Lévesque M F, Nakasato N, Vinters H V, Babb T L
Department of Neurology, University of California School of Medicine, Los Angeles.
J Neurosurg. 1991 Sep;75(3):364-70. doi: 10.3171/jns.1991.75.3.0364.
The authors present their review of 178 patients who underwent en bloc temporal lobectomies as surgical treatment for intractable epilepsy. Hippocampal cell density was quantitatively analyzed and the histology of the anterior temporal lobe was reviewed. Fifty-four patients (30.3%) had evidence of extrahippocampal lesions in addition to neuronal cell loss within the hippocampus (the dual pathology group). The pattern of cell loss was analyzed in the remaining 124 cases (69.7%) with no extrahippocampal pathology, and compared with that of the dual pathology group and a control group of four nonepileptic patients. Hippocampal cell loss was found in almost all epileptic patients compared to the control group. Severe cell loss greater than 30% of control values was found in 88.7% of patients without extrahippocampal lesions, but in only 51.8% of patients with dual pathology. The difference between these two groups was statistically significant (p less than 0.001). In the dual pathology group, lesions of different pathology had a significant relationship with the degree of hippocampal cell loss: all 12 patients with glioma had mild cell loss, whereas all 13 patients with heterotopia were associated with severe cell loss. Severity of hippocampal cell loss was also analyzed in relation to seizure history: a prior severe head injury was associated with severe cell loss. Other factors such as seizure duration, secondary generalization, or family history of seizures were not associated with hippocampal damage. Dual pathology may produce a combination of neocortical and temporolimbic epilepsies that warrants a precise definition of the true epileptogenic area prior to surgical treatment.
作者对178例接受整块颞叶切除术以治疗顽固性癫痫的患者进行了回顾性研究。对海马细胞密度进行了定量分析，并对颞叶前部的组织学进行了检查。54例患者（30.3%）除海马内神经元细胞丢失外，还有海马外病变的证据（双重病理组）。对其余124例无海马外病理改变的病例（69.7%）的细胞丢失模式进行了分析，并与双重病理组和4例非癫痫患者的对照组进行了比较。与对照组相比，几乎所有癫痫患者都有海马细胞丢失。在无海马外病变的患者中，88.7%发现严重细胞丢失超过对照值的30%，但在双重病理患者中仅为51.8%。两组之间的差异具有统计学意义（p<0.001）。在双重病理组中，不同病理的病变与海马细胞丢失程度有显著关系：12例胶质瘤患者均有轻度细胞丢失，而13例异位症患者均有严重细胞丢失。还根据癫痫病史分析了海马细胞丢失的严重程度：既往严重头部损伤与严重细胞丢失有关。其他因素如癫痫持续时间、继发性全身性发作或癫痫家族史与海马损伤无关。双重病理可能产生新皮质和颞叶边缘癫痫的组合，这需要在手术治疗前精确定义真正的致痫区。
