Department of Medicine, Division of Neurology, Dalhousie University, Halifax, Canada.
Neurology. 2013 Apr 30;80(18):1669-76. doi: 10.1212/WNL.0b013e3182904f82. Epub 2013 Apr 3.
To compare standard anterior temporal lobectomy (ATL) with selective amygdalohippocampectomy (SAH) for postoperative seizure control in temporal lobe epilepsy (TLE).
We searched MEDLINE and Embase using Medical Subject Headings and keywords related to ATL and SAH. We included original research that directly compared seizure outcomes in patients undergoing SAH or ATL for TLE. A fixed-effect model was used to derive a pooled risk ratio (RR) for either an Engel Class I (free of disabling seizures) or a composite of an Engel Class I and II (rare disabling seizures) outcome.
Of 4,675 abstracts initially identified by the search, 65 were reviewed as full text. Thirteen studies containing data from 8 countries (5 continents) met our inclusion criteria. Eleven studies comprising 1,203 patients demonstrated that participants were statistically more likely to achieve an Engel Class I outcome after ATL compared with SAH (risk ratio 1.32, 95% confidence interval [CI] 1.12-1.57; p < 0.01). The summary risk difference of 8% (95% CI 3%-14%) translates to a number needed to treat of 13 (95% CI 7-33) for 1 additional patient to achieve an Engel Class I outcome after ATL. The result remained significant when 2 studies that contained fewer than 15 participants in at least 1 arm were excluded and in analyses restricted to hippocampal sclerosis.
Standard ATL confers an improved chance of achieving freedom from disabling seizures in patients with TLE. Improved seizure freedom must be balanced against the neuropsychological impact of each procedure. A randomized controlled trial is justified.
比较标准颞叶前切除术（ATL）与选择性杏仁核海马切除术（SAH）治疗颞叶癫痫（TLE）术后的癫痫控制效果。
我们使用医学主题词和与 ATL 和 SAH 相关的关键词在 MEDLINE 和 Embase 中进行检索。我们纳入了直接比较 TLE 患者接受 SAH 或 ATL 术后癫痫发作结局的原始研究。使用固定效应模型得出 Engel Ⅰ级（无致残性发作）或 Engel Ⅰ级和Ⅱ级（罕见致残性发作）复合结局的汇总风险比（RR）。
通过检索共确定了 4675 篇摘要，其中 65 篇被纳入全文审查。13 项研究（来自 8 个国家/地区，涉及 5 个大洲）符合我们的纳入标准。11 项研究共纳入 1203 例患者，结果表明，与 SAH 相比，ATL 后患者更有可能达到 Engel Ⅰ级结局（风险比 1.32，95%置信区间[CI] 1.12-1.57；p<0.01）。8%（95%CI 3%-14%）的汇总风险差异意味着每增加 13 例（95%CI 7-33）患者接受 ATL 后达到 Engel Ⅰ级结局，需要治疗的患者数为 13 例。当排除至少 1 个臂内少于 15 名参与者的 2 项研究和仅纳入海马硬化的分析时，结果仍然具有统计学意义。
标准 ATL 可提高 TLE 患者无致残性发作的机会。需要权衡每种手术的神经认知影响。有理由进行随机对照试验。
