颞叶内侧癫痫手术治疗：前颞叶切除术与选择性杏仁核海马切除术

目的：比较前颞叶切除术(anterior temporal lobectomy，ATL)与经侧裂选择性杏仁核海马切除术(selective amygdalohippocampectomy，SeAH)治疗颞叶内侧癫痫(medial temporal lobe epilepsy，MTLE)在控制癫痫发作和改善神经 心理学结果方面的疗效。方法：回顾性分析SeAH(39例)和ATL(33例)治疗的72例MTLE患者的临床资料和随访资料。 临床心理评估采用Wechsler成人智力量表和Wechsler记忆量表。结果：72例患者中59例(81.9%)获得满意的癫痫控制 (62.5% Class I和19.4% Class II)。ATL组癫痫控制满意28例(84.8%)，SeAH组满意31例(79.5%)，两者之间差异无统计学意 义(P=0.76)。SeAH组左侧和右侧手术术后语言IQ评分均明显增加(P<0.05)，而ATL组左侧和右侧手术后语言IQ评分增 加无统计学意义(P>0.05)；左侧SeAH手术后语言记忆和总记忆评分显著增加(P<0.05)，但是左侧ATL手术后语言记 忆、非语言记忆、总记忆评分增加无统计学意义(P>0.05)；右侧手术两种术式的手术后语言记忆和总记忆评分显著增 加，非语言记忆评分增加无统计意义(P>0.05)。结论：ATL与SeAH是治疗MTLE的有效安全的方法，ATL与SeAH两种 术式对癫痫控制无明显差异，但对术后语言智商和语言记忆而言，在优势半球侧手术时SeAH优于ATL。

Clinical outcomes after medial temporal lobe epilepsy surgery: Anterior temporal lobectomy versus selective amygdalohippocampectomy

Objective: To compare the anterior temporal lobectomy (ATL) with transsylvian selective amygdalohippocampectomy (SeAH) in 72 patients with medial temporal lobe epilepsy (MTLE) regarding the seizure control and neuropsychological outcomes. Methods: Clinical data and follow-up data were collected and retrospectively analyzed. SeAH and ATL were used in 39 and 33 patients, respectively. All eligible patients were followed up at least one year. Wechsler Adult Intelligence Scale-Revised and the Wechsler Memory Scale-Revised were used to test the patients’ neuropsychology before and aft er the surgery for one year. Results: Fift y-nine patients (81.9%) achieved satisfactory seizure control (62.5% Engel Class I and 19.4% Class II). ATL obtained 84.8% satisfactory seizure control (28 patients), and the success rate was 79.5% (31 patients) for SeAH. Th ere was no signifi cant diff erence in seizure control between SeAH and ATL (P=0.760). Th e postoperative verbal IQ of SeAH group increased signifi cantly in both side surgery (P<0.05), while the increase was not signifi cant in the group of ATL of both side surgery (P>0.05). Regarding left-side surgery, postoperative verbal memory and total memory were increased signifi cantly in the group of SeAH (P<0.05), while the increases were not signifi cant in the group of ATL (P>0.05). In the right-side surgery, postoperative verbal memory and total memory were increased significantly in the two surgery strategy groups (P<0.05), while no signifi cant increases were seen in non-verbal memory of the two surgery strategy groups (P>0.05). Conclusion: Microsurgery for the treatment of refractory MTLE is successful and safe, and should be encouraged. Th e seizure outcome is not diff erent between ATL and SeAH, while regarding as verbal IQ and verbal memory outcomes, SeAH may be superior to ATL in dominant hemisphere surgery.