Kishima Haruhiko, Kato Amami, Oshino Satoru, Tani Naoki, Maruo Tomoyuki, Khoo Hui Ming, Yanagisawa Takufumi, Edakawa Kotaro, Kobayashi Maki, Tanaka Masataka, Hosomi Koichi, Hirata Masayuki, Yoshimine Toshiki
a Department of Neurosurgery , Osaka University Graduate School of Medicine , Suita, Osaka , Japan.
b Epilepsy Center , Osaka University Hospital , Suita , Japan.
Neurol Res. 2017 Mar;39(3):223-230. doi: 10.1080/01616412.2016.1275458. Epub 2017 Jan 9.
Selective amygdalohippocampectomy (SAH) can be used to obtain satisfactory seizure control in patients with mesial temporal lobe epilepsy (MTLE). Several SAH procedures have been reported to achieve satisfactory outcomes for seizure control, but none yield fully satisfactory outcomes for memory function. We hypothesized that preserving the temporal stem might play an important role. To preserve the temporal stem, we developed a minimally invasive surgical procedure, 'neuronavigation-assisted trans-inferotemporal cortex SAH' (TITC-SAH).
TITC-SAH was performed in 23 patients with MTLE (MTLE on the language-non-dominant hemisphere, n = 11). The inferior horn of the lateral ventricle was approached via the inferior or middle temporal gyrus along the inferior temporal sulcus under neuronavigation guidance. The hippocampus was dissected in a subpial manner and resected en bloc together with the parahippocampal gyrus. Seizure control at one year and memory function at 6 months postoperatively were evaluated.
One year after TITC-SAH, 20 of the 23 patients were seizure-free (ILAE class 1), 2 were class 2, and 1 was class 3. Verbal memory improved significantly in 13 patients with a diagnosis of hippocampal sclerosis, for whom WMS-R scores were available both pre- and post-operatively. Improvements were seen regardless of whether the SAH was on the language-dominant or non-dominant hemisphere. No major complication was observed.
Navigation-assisted TITC-SAH performed for MTLE offers a simple, minimally invasive procedure that appears to yield excellent outcomes in terms of seizure control and preservation of memory function, because this procedure does not damage the temporal stem. TITC-SAH should be one of the feasible surgical procedures for MTLE.
SAH: Amygdalohippocampectomy; MTLE: Mesial temporal lobe epilepsy (MTLE); TITC-SAH: Ttrans-inferotemporal cortex SAH; ILAE: International League Against Epilepsy (ILAE); MRI: Magnetic resonance imaging; EEG: Electroencephalography (EEG); FDG-PET: F-fluorodeoxyglucose (FDG)-positron emission tomography; ECoG: Electrocorticography; MEG: Magnetoencephalography; IMZ-SPECT: N-isopropyl-p(I)-iodoamphetamine single photon emission computed tomography; WMS-R: Wechsler Memory Scale-Revised.
选择性杏仁核海马切除术（SAH）可用于使内侧颞叶癫痫（MTLE）患者获得满意的癫痫控制。据报道，几种SAH手术在癫痫控制方面取得了满意的效果，但在记忆功能方面均未产生完全令人满意的结果。我们推测保留颞叶干可能起重要作用。为了保留颞叶干，我们开发了一种微创手术方法，即“神经导航辅助经颞下皮质SAH”（TITC-SAH）。
对23例MTLE患者（语言非优势半球的MTLE患者，n = 11）实施TITC-SAH。在神经导航引导下，经颞下回或颞中回沿颞下沟进入侧脑室下角。以软膜下方式解剖海马，并将其与海马旁回一并整块切除。评估术后1年的癫痫控制情况和术后6个月的记忆功能。
TITC-SAH术后1年，23例患者中有20例无癫痫发作（国际抗癫痫联盟（ILAE）1级），2例为2级，1例为3级。13例诊断为海马硬化且术前和术后均有韦氏记忆量表修订版（WMS-R）评分的患者，其言语记忆有显著改善。无论SAH是在语言优势半球还是非优势半球，均可见改善。未观察到重大并发症。
为MTLE实施的神经导航辅助TITC-SAH提供了一种简单的微创手术方法，在癫痫控制和记忆功能保留方面似乎产生了优异的结果，因为该手术不会损伤颞叶干。TITC-SAH应是MTLE可行的手术方法之一。
SAH：杏仁核海马切除术；MTLE：内侧颞叶癫痫（MTLE）；TITC-SAH：经颞下皮质SAH；ILAE：国际抗癫痫联盟（ILAE）；MRI：磁共振成像；EEG：脑电图（EEG）；FDG-PET：F-氟脱氧葡萄糖（FDG）-正电子发射断层扫描；ECoG：皮质脑电图；MEG：脑磁图；IMZ-SPECT：N-异丙基-p（I）-碘安非他明单光子发射计算机断层扫描；WMS-R：韦氏记忆量表修订版
