Division of Pediatric Neurosurgery, Seoul National University Children's Hospital, College of Medicine, Seoul, Republic of Korea.
Neurosurgery. 2011 Mar;68(3):582-7. doi: 10.1227/NEU.0b013e3182077552.
The optimal extent of resection for surgical treatment of lesional epilepsy is a controversial issue.
For patients with mesial temporal lobe lesions visible on magnetic resonance imaging, we compared the surgical outcome of selective lesionectomy with that of standard anterior temporal lobectomy (ATL) and amygdalohippocampectomy.
We conducted a retrospective analysis of the seizure outcome of 40 patients treated for lesional mesial temporal lobe epilepsy between 1993 and 2008. Before 2006, patients were managed by ATL (n=29) and from 2006 onward, by selective lesionectomy via the transsylvian-transcisternal approach (n=11).
The postoperative seizure-free rates for the 2 groups were comparable: 93% (27/29) for the ATL group and 91% (10/11) for the selective lesionectomy group (P=.814). In both groups, patients with persistent seizures commonly showed incomplete lesion resection, with complete resection often improving seizure outcome. Postoperative visual field defects were more common in the ATL group (21%) than in the selective lesionectomy group (0%) (P=.102).
Transsylvian-transcisternal selective lesionectomy is an effective and safe therapeutic modality in children with lesional mesial temporal lobe epilepsy. Completeness of resection is an important variable for seizure control regardless of surgical modality.
手术治疗病变性癫痫的最佳切除范围是一个有争议的问题。
对于磁共振成像可见内侧颞叶病变的患者，我们比较了选择性病变切除术与标准前颞叶切除术（ATL）和杏仁核海马切除术的手术结果。
我们对 1993 年至 2008 年间接受病变性内侧颞叶癫痫治疗的 40 例患者的癫痫发作结果进行了回顾性分析。2006 年前，患者采用 ATL 治疗（n=29），2006 年后，采用经颞叶经颅经颅入路选择性病变切除术治疗（n=11）。
两组术后无癫痫发作率相当：ATL 组为 93%（27/29），选择性病变切除术组为 91%（10/11）（P=.814）。在两组中，持续癫痫发作的患者通常存在不完全病变切除，完全切除通常会改善癫痫发作结果。术后视野缺损在 ATL 组（21%）比选择性病变切除术组（0%）更常见（P=.102）。
经颞叶经颅经颅选择性病变切除术是儿童病变性内侧颞叶癫痫的一种有效且安全的治疗方法。切除的完整性是控制癫痫发作的重要变量，与手术方式无关。
