Burneo Jorge G, Bilir Erhan, Faught Edward, Morawetz Richard, Knowlton Robert C, Martin Roy, Kuzniecky Ruben I
University of Alabama at Birmingham Epilepsy Center, and the Department of Neurology and Neurosurgery, University of Alabama at Birmingham, 35294, USA.
Arch Neurol. 2003 Sep;60(9):1238-42. doi: 10.1001/archneur.60.9.1238.
Previous magnetic resonance imaging (MRI) studies have shown concurrent fornix atrophy in a large proportion of patients with hippocampal atrophy. The contribution of the fornix as an independent preoperative determinant of surgical outcome is unknown.
To evaluate the contribution of the fornix as a determinant of surgical outcome in patients with preoperatively determined temporal lobe epilepsy.
We selected 78 patients who had undergone anterior temporal lobectomy for intractable temporal lobe epilepsy at the University of Alabama at Birmingham Epilepsy Center during a 24-month period. All patients underwent standard presurgical investigations and intracranial investigations when needed. Magnetic resonance imaging volumetric studies were performed prior to surgery using previously published techniques. Patients were assessed regularly for postoperative seizure control. Outcome after at least 3 years was evaluated using Engel's classification for epilepsy. The chi2 test was used to compare categorical data.
Seventy-eight patients were included in this study. Eight patients were excluded because of inadequate follow-up. Thirty-five patients (44.9%) had unilateral isolated hippocampal atrophy exclusively on MRI volumetry, 29 (37.2%) had unilateral hippocampal atrophy with ipsilateral fornix atrophy, and 6 (7.7%) had isolated fornix atrophy without hippocampal atrophy. Twenty-eight patients (80%) in the unilateral hippocampal atrophy group were seizure free (ie, Engel class 1: patients who are completely seizure free with no aura and who do not receive antiepileptic drugs) compared with 21 patients (73%) in the fornix and hippocampal atrophy group (P =.57). All 6 patients with isolated fornix atrophy achieved an Engel's class 1 outcome.
These findings suggest that identification of fornix atrophy with or without associated hippocampal atrophy is not an important preoperative determinant of surgical outcome. However, in the presence of a normal hippocampus, fornix atrophy may be valuable in predicting seizure-free outcome.
既往磁共振成像（MRI）研究表明，大部分海马萎缩患者同时存在穹窿萎缩。穹窿作为手术结果的独立术前决定因素的作用尚不清楚。
评估穹窿作为术前确诊的颞叶癫痫患者手术结果决定因素的作用。
我们选取了在阿拉巴马大学伯明翰分校癫痫中心24个月期间因难治性颞叶癫痫接受前颞叶切除术的78例患者。所有患者均接受了标准的术前检查，并在需要时进行了颅内检查。术前使用先前发表的技术进行磁共振成像容积研究。定期评估患者术后的癫痫控制情况。至少3年后的结果采用恩格尔癫痫分类法进行评估。采用卡方检验比较分类数据。
本研究纳入78例患者。8例患者因随访不充分被排除。35例患者（44.9%）仅在MRI容积测量上表现为单侧孤立性海马萎缩，29例（37.2%）表现为单侧海马萎缩伴同侧穹窿萎缩，6例（7.7%）表现为孤立性穹窿萎缩而无海马萎缩。单侧海马萎缩组28例患者（80%）无癫痫发作（即恩格尔1级：完全无癫痫发作、无先兆且未接受抗癫痫药物治疗的患者），而穹窿和海马萎缩组21例患者（73%）无癫痫发作（P = 0.57）。所有6例孤立性穹窿萎缩患者均达到恩格尔1级结果。
这些发现表明，无论有无相关海马萎缩，穹窿萎缩的识别并非手术结果的重要术前决定因素。然而，在海马正常的情况下，穹窿萎缩可能对预测无癫痫发作结果有价值。
