Ray A, Pathak-Ray V, Walters R, Hatfield R
Department of Neurosurgery, Cardiff Eye Unit, University Hospital of Wales, Cardiff, UK.
Br J Neurosurg. 2002 Oct;16(5):456-60. doi: 10.1080/0268869021000030258.
The aim of this study was to assess the eligibility to drive in patients with mesial temporal sclerosis who undergo anterior temporal lobectomy. The two major determinants in a patient's ability to drive after such surgery are visual field defects and their seizure frequency. Thirteen patients were selected. The postoperative seizure frequency was assessed using Engel's criteria. Automated static perimetry was performed which consisted of a Humphrey Field Analyser (HFA) 30-2 Test, one for each eye and a Binocular Esterman 120 Test. Seven out of the 13 (54%) selected patients had no seizures post-operatively (Engel's 1); three (23%) patients had less than two seizures per year (Engel's 2) and three (23%) had more than 90% improvement in the frequency of seizures (Engel's 3). The seven patients with no seizures postoperatively were eligible to apply for a driving licence. Automated static perimetry performed on the same patients revealed three (23%) had normal visual field or non-specific loss, seven (54%) had partial homonymous quadrantanopia, one (8%) had complete homonymous quadrantanopia and two (15%) had bilateral concentric loss attributable to vigabatrin, which may have masked any loss occurring due to surgery. Of the 13 patients, only seven (54%) passed the standardised DVLA Esterman visual field test. Of the six (46%) who failed DVLA Esterman visual field test, one had complete homonymous quadrantanopia, three had incomplete homonymous quadrantanopia and two had concentric loss (due to vigabatrin). Although seven (54%) patients passed the visual field test and seven (54%) patients were seizure free only five of the seven seizure-free patients (i.e. 38% of the total number of patients) had visual fields that would make them eligible to drive. As driving is now stated by patients' as a major factor that improves their quality of life, it is important to stress the significance of surgically induced or other iatrogenic visual field defects that may prevent them from driving prior to the operation to avoid disappointments afterwards.
本研究的目的是评估接受前颞叶切除术的内侧颞叶硬化症患者的驾驶资格。此类手术后患者驾驶能力的两个主要决定因素是视野缺损和癫痫发作频率。选取了13名患者。采用恩格尔标准评估术后癫痫发作频率。进行了自动静态视野检查，包括使用汉弗莱视野分析仪（HFA）30 - 2测试，每只眼睛各进行一次，以及双眼埃斯特曼120测试。13名入选患者中有7名（54%）术后无癫痫发作（恩格尔1级）；3名（23%）患者每年癫痫发作少于2次（恩格尔2级），3名（23%）患者癫痫发作频率改善超过90%（恩格尔3级）。7名术后无癫痫发作的患者有资格申请驾驶执照。对同一批患者进行的自动静态视野检查显示，3名（23%）患者视野正常或有非特异性缺损，7名（54%）患者有部分同向象限盲，1名（8%）患者有完全同向象限盲，2名（15%）患者因vigabatrin导致双侧同心性缺损，这可能掩盖了手术造成的任何缺损。13名患者中，只有7名（54%）通过了标准化的英国驾驶员及车辆执照管理局（DVLA）埃斯特曼视野测试。在未通过DVLA埃斯特曼视野测试的6名（46%）患者中，1名有完全同向象限盲，3名有不完全同向象限盲，2名有同心性缺损（因vigabatrin）。虽然7名（54%）患者通过了视野测试，7名（54%）患者无癫痫发作，但7名无癫痫发作的患者中只有5名（即占患者总数的38%）的视野符合驾驶资格。由于患者现在将驾驶视为改善生活质量的一个主要因素，在手术前强调手术引起的或其他医源性视野缺损可能导致他们无法驾驶的重要性，以避免术后失望，这一点很重要。
