Kubota Yuichi, Ochiai Taku, Hori Tomokatsu, Kawamata Takakazu
Department of Neurosurgery, Tokyo Women's Medical University, Shinjuku, Tokyo, Japan.
Ochiai Brain Clinic, Saitama, Saitama, Japan.
Clin Neurol Neurosurg. 2017 Jul;158:67-71. doi: 10.1016/j.clineuro.2017.04.026. Epub 2017 May 1.
Surgical options for medial temporal lobe epilepsy (MTLE) include anterior temporal lobectomy (ATL) and selective amygdalohippocampectomy (SAH). Optimal criteria for choosing the appropriate surgical approach remain uncertain. This article reports 11 consecutive cases in which electrophysiological findings of stereoelectroencephalography (SEEG) were used to determine the optimal surgical approach.
Eleven consecutive patients with MTLE underwent SEEG evaluation and were placed in either the medial or the medial+lateral group based on the findings. Patients in the medial group underwent SAH using the subtemporal approach, and patients in the medial+lateral group underwent SEEG-guided anterior temporal lobectomy. SEEG findings were also compared with other examinations including flumazenil (FMZ)-positron emission tomography (PET), fluorine-18 labeled fluorodeoxyglucose (FDG)-PET, and magnetoencephalography (MEG). Results were evaluated to determine which examinations most consistently identified the epileptogenic zone.
Of the 11 cases, 4 patients were placed in the medial group, and 7 patients in the medial+lateral group. Of patients, 90.9% were classified in class I of the Engel Epilepsy Surgery Outcome Scale, while 72.7% were classified in class I by the International League Against Epilepsy (ILAE) system. Analyzed by group, 100% of the medial group experienced an Engel class I outcome in the medial group, compared to 85.7% in the medial+lateral group. SEEG findings were comparable with FDG-PET results (10 of 11, 91%).
Tailored surgery guided by SEEG is an electrophysiologically feasible treatment for MTLE that can result in favorable outcomes. Although seizures are thought to originate in the medial temporal lobe in MTLE, it is important for involvement of the lateral temporal cortex to be also considered in some cases.
内侧颞叶癫痫（MTLE）的手术选择包括前颞叶切除术（ATL）和选择性杏仁核海马切除术（SAH）。选择合适手术方法的最佳标准仍不明确。本文报告了连续11例病例，其中利用立体定向脑电图（SEEG）的电生理结果来确定最佳手术方法。
11例连续的MTLE患者接受了SEEG评估，并根据评估结果分为内侧组或内侧+外侧组。内侧组患者采用颞下入路进行SAH，内侧+外侧组患者接受SEEG引导下的前颞叶切除术。还将SEEG结果与其他检查进行了比较，包括氟马西尼（FMZ）-正电子发射断层扫描（PET）、氟-18标记的氟脱氧葡萄糖（FDG）-PET和脑磁图（MEG）。对结果进行评估，以确定哪种检查最能一致地识别致痫区。
11例病例中，4例患者被分入内侧组，7例患者被分入内侧+外侧组。患者中，90.9%在恩格尔癫痫手术结果量表中被评为I级，而72.7%在国际抗癫痫联盟（ILAE）系统中被评为I级。按组分析，内侧组100%的患者在内侧组中达到恩格尔I级结果，而内侧+外侧组为85.7%。SEEG结果与FDG-PET结果相当（11例中的10例，91%）。
由SEEG引导的个体化手术是一种电生理上可行的MTLE治疗方法，可带来良好的结果。虽然在MTLE中癫痫发作被认为起源于内侧颞叶，但在某些情况下，外侧颞叶皮质的受累也很重要，也应予以考虑。
