Department of Neurosurgery, University of Michigan Health System, Ann Arbor, Michigan 48109, USA.
Neurosurg Focus. 2012 Mar;32(3):E8. doi: 10.3171/2011.12.FOCUS11342.
Anterior temporal lobectomy (ATL) and selective amygdalohippocampectomy (SelAH) are the preferred surgical approaches for the treatment of medically refractory epilepsy involving the nondominant and dominant temporal lobes, respectively. Both techniques provide access to mesial structures-with the ATL providing a wider surgical corridor than SelAH. Because the extent of mesial temporal resection potentially impacts seizure outcome, the authors examined mesial resection volumes, seizure outcomes, and neuropsychiatric test scores in patients undergoing either ATL or transcortical SelAH at a single institution.
A retrospective study was conducted in 96 patients with medically refractory mesial temporal lobe epilepsy. Fifty-one patients who had nondominant temporal lobe epilepsy underwent standard ATL, and 45 patients with language-dominant temporal lobe epilepsy underwent transcortical SelAH. Volumetric MRI analysis was used to quantify the mesial resection in both groups. In addition, the authors examined seizure outcomes and the change in neuropsychiatric test scores.
Seizure-free outcome in the entire patient cohort was 94% at a mean follow-up of 44 months. There was no significant difference in the seizure outcome between the 2 groups. The extent of resection of the mesial structures following ATL was slightly higher than for SelAH (98% vs. 91%, p < 0.0001). The change in neuropsychiatric test scores largely reflected the side of surgery, but overall IQ and memory function did not change significantly in either group.
Transcortical SelAH provides adequate access to the mesial structures, and allows for a resection that is nearly as extensive as that achieved with standard ATL. Seizure outcomes and neuropsychiatric sequelae are similar in both procedures.
前颞叶切除术（ATL）和选择性杏仁核海马切除术（SelAH）分别是治疗非优势和优势颞叶药物难治性癫痫的首选手术方法。这两种技术都可以进入内侧结构——与 SelAH 相比，ATL 提供了更宽的手术通道。由于内侧颞叶切除术的范围可能会影响癫痫发作的结果，作者在一个单机构中检查了接受 ATL 或皮质下 SelAH 的患者的内侧切除体积、癫痫发作结果和神经心理测试评分。
对 96 例药物难治性内侧颞叶癫痫患者进行回顾性研究。51 例非优势颞叶癫痫患者行标准 ATL，45 例语言优势颞叶癫痫患者行皮质下 SelAH。使用容积 MRI 分析对两组患者的内侧切除术进行定量分析。此外，作者还检查了癫痫发作结果和神经心理测试评分的变化。
在整个患者队列中，平均随访 44 个月时，无癫痫发作的结果为 94%。两组之间的癫痫发作结果无显著差异。ATL 后内侧结构的切除范围略高于 SelAH（98%比 91%，p < 0.0001）。神经心理测试评分的变化在很大程度上反映了手术的侧别，但两组的总体智商和记忆功能均无显著变化。
皮质下 SelAH 为内侧结构提供了足够的进入通道，并允许进行与标准 ATL 几乎相同的广泛切除。两种手术的癫痫发作结果和神经心理后遗症相似。
