Department of Neurosurgery, Tokyo Metropolitan Neurological Hospital, Tokyo, Japan.
J Neurosurg. 2013 Nov;119(5):1098-104. doi: 10.3171/2013.6.JNS13244. Epub 2013 Aug 2.
Amygdalohippocampectomy is a well-established, standard surgery for medically intractable mesial temporal lobe epilepsy (MTLE). However, in the case of MTLE without hippocampal atrophy or sclerosis, amygdalohippocampectomy is associated with decreased postoperative memory function. Hippocampal transection (HT) has been developed to overcome this problem. In HT the hippocampus is not removed; rather, the longitudinal hippocampal circuits of epileptic activities are disrupted by transection of the pyramidal layer of the hippocampus. The present study describes a less invasive modification of HT (transsylvian HT) and presents the seizure and memory outcomes for this procedure.
Thirty-seven patients with MTLE (18 men and 19 women; age range 9-63 years; 19 with surgery on the right side and 18 with surgery on the left side; seizure onset from 3 to 34 years) who were treated with transsylvian HT were retrospectively analyzed. All patients had left-side language dominance, and follow-up periods ranged from 12 to 94 months (median 49 months). Seizure outcomes were evaluated for all patients by using the Engel classification. Memory function was evaluated for 22 patients based on 3 indices (verbal memory, nonverbal memory, and delayed recall), with those scores obtained using the Wechsler Memory Scale-Revised. Patients underwent evaluation of the memory function before and after surgery (6 months-1 year).
Engel Class I (completely seizure free) was achieved in 25 patients (67.6%). Class II and Class III designation was achieved in 10 (27%) and 2 patients (5.4%), respectively. There were differences in memory outcome between the sides of operation. On the right side, verbal memory significantly increased postoperatively (p = 0.003) but nonverbal memory and delayed recall showed no significant change after the operation (p = 0.718 and p = 0.210, respectively). On the left side, all 3 indices (verbal memory, nonverbal memory, and delayed recall) showed no significant change (p = 0.331, p = 0.458, and p = 0.366, respectively).
Favorable seizure outcome and preservation of verbal memory were achieved with transsylvian HT for the treatment of MTLE without hippocampal atrophy or sclerosis.
杏仁核海马切除术是一种成熟的、标准的手术方法，适用于药物难治性内侧颞叶癫痫（MTLE）。然而，对于没有海马萎缩或硬化的 MTLE，杏仁核海马切除术与术后记忆功能下降有关。海马切断术（HT）的发展就是为了克服这个问题。在 HT 中，海马并未被切除；而是通过切断海马的锥体细胞层来破坏癫痫活动的纵向海马回路。本研究描述了 HT 的一种微创改良（经外侧裂 HT），并介绍了该手术的癫痫发作和记忆结果。
对 37 例 MTLE 患者（18 例男性，19 例女性；年龄 9-63 岁；19 例右侧手术，18 例左侧手术；癫痫发作始于 3 至 34 岁）进行回顾性分析，这些患者接受了经外侧裂 HT 治疗。所有患者均有左侧语言优势，随访时间为 12 至 94 个月（中位数 49 个月）。所有患者均采用 Engel 分类法评估癫痫发作结果。根据 3 项指标（言语记忆、非言语记忆和延迟回忆），对 22 例患者的记忆功能进行评估，采用韦氏记忆量表修订版获得这些评分。患者在术前和术后 6 个月至 1 年进行记忆功能评估。
25 例患者（67.6%）达到 Engel Ⅰ级（完全无癫痫发作）。10 例（27%）和 2 例（5.4%）患者分别达到Ⅱ级和Ⅲ级。手术侧之间的记忆结果存在差异。在右侧，术后言语记忆显著增加（p=0.003），但术后非言语记忆和延迟回忆无显著变化（p=0.718 和 p=0.210）。在左侧，所有 3 项指标（言语记忆、非言语记忆和延迟回忆）均无显著变化（p=0.331、p=0.458 和 p=0.366）。
经外侧裂 HT 治疗无海马萎缩或硬化的 MTLE，可获得良好的癫痫发作结果和言语记忆保留。
