Hori Tomokatsu, Yamane Fumitaka, Ochiai Taku, Kondo Shinji, Shimizu Satoru, Ishii Kenji, Miyata Hajime
Department of Neurosurgery, Tokyo Women's Medical University, Japan.
J Neurosurg. 2007 Jan;106(1):134-41. doi: 10.3171/jns.2007.106.1.134.
The authors evaluated operative, neuropathological, and neuropsychological results after selective subtemporal amygdalohippocampectomy for refractory temporal lobe epilepsy in patients who were observed for at least 2 years after surgery.
Twenty-six consecutive patients underwent selective subtemporal amygdalohippocampectomy for nonlesional, medically refractory temporal lobe epilepsy. Neuropsychological evaluation using the Wechsler Adult Intelligence Scale was done before surgery in all patients, 2 months after surgery in 24 patients, and at 2-year follow up in 19 patients. A verbal paired associates learning test was administered before surgery and 2 months after surgery in 19 patients. The data were compared between the 13 patients in whom the language-dominant hemisphere was surgically treated and the six patients in whom the language-nondominant hemisphere was treated. After surgery, 84% of the patients attained either Engel Class I or II seizure outcome. There were no permanent subjective complications except postoperative memory impairment in one patient. Neuropathological examination confirmed hippocampal sclerosis in 19 patients. No significant differences in IQ and verbal memory test scores were observed between the patients in whom the language-dominant hemisphere was treated and those in whom the language-nondominant hemisphere was treated. Significant postoperative increases in verbal IQ, performance IQ, and full-scale IQ were observed over time. No significant differences were found between pre- and postoperative verbal memory test scores, and no subjective visual field loss was marked in any patient.
Subtemporal selective amygdalohippocampectomy provides favorable surgical and neuropsychological outcomes and does not cause significant postoperative decline of verbal memory if performed on the language-dominant side.
作者评估了选择性颞下杏仁核海马切除术治疗难治性颞叶癫痫患者的手术、神经病理学和神经心理学结果，这些患者术后至少随访了2年。
26例连续性患者接受了选择性颞下杏仁核海马切除术，治疗非病变性、药物难治性颞叶癫痫。所有患者术前均使用韦氏成人智力量表进行神经心理学评估，24例患者术后2个月进行评估，19例患者在术后2年随访时进行评估。19例患者术前和术后2个月进行了言语配对联想学习测试。对13例接受语言优势半球手术治疗的患者和6例接受非语言优势半球手术治疗的患者的数据进行了比较。术后，84%的患者达到Engel I级或II级癫痫发作结果。除1例患者术后出现记忆障碍外，无永久性主观并发症。神经病理学检查证实19例患者存在海马硬化。接受语言优势半球治疗的患者与接受非语言优势半球治疗的患者在智商和言语记忆测试分数上无显著差异。随着时间的推移，术后言语智商、操作智商和全量表智商均有显著提高。术前和术后言语记忆测试分数无显著差异，且所有患者均未出现明显的主观视野缺损。
颞下选择性杏仁核海马切除术可提供良好的手术和神经心理学结果，且在语言优势侧进行手术时不会导致术后言语记忆显著下降。
