MRI 引导下立体定向激光杏仁核海马切除术治疗颞叶癫痫的更好的物体识别和命名结果。
Better object recognition and naming outcome with MRI-guided stereotactic laser amygdalohippocampotomy for temporal lobe epilepsy.
机构信息
Department of Neurology, Emory University School of Medicine, Atlanta, Georgia, U.S.A; Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, U.S.A; Department of Neurology, University of Washington School of Medicine, Seattle, Washington, U.S.A.
出版信息
Epilepsia. 2015 Jan;56(1):101-13. doi: 10.1111/epi.12860. Epub 2014 Dec 8.
OBJECTIVES
Patients with temporal lobe epilepsy (TLE) experience significant deficits in category-related object recognition and naming following standard surgical approaches. These deficits may result from a decoupling of core processing modules (e.g., language, visual processing, and semantic memory), due to "collateral damage" to temporal regions outside the hippocampus following open surgical approaches. We predicted that stereotactic laser amygdalohippocampotomy (SLAH) would minimize such deficits because it preserves white matter pathways and neocortical regions that are critical for these cognitive processes.
METHODS
Tests of naming and recognition of common nouns (Boston Naming Test) and famous persons were compared with nonparametric analyses using exact tests between a group of 19 patients with medically intractable mesial TLE undergoing SLAH (10 dominant, 9 nondominant), and a comparable series of TLE patients undergoing standard surgical approaches (n=39) using a prospective, nonrandomized, nonblinded, parallel-group design.
RESULTS
Performance declines were significantly greater for the patients with dominant TLE who were undergoing open resection versus SLAH for naming famous faces and common nouns (F=24.3, p<0.0001, η2=0.57, and F=11.2, p<0.001, η2=0.39, respectively), and for the patients with nondominant TLE undergoing open resection versus SLAH for recognizing famous faces (F=3.9, p<0.02, η2=0.19). When examined on an individual subject basis, no SLAH patients experienced any performance declines on these measures. In contrast, 32 of the 39 patients undergoing standard surgical approaches declined on one or more measures for both object types (p<0.001, Fisher's exact test). Twenty-one of 22 left (dominant) TLE patients declined on one or both naming tasks after open resection, while 11 of 17 right (nondominant) TLE patients declined on face recognition.
SIGNIFICANCE
Preliminary results suggest (1) naming and recognition functions can be spared in TLE patients undergoing SLAH, and (2) the hippocampus does not appear to be an essential component of neural networks underlying name retrieval or recognition of common objects or famous faces.
目的
颞叶癫痫（TLE）患者在接受标准手术治疗后，在类别相关物体识别和命名方面存在显著缺陷。这些缺陷可能是由于在开放性手术治疗后，海马体以外的颞叶区域受到“附带损伤”，导致核心处理模块（如语言、视觉处理和语义记忆）之间的分离。我们预测，立体定向激光杏仁核海马切除术（SLAH）将最大限度地减少这些缺陷，因为它保留了对这些认知过程至关重要的白质通路和新皮质区域。
方法
使用波士顿命名测试（Boston Naming Test）和名人识别测试对 19 例接受 SLAH 治疗的药物难治性内侧 TLE 患者（10 例优势半球，9 例非优势半球）进行了比较，并采用非参数分析进行了精确检验。使用前瞻性、非随机、非盲、平行组设计，对接受标准手术治疗的 TLE 患者（n=39）进行了比较。
结果
在接受开放性切除术的优势半球 TLE 患者中，与 SLAH 相比，在命名名人面孔和常见名词时，患者的表现下降更为显著（F=24.3，p<0.0001，η2=0.57，和 F=11.2，p<0.001，η2=0.39），在接受开放性切除术的非优势半球 TLE 患者中，在识别名人面孔时，患者的表现下降更为显著（F=3.9，p<0.02，η2=0.19）。当在个体患者的基础上进行检查时，没有 SLAH 患者在这些指标上出现任何表现下降。相比之下，接受标准手术治疗的 39 例患者中有 32 例在一种或多种物体类型上的一项或多项测量中下降（p<0.001，Fisher 精确检验）。22 例左（优势）TLE 患者中有 21 例在开放性手术后在一种或两种命名任务中下降，而 17 例右（非优势）TLE 患者中有 11 例在面部识别中下降。
意义
初步结果表明：（1）接受 SLAH 治疗的 TLE 患者可以保留命名和识别功能，（2）海马体似乎不是命名检索或常见物体或名人面孔识别的神经网络的必要组成部分。
Zotero 插件