Department of Presurgical Evaluation, Bethel Epilepsy Center, Bielefeld, Germany.
Acta Neurochir (Wien). 2011 Feb;153(2):231-8. doi: 10.1007/s00701-010-0734-2. Epub 2010 Jul 17.
It is the aim of epilepsy surgery in patients with lesional epilepsy for the surgeon to not only remove the lesion itself, but also the epileptogenic zone. Here, we report our experience with a modified temporal resection technique confined to the apical temporal lobe, i.e., sparing the hippocampal formation in patients with epileptogenic lesions in the anterior part of the temporal lobe. This apical temporal lobe resection (aTLR) includes tailored lesionectomy, amygdalectomy, and resection of the mesial structures only in the apex of the temporal lobe. This paper presents our surgical technical details and the outcome of aTLR.
Between 2001 and 2008, aTLR was performed in 61 patients. All patients underwent comprehensive presurgical evaluation including video-EEG monitoring, magnetic resonance imaging (MRI), and neuropsychological testing. All patients had a lesion in the apex of the temporal lobe and a normal hippocampus as seen in MRI, as well as intact memory functions in neuropsychological examination. There were 33 males (54.1%) and 28 females (45.9%). The mean age in years at epilepsy onset was 20.2 ± 13.4, the mean age at epilepsy surgery was 32.1 ± 11.9, the mean preoperative epilepsy duration was 11.8 ± 8.8 years and the mean duration of follow-up was 2.1 ± 1.3 years (range 0.5-6 years).
Fifty-four (88.5%) of 61 patients were in Engel Class 1 at 6 months, 38 (80.9%) of 47 at 2 years and nine (81.8%) of 11 at the 5 year follow-up. Histopathological examination showed tumors in 31 patients, FCD in ten patients, amygdala sclerosis in seven patients, cavernomas in six patients, unspecific reactions in eight patients, and gliosis in one patient. Surgical complications occurred in four patients: one had a permanent and three had transient complications which could be successfully treated. Fifty (82%) resections were considered to be complete resections as evaluated by serial postoperative MRI, seven patients (11.5%) had incomplete resection of the preoperative MRI lesion and in four patients (6.6%) it remained unclear. Fifteen patients (29.4%) were withdrawn from antiepileptic drugs for more than 2 years without relapse. Postoperative neuropsychological examination revealed worsening of memory performance in two patients (3.2%) and improved or no changes in the rest of the patients.
Apical temporal resection sparing the mesial temporal structures is an effective procedure with good long-term seizure outcome in patients with refractory epilepsy due to lesions confined to the apex of the temporal lobe.
对于病变性癫痫患者，癫痫外科医生的目标不仅是切除病变本身，还要切除致痫区。在这里，我们报告了我们在一项改良的颞叶前部切除术（apical temporal lobe resection，aTLR）中的经验，该术式仅限于颞叶尖部，即保留海马结构，适用于颞叶前部有致痫病灶的患者。这种颞叶尖部切除术（aTLR）包括有针对性的病变切除术、杏仁核切除术和仅在颞叶尖部切除内侧结构。本文介绍了我们的手术技术细节和 aTLR 的结果。
2001 年至 2008 年间，61 例患者接受了 aTLR。所有患者均接受了全面的术前评估，包括视频-脑电图监测、磁共振成像（MRI）和神经心理学测试。所有患者的 MRI 均显示在颞叶尖部有病变，而海马正常，神经心理学检查也显示记忆功能正常。其中 33 例为男性（54.1%），28 例为女性（45.9%）。癫痫发病年龄的平均值为 20.2±13.4 岁，癫痫手术年龄的平均值为 32.1±11.9 岁，术前癫痫持续时间的平均值为 11.8±8.8 年，随访时间的平均值为 2.1±1.3 年（范围为 0.5-6 年）。
61 例患者中，54 例（88.5%）在术后 6 个月达到 Engel 分级 1 级，47 例中有 38 例（80.9%）在术后 2 年达到该级别，11 例中有 9 例（81.8%）在术后 5 年达到该级别。组织病理学检查显示 31 例患者有肿瘤，10 例有局灶性皮质发育不良，7 例有杏仁核硬化，6 例有海绵状血管瘤，8 例有非特异性反应，1 例有神经胶质增生。4 例患者出现手术并发症：1 例为永久性并发症，3 例为暂时性并发症，均得到成功治疗。50 例（82%）的切除被认为是完全切除，这是通过术后连续 MRI 评估得出的，7 例（11.5%）患者术前 MRI 病变切除不完全，4 例（6.6%）患者切除情况仍不清楚。15 例（29.4%）患者停用抗癫痫药物超过 2 年无复发。术后神经心理学检查显示，2 例（3.2%）患者记忆功能恶化，其余患者均有改善或无变化。
对于病变局限于颞叶尖部的难治性癫痫患者，保留颞叶内侧结构的颞叶尖部切除术是一种有效术式，具有良好的长期癫痫发作结果。
