Drane Daniel L
Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA; Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA; Department of Neurology, University of Washington School of Medicine, Seattle, WA, USA.
Epilepsy Res. 2018 May;142:170-175. doi: 10.1016/j.eplepsyres.2017.09.016. Epub 2017 Sep 23.
Cognitive outcome data are reviewed with respect to the use of magnetic-resonance guided stereotactic laser ablation (SLA) as an epilepsy surgical procedure, with comparisons drawn to traditional open resection procedures. Cognitive outcome with stereotactic laser amygdalohippocampotomy (SLAH) appears better than open resection for several functions dependent on extra-mesial temporal lobe (TL) structures, including category-related naming, verbal fluency, and object/familiar person recognition. Preliminary data suggests episodic, declarative verbal memory can decline following SLAH in the language dominant hemisphere, although early findings suggest comparable or even superior outcomes compared with open resection. The hippocampus has long been considered a central structure supporting episodic, declarative memory, with epilepsy surgical teams attempting to spare it whenever possible. However, ample data from animal and human neuroscience research suggests declarative memory deficits are greater following broader mesial TL lesions that include parahippocampal gyrus and lateral TL inputs. Therefore, employing a neurosurgical technique that restricts the surgical lesion zone holds promise for achieving a better cognitive outcome. Focal SLA lesions outside of the amygdalohippocampal complex may impair select cognitive functions, although few data have been published in such patients to date. SLA is being effectively employed with adults and children with TL or lesional epilepsies across several U.S. epilepsy centers, which may simultaneously optimize cognitive outcome while providing a curative treatment for seizures.
本文回顾了磁共振引导立体定向激光消融术（SLA）作为一种癫痫外科手术的认知结果数据，并与传统的开放性切除术进行了比较。立体定向激光杏仁核海马切开术（SLAH）在依赖颞叶内侧以外结构的多种功能方面，其认知结果似乎优于开放性切除术，这些功能包括类别相关命名、语言流畅性以及物体/熟悉人物识别。初步数据表明，在语言优势半球进行SLAH后，情景性、陈述性言语记忆可能会下降，不过早期研究结果显示，与开放性切除术相比，其结果相当甚至更优。长期以来，海马体一直被认为是支持情景性、陈述性记忆的核心结构，癫痫手术团队尽可能地保留它。然而，来自动物和人类神经科学研究的大量数据表明，包括海马旁回和颞叶内侧外侧输入在内的更广泛的颞叶内侧病变后，陈述性记忆缺陷更为严重。因此，采用一种限制手术损伤区域的神经外科技术有望获得更好的认知结果。杏仁核海马复合体以外的局灶性SLA病变可能会损害某些认知功能，不过迄今为止，这类患者发表的数据很少。在美国的几个癫痫中心，SLA正有效地应用于患有颞叶或病灶性癫痫的成人和儿童患者，这可能在为癫痫发作提供治愈性治疗的同时，优化认知结果。
