Mathon B, Bédos Ulvin L, Adam C, Baulac M, Dupont S, Navarro V, Cornu P, Clemenceau S
Department of neurosurgery, groupe hospitalier universitaire de la Pitié-Salpêtrière, 47-83, boulevard de l'Hôpital, 75013 Paris, France.
Department of epileptology, groupe hospitalier universitaire de la Pitié-Salpêtrière, 47-83, boulevard de l'Hôpital, 75013 Paris, France.
Rev Neurol (Paris). 2015 Mar;171(3):315-25. doi: 10.1016/j.neurol.2015.01.561. Epub 2015 Mar 3.
Hippocampal sclerosis is the most common cause of pharmacoresistant epilepsy amenable for surgical treatment and seizure control. The aim of this article is to review and evaluate the published literature related to the outcome of the surgical treatment of mesial temporal lobe epilepsy (MTLE) associated with hippocampal sclerosis (HS) and to describe the future prospects in this field.
Surgery of MTLE associated with HS achieves long-term seizure freedom in about 70% (62-83%) of cases. Seizure outcome is similar in the pediatric population. Mortality following temporal resection is very rare (<1%) and the rate of definitive neurological complication is low (1%). Gamma knife stereotactic radiosurgery used as a treatment for MTLE would have a slightly worse outcome to that of surgical resection, but would provide neuropsychological advantage. However, the average latency before reducing or stopping seizures is at least 9 months with radiosurgery. Regarding palliative surgery, amygdalohippocampal stimulation has been demonstrated to improve the control of epilepsy in carefully selected patients with intractable MTLE who are not candidates for resective surgery.
Recent progress in the field of imaging and image-guidance should allow to elaborate tailored surgical strategies for each patient in order to achieve seizure freedom. Concerning therapeutics, closed-loop stimulation strategies allow early seizure detection and responsive stimulation. It may be less toxic and more effective than intermittent and continuous neurostimulation. Moreover, stereotactic radiofrequency amygdalohippocampectomy is a recent approach leading to hopeful results. Closed-loop stimulation and stereotactic radiofrequency amygdalohippocampectomy may provide a new treatment option for patients with pharmacoresistant MTLE.
Mesial temporal lobe surgery has been widely evaluated and has become the standard treatment for MTLE associated with HS. Alternative surgical procedures like gamma knife stereotactic radiosurgery and amygdalohippocampal stimulation are currently under assessment, with promising results.
海马硬化是药物难治性癫痫中最常见的可通过手术治疗和控制癫痫发作的病因。本文旨在回顾和评估已发表的与海马硬化（HS）相关的内侧颞叶癫痫（MTLE）手术治疗结果相关的文献，并描述该领域的未来前景。
与HS相关的MTLE手术在约70%（62 - 83%）的病例中实现了长期无癫痫发作。儿科人群的癫痫发作结果相似。颞叶切除术后的死亡率非常低（<1%），明确的神经并发症发生率也很低（1%）。用于MTLE治疗的伽玛刀立体定向放射外科手术的结果略逊于手术切除，但具有神经心理学优势。然而，放射外科手术减少或停止癫痫发作前的平均延迟至少为9个月。关于姑息性手术，杏仁核海马刺激已被证明可改善精心挑选的、不适合进行切除性手术的难治性MTLE患者的癫痫控制。
成像和图像引导领域的最新进展应有助于为每位患者制定量身定制的手术策略，以实现无癫痫发作。在治疗方面，闭环刺激策略可实现癫痫发作的早期检测和响应性刺激。它可能比间歇性和持续性神经刺激毒性更小、更有效。此外，立体定向射频杏仁核海马切除术是一种近期出现的方法，取得了令人鼓舞的结果。闭环刺激和立体定向射频杏仁核海马切除术可能为药物难治性MTLE患者提供新的治疗选择。
内侧颞叶手术已得到广泛评估，并已成为与HS相关的MTLE的标准治疗方法。伽玛刀立体定向放射外科手术和杏仁核海马刺激等替代手术方法目前正在评估中，结果令人期待。
