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(selectiveamygdalohippocampectomy,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 selectiveamygdalohippocampectomy (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 andATL were used in 39 and 33 patients, respectively. All eligible patients were followed up at least oneyear. Wechsler Adult Intelligence Scale-Revised and the Wechsler Memory Scale-Revised were usedto 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 and19.4% Class II). ATL obtained 84.8% satisfactory seizure control (28 patients), and the success ratewas 79.5% (31 patients) for SeAH. Th ere was no signifi cant diff erence in seizure control betweenSeAH and ATL (P=0.760). Th e postoperative verbal IQ of SeAH group increased signifi cantly inboth side surgery (P<0.05), while the increase was not signifi cant in the group of ATL of both sidesurgery (P>0.05). Regarding left-side surgery, postoperative verbal memory and total memorywere increased signifi cantly in the group of SeAH (P<0.05), while the increases were not signifi cantin the group of ATL (P>0.05). In the right-side surgery, postoperative verbal memory and totalmemory were increased significantly in the two surgery strategy groups (P<0.05), while nosignifi 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 shouldbe encouraged. Th e seizure outcome is not diff erent between ATL and SeAH, while regarding asverbal IQ and verbal memory outcomes, SeAH may be superior to ATL in dominant hemispheresurgery.