Department of Neurological Surgery, University of California, San Francisco, California 94143-0112, USA.
Neurosurgery. 2012 Apr;70(4):921-8; discussion 928. doi: 10.1227/NEU.0b013e31823c3a30.
Achieving seizure control in patients with low-grade temporal lobe gliomas or glioneuronal tumors remains highly underappreciated, because seizures are the most frequent presenting symptom and significantly impact patient quality-of-life.
To assess how the extent of temporal lobe resection influences seizure outcome.
We performed a quantitative, comprehensive systematic literature review of seizure control outcomes in 1181 patients with epilepsy across 41 studies after surgical resection of low-grade temporal lobe gliomas and glioneuronal tumors. We measured seizure-freedom rates after subtotal resection vs gross-total lesionectomy alone vs tailored resection, including gross-total lesionectomy with hippocampectomy and/or anterior temporal lobe corticectomy.
Included studies were observational case series, and no randomized, controlled trials were identified. Although only 43% of patients were seizure-free after subtotal tumor resection, 79% of individuals were seizure-free after gross-total lesionectomy (OR = 5.00, 95% confidence interval [CI]: 3.33-7.14). Furthermore, tailored resection with hippocampectomy plus corticectomy conferred additional benefit over gross-total lesionectomy alone, with 87% of patients achieving seizure freedom (OR = 1.82, 95% CI: 1.23-2.70). Overall, extended resection with hippocampectomy and/or corticectomy over gross-total lesionectomy alone significantly predicted seizure freedom (OR = 1.18, 95% CI: 1.11-1.26). Age <18 years and mesial temporal location also prognosticated favorable seizure outcome.
Gross-total lesionectomy of low-grade temporal lobe tumors results in significantly improved seizure control over subtotal resection. Additional tailored resection including the hippocampus and/or adjacent cortex may further improve seizure control, suggesting dual pathology may sometimes allow continued seizures after lesional excision.
低级别颞叶胶质瘤或神经胶质神经元肿瘤患者的癫痫发作控制仍未得到充分重视，因为癫痫发作是最常见的首发症状，严重影响患者的生活质量。
评估颞叶切除术的范围如何影响癫痫发作的结果。
我们对 41 项研究中的 1181 例接受低级别颞叶胶质瘤和神经胶质神经元肿瘤手术切除的癫痫患者的癫痫控制结果进行了定量、全面的系统文献回顾。我们测量了次全切除与单纯大体全切除与个体化切除（包括海马体切除术和/或前颞叶皮质切除术的大体全切除）后的无癫痫发作率。
纳入的研究为观察性病例系列研究，未发现随机对照试验。尽管仅有 43%的患者在次全肿瘤切除后无癫痫发作，但 79%的患者在大体全切除后无癫痫发作（OR=5.00，95%置信区间[CI]：3.33-7.14）。此外，海马体切除术联合皮质切除术的个体化切除比单纯大体全切除有额外获益，87%的患者达到癫痫无发作（OR=1.82，95% CI：1.23-2.70）。总体而言，与单纯大体全切除相比，扩大切除包括海马体和/或皮质显著预测癫痫无发作（OR=1.18，95% CI：1.11-1.26）。年龄<18 岁和颞叶内侧部位也与良好的癫痫结局相关。
低级别颞叶肿瘤的大体全切除比次全切除显著改善癫痫发作控制。包括海马体和/或邻近皮质的个体化切除可能进一步改善癫痫发作控制，这表明双重病变有时可能允许在病变切除后继续发作。
