Mansouri Alireza, Fallah Aria, McAndrews Mary Pat, Cohn Melanie, Mayor Diana, Andrade Danielle, Carlen Peter, Del Campo Jose M, Tai Peter, Wennberg Richard A, Valiante Taufik A
Division of Neurosurgery, University of Toronto, Toronto, ON, Canada M5G 1X8 ; Toronto Western Hospital, University Health Network, 399 Bathurst Street, Toronto, ON, Canada M5T 2S8.
Division of Neurosurgery, University of Toronto, Toronto, ON, Canada M5G 1X8 ; Toronto Western Hospital, University Health Network, 399 Bathurst Street, Toronto, ON, Canada M5T 2S8 ; Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Canada L8S 4K1.
Epilepsy Res Treat. 2014;2014:306382. doi: 10.1155/2014/306382. Epub 2014 Oct 1.
Objective. To report our institutional seizure and neuropsychological outcomes for a series of patients with mesial temporal lobe epilepsy (mTLE) undergoing anterior temporal lobectomy (ATL) or selective amygdalohippocampectomy (SelAH) between 2004 and 2011. Methods. A retrospective study of patients with mTLE was conducted. Seizure outcome was reported using time-to-event analysis. Cognitive outcome was reported using the change principal in component factor scores, one each, for intellectual abilities, visuospatial memory, and verbal memory. The Boston Naming Test was used for naming assessment. Language dominant and nondominant resections were compared separately. Student's t-test was used to assess statistical significance. Results. Ninety-six patients (75 ATL, 21 SelAH) were included; fifty-four had complete neuropsychological follow-up. Median follow-up was 40.5 months. There was no statistically significant difference in seizure freedom or any of the neuropsychological outcomes, although there was a trend toward greater postoperative decline in naming in the dominant hemisphere group following ATL. Conclusion. Seizure and neuropsychological outcomes did not differ for the two surgical approaches which is similar to most prior studies. Given the theoretical possibility of SelAH sparing language function in patients with epilepsy secondary to mesial temporal sclerosis and the limited high-quality evidence creating equipoise, a multicenter randomized clinical trial is warranted.
目的。报告2004年至2011年间一系列接受前颞叶切除术（ATL）或选择性杏仁核海马切除术（SelAH）的内侧颞叶癫痫（mTLE）患者的机构癫痫发作和神经心理学结果。方法。对mTLE患者进行回顾性研究。使用事件发生时间分析报告癫痫发作结果。使用成分因子得分的变化原则报告认知结果，分别针对智力能力、视觉空间记忆和言语记忆各一项。使用波士顿命名测试进行命名评估。分别比较语言优势半球和非优势半球切除术。使用学生t检验评估统计学意义。结果。纳入96例患者（75例行ATL，21例行SelAH）；54例有完整的神经心理学随访。中位随访时间为40.5个月。癫痫发作自由或任何神经心理学结果均无统计学显著差异，尽管ATL后优势半球组命名术后下降趋势更明显。结论。两种手术方法的癫痫发作和神经心理学结果无差异，这与大多数先前研究相似。鉴于SelAH在继发于内侧颞叶硬化的癫痫患者中保留语言功能的理论可能性以及高质量证据有限导致难以抉择，有必要进行多中心随机临床试验。
