Takaya Shigetoshi, Mikuni Nobuhiro, Mitsueda Takahiro, Satow Takeshi, Taki Junya, Kinoshita Masako, Miyamoto Susumu, Hashimoto Nobuo, Ikeda Akio, Fukuyama Hidenao
Radioisotope Research Center, Kyoto University, Yoshidakonoe-cho, Kyoto, Japan.
Brain. 2009 Jan;132(Pt 1):185-94. doi: 10.1093/brain/awn218. Epub 2008 Sep 12.
The functional changes that occur throughout the human brain after the selective removal of an epileptogenic lesion remain unclear. Subtemporal selective amygdalohippocampectomy (SAH) has been advocated as a minimally invasive surgical procedure for patients with medically intractable mesial temporal lobe epilepsy (MTLE). We evaluated the effects of subtemporal SAH on cerebral glucose metabolism and memory function in 15 patients with medically intractable MTLE with hippocampal sclerosis using [(18)F]-fluorodeoxyglucose PET (FDG-PET) and the Wechsler Memory Scale-Revised. The patients were evaluated before and 1-5 years (mean 2.6 years) after surgery. In patients with MTLE of the language-dominant hemisphere, the basal temporal language area was preserved by this surgical approach. Voxel-wise comparison of FDG-PET images was conducted using SPM5 to identify the brain regions showing postoperative changes in glucose metabolism (height threshold, P = 0.01 corrected for multiple comparisons; extent threshold, 100 voxels). During spatial normalization of the postoperative FDG-PET images, we used cost-function masking to minimize any inappropriate image distortion as a result of the abnormal signal within the surgically resected region. Postoperative glucose metabolism increased in extratemporal areas ipsilateral to the affected side, such as the dorsolateral prefrontal cortex, and the dorsomedial and ventromedial frontal cortices. Glucose metabolism also increased in the bilateral inferior parietal lobules and in the remaining temporal lobe regions remote from the resected mesial temporal region, such as the superior temporal gyrus and the temporal pole. By contrast, postoperative glucose metabolism decreased only in the mesial temporal area adjacent to the resected region. Postoperative verbal memory, delayed recall and attention/concentration scores were significantly better than preoperative scores regardless of the resected side. This study suggests that the selective removal of the epileptogenic region in MTLE using a subtemporal approach improved cerebral glucose metabolism in the areas receiving projections from the affected mesial temporal lobe. Cognitive improvement might result from a combination of good seizure control and minimizing the regions of the brain with postoperative functional impairment.
在选择性切除致痫性病变后，人脑中发生的功能变化仍不清楚。颞下选择性杏仁核海马切除术（SAH）已被提倡作为一种针对药物难治性内侧颞叶癫痫（MTLE）患者的微创手术。我们使用[（18）F] - 氟脱氧葡萄糖PET（FDG - PET）和韦氏记忆量表修订版，评估了15例患有药物难治性MTLE伴海马硬化的患者接受颞下SAH后对脑葡萄糖代谢和记忆功能的影响。在手术前以及术后1 - 5年（平均2.6年）对患者进行评估。对于语言优势半球的MTLE患者，这种手术方法保留了颞叶基部语言区。使用SPM5对FDG - PET图像进行体素级比较，以识别显示术后葡萄糖代谢变化的脑区（高度阈值，经多重比较校正后P = 0.01；范围阈值，100个体素）。在术后FDG - PET图像的空间归一化过程中，我们使用成本函数掩蔽来最小化由于手术切除区域内的异常信号导致的任何不适当的图像失真。术后葡萄糖代谢在患侧同侧的颞外区域增加，如背外侧前额叶皮质、背内侧和腹内侧额叶皮质。双侧下顶叶小叶以及远离切除的内侧颞叶区域的其余颞叶区域，如颞上回和颞极，葡萄糖代谢也增加。相比之下，术后葡萄糖代谢仅在与切除区域相邻的内侧颞叶区域降低。无论切除哪一侧，术后言语记忆、延迟回忆和注意力/集中力得分均显著优于术前得分。这项研究表明，使用颞下方法选择性切除MTLE中的致痫区域可改善来自受影响内侧颞叶投射区域的脑葡萄糖代谢。认知改善可能是良好的癫痫控制和最小化术后功能受损脑区的综合结果。
