患者为B组;统计分析两组术后1年发作控制为Engel I-II级和Engel III-IV级的人数。结果 A组Engel I-II级56例(83.58%),Engel III-IV级11例(16.42%);B组Engel I-II级40例(86.95%),Engel III-IV级6例(13.05%)。经χ2检验两组术后对MTLE发作的控制率无统计学差异,χ2=0.243,P0.05。结论前颞叶切除术和选择性海马、杏仁核切除术对颞叶内侧癫痫发作都能获得良好的控制,两者疗效无明显差异。  相似文献   

3.
目的探讨不同术式选择对颞叶癫痫患者术后记忆功能的影响。方法 2009~2013年共248例海马硬化性颞叶癫痫患者在我院接受手术治疗,其中83例行标准前颞叶切除术(anterior temporal lobectomy,ATL),165例行选择性海马杏仁核切除术(selective amygdalohippocampectomy,SAH)。患者在术前、术后3个月及术后两年分别接受临床记忆功能评估。结果 ATL组和SAH组优势半球侧手术的患者临床记忆商数(memory quotient,MQ)在术后3个月(74.5±16.2,75.6±19.5)均有明显下降(P0.05),术后两年(75.1±14.1,76.1±17.6)略有恢复但仍然显著低于术前(82.9±15.8,83.2±21.2)(P0.05),其中SAH组术后3个月及术后两年相较术前MQ的减低程度都小于ATL组(7.6 vs.8.4;7.1 vs.7.8);ATL组和SAH组非优势半球侧手术的患者术后3个月的MQ(87.2±15.1,88.1±16.9)均高于术前(85.5±13.5,85.3±19.7),但无统计学意义,至术后两年时,两组患者的MQ(92.8±12.7,93.7±17.1)对比术前都有了显著的改善(P0.05),其中SAH组患者的改善幅度较ATL组略大(8.4 vs.7.3)。结论相比于ATL,SAH可能更有利于保护海马硬化性颞叶癫痫患者的术后记忆功能。  相似文献   

4.
Objective: Selective amygdalohippocampectomy (SAH) can be used to obtain satisfactory seizure control in patients with mesial temporal lobe epilepsy (MTLE). Several SAH procedures have been reported to achieve satisfactory outcomes for seizure control, but none yield fully satisfactory outcomes for memory function. We hypothesized that preserving the temporal stem might play an important role. To preserve the temporal stem, we developed a minimally invasive surgical procedure, ‘neuronavigation-assisted trans-inferotemporal cortex SAH’ (TITC-SAH).

Methods: TITC-SAH was performed in 23 patients with MTLE (MTLE on the language-non-dominant hemisphere, n = 11). The inferior horn of the lateral ventricle was approached via the inferior or middle temporal gyrus along the inferior temporal sulcus under neuronavigation guidance. The hippocampus was dissected in a subpial manner and resected en bloc together with the parahippocampal gyrus. Seizure control at one year and memory function at 6 months postoperatively were evaluated.

Results: One year after TITC-SAH, 20 of the 23 patients were seizure-free (ILAE class 1), 2 were class 2, and 1 was class 3. Verbal memory improved significantly in 13 patients with a diagnosis of hippocampal sclerosis, for whom WMS-R scores were available both pre- and post-operatively. Improvements were seen regardless of whether the SAH was on the language-dominant or non-dominant hemisphere. No major complication was observed.

Conclusion: Navigation-assisted TITC-SAH performed for MTLE offers a simple, minimally invasive procedure that appears to yield excellent outcomes in terms of seizure control and preservation of memory function, because this procedure does not damage the temporal stem. TITC-SAH should be one of the feasible surgical procedures for MTLE.

Abbreviations: SAH: Amygdalohippocampectomy; MTLE: Mesial temporal lobe epilepsy (MTLE); TITC-SAH: Ttrans-inferotemporal cortex SAH; ILAE: International League Against Epilepsy (ILAE); MRI: Magnetic resonance imaging; EEG: Electroencephalography (EEG); FDG-PET: 8F-fluorodeoxyglucose (FDG)-positron emission tomography; ECoG: Electrocorticography; MEG: Magnetoencephalography; IMZ-SPECT: N-isopropyl-p(123I)-iodoamphetamine single photon emission computed tomography; WMS-R: Wechsler Memory Scale-Revised.  相似文献   


5.
PURPOSE: In the surgical treatment of mesial temporal lobe epilepsy, there is converging evidence that individually tailored or selective approaches have a favorable cognitive outcome compared to standard resections. There is, however, also evidence that due to collateral damage, selective surgery can be less selective than suggested. As part of a prospective transregional research project the present study evaluated the outcome in memory and nonmemory functions, following two selective approaches: a combined temporal pole resection with amygdalohippocampectomy (TPR+) and transsylvian selective amygdalohippocampectomy (SAH). METHODS: One year after surgery, cognitive outcomes of postoperatively seizure-free patients with mesial TLE and hippocampal sclerosis, who underwent either TPR+ (N = 35) or SAH (N = 62) in two German epilepsy centers (Bonn/Berlin), were compared. RESULTS: Repeated measurement MANOVA and separate post hoc testing indicated a double dissociation of verbal/figural memory outcome as dependent on side and type of surgery. Verbal memory outcome was worse after left-sided operation, but especially for SAH, whereas figural memory outcome was worse after right-sided operation, preferentially for TPR+. Attention improved independent of side or type of surgery, and language functions showed some improvement after right-sided surgeries. DISCUSSION: The results indicate a differential effect of left/right SAH versus TPR+ on material-specific memory insofar as transsylvian SAH appears to be favorable in right and TPR+ in left MTLE. The different outcomes are discussed in terms of a different surgical affection of the temporal pole and stem, and different roles of these structures for verbal and figural memory.  相似文献   

6.
目的 探讨选择性杏仁核-海马切除术(SAH)对内侧颞叶癫痫病人认知功能的影响。方法 回顾性分析2009年1月~2017年5月接受SAH治疗的67例内侧颞叶癫痫的临床资料,术前、术后3个月和术后1年均行详细的神经心理学评估,包括智商、记忆商和语言功能。结果 36例行左侧SAH,31例行右侧SAH。术后1年,癫痫控制效果达到Engel分级Ⅰ级50例,Ⅱ级7例,Ⅲ级8例,Ⅳ级2例。术后3个月,左侧手术病人言语功能、记忆商较术前明显降低(P<0.05),右侧手术病人言语理解指数、语义流畅性测验明显改善(P<0.05);术后1年,无论是左侧手术病人,还是右侧手术病人,智商、记忆商、言语功能较术后3个月略改善(P>0.05);手术前后视觉记忆均无明显变化(P>0.05)。结论 海马硬化性内侧颞叶癫痫行SAH后,左侧手术病人会出现比较明显的言语和记忆功能减低。  相似文献   

7.
Summary:  Purpose: In a previous study we reported clinically significant memory declines 3 months after selective amygdalohippocampectomy (SAH) in 140 patients with mesial temporal lobe epilepsy, particularly if the resection was left-sided. We supposed that the observed postoperative impairments might have reflected acute effects of surgery. Therefore we evaluated in the present study whether a recovery can be found 1 year after surgery.
Methods: Verbal and nonverbal memory functions were assessed in 115 patients before and 3 and 12 months after unilateral SAH.
Results: No recovery of postoperative verbal memory declines was found in the left-SAH group. Clinically meaningful losses were still evident in 33 to 50% of patients. In right-SAH patients, a recovery of verbal memory was indicated, and effects of surgical complications were no longer evident. One year after surgery, the corresponding preoperative performance was the only significant predictor of a postoperative change in the left-SAH group.
Conclusions: Verbal memory decline observed 3 months after left SAH is persistent 1 year after surgery. Declines in verbal memory, which were observed in some right-SAH patients at the short-term follow-up, seem to be temporary.  相似文献   

8.
侧裂入路选择性海马、杏仁核切除术治疗颞叶癫癎   总被引:2,自引:0,他引:2  
目的总结对颞叶癫病人行侧裂径路选择性海马、杏仁核显微切除术的经验。方法对28例顽固性颞叶癫病人进行常规脑电图(蝶骨电极)、视频脑电图实时监测、MRI、单光子发射断层显像(SPECT)、正电子发射断层成像(PET)等检查,确定颞叶癫灶。行翼点开颅,经右侧手术17例,左侧11例,行颞叶径路选择性海马、杏仁核显微切除术。结果术后发作完全停止20例(71.4%);症状显著改善,偶有发作3例(10.7%);好转3例(10.7%);无效2例。结论根据临床表现及综合性辅助检查确定颞叶癫,行侧裂径路选择性海马、杏仁核显微切除术,可以取得满意疗效;但要求解剖清晰,显微外科技术熟练,避免意外损伤脉络膜前动脉和大脑中动脉。  相似文献   

9.
ObjectivesSome patients with left temporal degeneration develop visual artistic abilities. These new artistic abilities may be due to disinhibition of the visuo-spatially dominant right hemisphere. Many famous artists have had epilepsy and it is possible that some may have had left temporal seizures (LTS) and this left temporal dysfunction disinhibited their right hemisphere. Alternatively, unilateral epilepsy may alter intrahemispheric connectivity and right anterior temporal lobe seizures (RTS) may have increased these artists' right hemisphere mediated visual artistic creativity.MethodsTo test the disinhibition versus enhanced connectivity hypotheses we studied 9 participants with RTS and 9 with left anterior temporal seizures (LTS) who underwent unilateral lobectomy for the treatment of medically refractory epilepsy. Creativity was tested using the Torrance Test of Creative Thinking (TTCT).Results and conclusionsThere were no between group differences in either the verbal or figural scores of the TTCT, suggesting that unilateral anterior temporal ablation did not enhance visual artistic ability; however, for the RTS participants' figural creativity scores were significantly higher than verbal scores. Whereas these results fail to support the left temporal lobe disinhibition postulate of enhanced figural creativity, the finding that the patients with RTS had better figural than verbal creativity suggests that their recurrent right hemispheric seizures lead to changes in their right hemispheric networks that facilitated visual creativity. To obtain converging evidence, studies on RTS participants who have not undergone lobectomy will need to be performed.  相似文献   

10.
PURPOSE: The technique of selective amygdalohippocampectomy (SAH) was originally developed in epilepsy surgery to spare unaffected brain tissue from surgery, thus minimizing the cognitive consequences of temporal lobe surgery. The results of previous studies, however, are equivocal in this regard. This study evaluated memory after SAH in a large sample of patients with mesial temporal lobe epilepsy. METHODS: The 140 patients received material-specific memory tests before and 3 months after unilateral SAH. RESULTS: Significant declines in all aspects of verbal learning and memory were found particularly for the left resected group. With reliability-of-change indices, a high number of patients showed postoperative verbal memory declines, < or = 51% in left SAH and < or = 32% in right SAH. For left SAH, a higher preoperative verbal memory performance, a lower preoperative nonverbal memory score, an older age at surgery, and a later onset of epilepsy predicted a stronger decline in verbal memory. After right SAH, the risk for a verbal memory decline was slightly increased when patients had surgical complications or a presurgical evaluation with bilateral intrahippocampal depth electrodes. Results concerning nonverbal memory were less clear. CONCLUSIONS: The results clearly indicate, that particularly left SAH can lead to a significant decline in memory functions. Predictors of postoperative verbal memory were similar to those reported for temporal lobectomy. Postoperative deteriorations were broader and stronger in our study than in previous studies. We discuss methodologic differences (sample size, retest interval, extent of resection) and other factors as possible reasons.  相似文献   

11.
To search for a method for treatment of bilateral temporal lobe epilepsy (BTLE), we report one patient with BTLE experienced bilateral stereotactic radiofrequency amygdalohippocampectomy (SAHE). Neuropsychological examinations were performed before and 5 days, and 6, 18, and 48 months after operation. No seizure occurred in the follow‐up time, and no long‐term memory and intelligence deficits were found except for a transient decline of the scores immediately after operation. Because severe damage of memory could be caused by bilateral resection surgery, bilateral SAHE should be considered as a possible approach for the treatment of BTLE. However, further studies with accumulation of cases are needed, especially in the detailed assessment of neuropsychological function.  相似文献   

12.
Retrospectively we analysed postoperative AED treatment in patients with mesial temporal lobe epilepsy and hippocampal sclerosis (MTLE-HS) who were seizure free following selective amygdalohippocampectomy (AHE). In this subgroup, we compared the patients without AEDs with that in the entire series. RESULTS: During the year prior to surgery, in the MTLE-HS group, a mean of 2.3 +/- 0.8 AEDs were taken. The percentage of seizure-free MTLE-HS patients without AEDs increases to 40% from the postoperative year 5 on. In the ILAE Class 1a (seizure- and aura-free since surgery) at postoperative year 5 more than 60% and from postoperative year 7 on more than 90% have discontinued AED intake. CONCLUSION: These figures indicate that reduction and discontinuation of AEDs is the same in the subgroup "seizure-free MTLE-HS patients" compared to the entire series.  相似文献   

13.
目的 探讨神经导航下锁孔入路选择性海马杏仁核切除术治疗顽固性内侧颞叶癫痫的可行性.方法 总结分析18例神经导航下锁孔入路选择性海马杏仁核切除病例,所有病例均经过临床特征、影像检查、视频脑电监测、脑磁图检查确定为顽固性内侧颞叶癫痫.结果 随访结果显示72.2%病例术后癫痫发作停止.Engel癫痫疗效分级:Ⅰ级72.2%,Ⅱ级22.2%,Ⅲ级5.6%.结论 神经导航下锁孔入路选择性海马杏仁核切除术是一种安全可行的手术方法,疗效满意.  相似文献   

14.
Transsylvian selective amygdalohippocampectomy (TSA) is an operative technique designed to spare unaffected brain tissue during surgical treatment for mesial temporal lobe epilepsy. In contrast to standard anterior temporal lobectomy (ATL), the advantages of TSA with respect to postoperative cognitive outcome are equivocal. We compared cognitive function before and after surgery in 49 patients with unilateral mesial temporal lobe seizures who underwent either ATL (n=17) or TSA (n=32). All patients received neuropsychological testing before and 1 year after surgery. The intelligence quotient (IQ) increased postoperatively in both surgical groups. Memory evaluation in the ATL group revealed a postoperative decline in nonverbal memory after right-sided resection and a postoperative decline in verbal memory after left-sided resection. In the TSA group, there was a slight postoperative decline only in verbal memory after left-sided resection, but other memory function was well preserved. In particular, there was significant postoperative improvement in verbal memory after right-sided resection. Overall, memory function was better preserved in the TSA group than in the ATL group.  相似文献   

15.
Objective – To identify predictors of outcome after epilepsy surgery in patients with temporal lobe epilepsy (TLE). Methods – Seventy‐six patients with normal magnetic resonance imaging (MRI) or hippocampal sclerosis on MRI who underwent anterior temporal lobe resections were included. Outcome 2 years after surgery was classified as good (Engel I and II) or poor (Engel III and IV). Gender, age at onset and duration of epilepsy, history of febrile convulsions, auras, right‐ or left‐sided TLE, memory ipsilateral to seizure onset (Wada test), hippocampal asymmetry (HA) and T2 relaxation time, amygdala, temporal lobe and hemispheral volume were tested for associations with outcome. Results – Sixty‐seven percent had a good outcome. Of all parameters tested, only a history of febrile convulsions and HA on quantitative MRI were significantly associated with a good seizure outcome. The absence of these parameters did not exclude a good outcome, but only five of 18 patients (28%) without HA and without a history of febrile convulsions had a good outcome. Conclusion – Febrile convulsions and HA were predictors of outcome after epilepsy surgery in TLE. Subtle volume loss in amygdala, temporal lobe or hemispheres and the memory ipsilateral to the side of resection were not associated with outcome.  相似文献   

16.
目的 探讨经颞下回-侧脑室入路选择性海马杏仁核切除术治疗内侧颞叶癫痫的手术方法 、疗效及并发症. 方法 对确诊为药物难治性内侧颞叶癫痫的62例患者,经颞部锁孔开颅,切除中前段颞下回,进入颞角前外侧区,选择性切除海马杏仁核及海马旁回等内侧颞叶结构.结果 62例患者术后随访至少24~80个月,无严重手术并发症;Engel癫痫疗效分级;Ⅰ级45例(72.6%),Ⅱ级12例(19.4%),Ⅲ级5例(8.0%). 结论 经颢下回-侧脑室入路选择性海马杏仁核切除术是治疗内侧颞叶癫痫的有效方法 ,其手术创伤小,可妥善保护语言区和视放射,安全性高.  相似文献   

17.
The investigation employed monorhinic (single nostril) olfactory testing to decide whether patients with unilateral anterior temporal lobe resection (N = 16) and patients with unoperated temporal lobe epilepsy (N = 18) have impaired ability to detect, remember, and identify odors. A shape memory task accompanied the odor memory task for comparison. The lobectomy patients showed a minor bilateral depression of absolute sensitivity but still fell within the clinically normal range. The lobectomy patients showed impairment of odor recognition memory but strictly via the nostril ipsilateral to the resected lobe. A similar ipsilateral-contralateral asymmetry characterized the performance of these patients in odor identification. In that case, however, performance via the contralateral nostril showed some impairment too. Nonsurgery patients also exhibited some impairment in odor identification, but bilaterally. Finally, both groups of patients fell somewhat below normals in recognition memory for amorphous shapes. The various results implied that temporal lobe epilepsy alone takes some toll on olfactory information processing and that temporal lobe resection exacerbates the problem, but only on the side of surgery.  相似文献   

18.
Thirty-one surgical candidates with a unilateral temporal lobe seizure focus, 72 temporal lobectomy patients, 63 non-epileptic controls and their relatives, respectively, filled in the Memory Observation Questionnaire. The two patient groups rated their current memory similarly, but significantly worse than controls rated their own memory. Memory status was judged to be improved approximately three years after a temporal lobectomy. The relatives' ratings agreed with those of the patients. Thus patients who underwent surgical resection for relief of temporal lobe epilepsy did not report further subjective deterioration in memory compared to pre-operative cases. Laterality of excision did not affect self-report of general memory function. Nevertheless, a brief Verbal memory subscale yielded the expected material specific pattern after unilateral temporal lobectomy.  相似文献   

19.
OBJECTIVES: Magnetic resonance spectroscopic imaging (MRSI) may show circumscribed or extensive decreased brain N-acetyl aspartate (NAA)/creatine and phosphocreatine (Cr) in epilepsy patients. We compared temporal lobe MRSI in patients seizure-free (SzF) or with persistent seizures (PSz) following selective amygdalohippocampectomy (SAH) for medically intractable mesial temporal lobe epilepsy (mTLE). We hypothesized that PSz patients had more extensive temporal lobe metabolite abnormalities than SzF patients. MATERIALS AND METHODS: MRSI was used to study six regions of interest (ROI) in the bilateral medial and lateral temporal lobes in 14 mTLE patients following SAH and 11 controls. RESULTS: PSz patients had more temporal lobe ROI with abnormally low NAA/Cr than SzF patients, including the unoperated hippocampus and ipsilateral lateral temporal lobe. CONCLUSION: Postoperative temporal lobe MRSI abnormalities are more extensive if surgical outcome following SAH is poor. MRSI may be a useful tool to improve selection of appropriate candidates for SAH by identifying patients requiring more intensive investigation prior to epilepsy surgery. Future prospective studies are needed to evaluate the utility of MRSI, a predictor of successful outcome following SAH.  相似文献   

20.
目的 探讨裁剪式前颞叶内侧切除术治疗颞叶内侧型癫痫的手术方法和治疗效果.方法 21例顽固性颞叶癫痫患者,采用脑功能制图及神经导航等辅助,行裁剪式前颞叶内侧切除术治疗,切除前颞叶、杏仁核及海马.采用分级量表针对癫痫发作控制效果进行评价.结果 术后随访6 ~ 29个月,21例患者神经功能均改善,无严重手术并发症.其中Engel Ⅰ级16例(76%);EngelⅡ级3例(14%);EngelⅢ级2例(10%).结论 裁剪式前颞叶内侧切除术是治疗颞叶癫痫的有效方法.脑功能制图及神经导航辅助下手术切除杏仁核及海马彻底,避免了语言区和视放射的损伤.  相似文献   

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