Kork Epilepsy Centre, Kehl-Kork, Germany; Department of Neurology, University Hospital of Strasbourg, Strasbourg, France.
Epilepsy Res. 2013 Mar;104(1-2):94-104. doi: 10.1016/j.eplepsyres.2012.09.007. Epub 2012 Sep 28.
Several studies have demonstrated the positive effect of resective epilepsy surgery in drug-resistant temporal lobe epilepsy (TLE). However, it is still a matter of debate whether selective amygdalohippocampectomy (SAH) or standard temporal lobectomy (STL) are the most effective approaches concerning seizure outcome, quality of life and memory. In each of the two centers participating in this study either SAH or STL was the neurosurgical standard procedure irrespective of contextual aspects. Thus, with this postoperative assessment of resected patients we sought to avoid any selection bias that usually impaired comparative trials of both surgical approaches. We finally identified and studied 95 adult patients who had undergone either SAH (n=46) or STL (n=49) between 1999 and 2009 and fulfilled the inclusion criteria, namely drug-resistant unilateral mesial TLE with hippocampal sclerosis without any further structural lesions. We assessed the postoperative seizure outcome according to the ILAE criteria and postoperative quality of life by means of standardized questionnaires. Finally, we compared postoperative neuropsychological performance in 60 completely seizure-free patients (n=27 after SAH, n=33 after STL) prior to, one year after surgery and at a long-term follow-up with a mean of seven years. 78.2% of SAH and 85.7% of STL were seizure-free at the last observation. Quality of life had improved in 95.6% of the SAH patients and 89.8% of the STL patients. These differences were not statistically significant. Left-sided TLE patients had a significantly worse verbal memory outcome irrespective of the surgical method. However, SAH patients had a significantly better outcome concerning visual encoding, verbal and visual short-term memory and visual working memory. In this study, seizure outcome and quality of life did not differ depending on the surgical approach. However, a more selective resection led to better neuropsychological performances.
几项研究已经证明了切除性癫痫手术对耐药性颞叶癫痫（TLE）的积极影响。然而，关于手术结果、生活质量和记忆力，选择性杏仁核海马切除术（SAH）或标准颞叶切除术（STL）哪个更有效，仍存在争议。在这项研究的两个参与中心中，无论上下文如何，SAH 或 STL 都是神经外科的标准手术。因此，通过对接受手术的患者进行术后评估，我们试图避免任何选择偏差，这些偏差通常会影响两种手术方法的比较试验。我们最终确定并研究了 95 名成年患者，他们在 1999 年至 2009 年间接受了 SAH（n=46）或 STL（n=49）手术，符合纳入标准，即耐药性单侧内侧 TLE 伴海马硬化，无任何其他结构病变。我们根据 ILAE 标准评估术后癫痫发作结果，并通过标准化问卷评估术后生活质量。最后，我们比较了 60 名完全无癫痫发作的患者（n=27 例接受 SAH 治疗，n=33 例接受 STL 治疗）的术后神经心理学表现，包括术前、术后一年和平均 7 年的长期随访。SAH 和 STL 的最后观察结果分别为 78.2%和 85.7%无癫痫发作。SAH 患者中有 95.6%和 STL 患者中有 89.8%的生活质量得到改善。这些差异没有统计学意义。无论手术方法如何，左侧 TLE 患者的语言记忆结果都明显较差。然而，SAH 患者在视觉编码、语言和视觉短期记忆以及视觉工作记忆方面的表现明显更好。在这项研究中，手术结果和生活质量与手术方法无关。然而，更选择性的切除导致更好的神经心理学表现。
