Epilepsy Centre, University Hospital Freiburg, Breisacher Str. 64, Freiburg 79106, Germany.
J Neurol Neurosurg Psychiatry. 2013 Jun;84(6):630-6. doi: 10.1136/jnnp-2012-304052. Epub 2013 Jan 23.
Epilepsy surgery within the temporal lobe of the language dominant hemisphere bears the risk of postoperative verbal memory decline. As surgical procedures have become more tailored, the question has arisen, which type of resection within the temporal lobe is more favourable for memory outcome. Since the hippocampus (HC) is known to play an essential role for long-term memory, we examined whether HC sparing resections help to preserve verbal memory functions.
We retrospectively analysed neuropsychological data (prior to and 1 year after surgery) of patients undergoing either HC sparing resections (HC-S, N=65) or resections including the hippocampus (HC-R, N=62).
Prior to surgery, the HC-R group showed worse memory performance as compared to HC-S patients. Both patient groups revealed further deterioration over time, but in verbal learning HC-R patients demonstrated a stronger decline. Predictors for verbal learning decline were left-sided surgery, better preoperative performance, higher age at surgery, hippocampus resection, and lower preoperative IQ. In patients with spared HC, resection of the left-sided parahippocampal gyrus was rather accompanied by a decline in verbal learning performance. For visual memory, better preoperative performance best predicted deterioration after surgery. Seizure outcome was comparable between the two groups (HC-S: 66%, HC-R: 65% Engel 1a).
Temporal lobe resections within the language dominant hemisphere can be accompanied by a decline in verbal memory performance, even if the HC is spared. Yet, HC sparing surgery is associated with a benefit in verbal learning performance. These results can help when counselling patients prior to epilepsy surgery.
在优势半球的颞叶内进行癫痫手术存在术后言语记忆下降的风险。随着手术方法变得更加个体化，出现了一个问题，即颞叶内的哪种切除方式对记忆结果更有利。由于海马（HC）已知对长期记忆起重要作用，我们研究了是否保留 HC 的切除术有助于保留言语记忆功能。
我们回顾性分析了接受 HC 保留切除术（HC-S，N=65）或包括海马切除术（HC-R，N=62）的患者的神经心理学数据（术前和术后 1 年）。
术前，HC-R 组的记忆表现较 HC-S 组差。两组患者均随时间进一步恶化，但在言语学习中，HC-R 患者的下降更为明显。言语学习下降的预测因素包括左侧手术、术前表现较好、手术时年龄较大、海马切除术和术前 IQ 较低。在保留 HC 的患者中，左侧旁海马回的切除与言语学习表现下降有关。对于视觉记忆，更好的术前表现最好预测术后恶化。两组之间的癫痫发作结果无差异（HC-S：66%，HC-R：65% Engel 1a）。
即使保留了 HC，优势半球的颞叶内切除术也可能伴随着言语记忆表现下降。然而，保留 HC 的手术与言语学习表现的改善相关。这些结果有助于在癫痫手术前向患者提供咨询。
