Prasad Avīnash, Pacia Steven V, Vazquez Blanca, Doyle Werner K, Devinsky Orrin
Department of Neurology, University of Alabama Hospital, Birmingham, Alabama, USA.
J Clin Neurophysiol. 2003 Jul-Aug;20(4):243-8. doi: 10.1097/00004691-200307000-00003.
In patients with mesiotemporal sclerosis, posterior hippocampal involvement at the ictal onset is not associated with an excellent outcome. A study confirmed that ictal onset in the posterior parahippocampal gyrus is associated with a less favorable outcome compared with ictal onset in the anterior parahippocampal gyrus in patients with mesiobasal temporal lobe epilepsy who are undergoing foramen ovale recording. The authors hypothesized that involvement of the two medial contact points of posterior basal temporal subdural (SD) strip at the ictal onset, representing ictal onset in the posterior parahippocampal gyrus, may also adversely influence the surgical outcome. With this objective, the authors assessed the incidence of posterior basal temporal SD strip (the two medial contact points) involvement at the ictal onset in patients with mesiotemporal sclerosis and determined whether presence of this finding influenced surgical outcome. Thirty-six patients with mesiotemporal sclerosis underwent a single SD grid (lateral frontotemporal) and strips (three basal temporal and one orbitosubfrontal) monitoring. Based on the earliest involvement of basal temporal strips (the two medial contact points) during the seizure, patients were classified into (1) anterior and/or middle basal temporal, or (2) posterior basal temporal (with or without involvement of anterior and/or middle basal temporal) ictal onset groups. A temporal lobectomy with adequate resection of the ictal onset zone was performed in all patients. Surgical outcome was based on Engel's classification. Six of 36 (17%) patients were classified into the posterior basal temporal ictal onset group. Only two patients from the posterior basal temporal ictal onset group experienced a good outcome compared with 26 of 30 patients from anterior and/or middle basal temporal ictal onset group (P = 0.01). In patients with mesiotemporal sclerosis who were monitored with SD electrodes, involvement of the two medial contact points of posterior basal temporal strip at the ictal onset (representing ictal onset in the posterior parahippocampal gyrus) occurred in 17% of the patients. These patients might not experience an excellent surgical outcome despite including the ictal onset zone in resection. These findings may be useful in presurgical counseling of patients with mesiotemporal sclerosis who undergo intracranial SD monitoring.
在颞叶内侧硬化患者中，发作起始时海马后部受累与良好预后无关。一项研究证实，在接受卵圆孔记录的颞叶内侧基底癫痫患者中，海马旁回后部发作起始与比海马旁回前部发作起始更差的预后相关。作者推测，发作起始时颞叶基底后部硬膜下（SD）条带的两个内侧接触点受累，代表海马旁回后部发作起始，也可能对手术结果产生不利影响。基于此目的，作者评估了颞叶内侧硬化患者发作起始时颞叶基底后部SD条带（两个内侧接触点）受累的发生率，并确定这一发现是否影响手术结果。36例颞叶内侧硬化患者接受了单次SD网格（外侧额颞部）和条带（三条颞叶基底和一条眶额下部）监测。根据发作期间颞叶基底条带（两个内侧接触点）最早受累情况，患者被分为（1）颞叶基底前部和/或中部，或（2）颞叶基底后部（有或无颞叶基底前部和/或中部受累）发作起始组。所有患者均进行了颞叶切除术，并充分切除发作起始区。手术结果基于恩格尔分类。36例患者中有6例（17%）被归入颞叶基底后部发作起始组。与颞叶基底前部和/或中部发作起始组的30例患者中的26例相比，颞叶基底后部发作起始组中只有2例患者预后良好（P = 0.01）。在用SD电极监测的颞叶内侧硬化患者中，17%的患者发作起始时颞叶基底后部条带的两个内侧接触点受累（代表海马旁回后部发作起始）。尽管切除范围包括发作起始区，但这些患者可能不会有良好的手术结果。这些发现可能有助于对接受颅内SD监测的颞叶内侧硬化患者进行术前咨询。
