University of Virginia, Charlottesville, VA, United States.
Indiana University, Indianapolis, IN, United States.
Seizure. 2018 Dec;63:62-67. doi: 10.1016/j.seizure.2018.10.017. Epub 2018 Oct 31.
Stereotactic radiosurgery (SRS) may be an alternative to anterior temporal lobectomy (ATL) for mesial temporal lobe epilepsy (MTLE). Visual field defects (VFD) occur in 9-100% of patients following open surgery for MTLE. Postoperative VFD after minimally invasive versus open surgery may differ.
This prospective trial randomized patients with unilateral hippocampal sclerosis and concordant video-EEG findings to SRS versus ATL. Humphries perimetry was obtained at 24 m after surgery. VFD ratios (VFDR = proportion of missing homonymous hemifield with 0 = no VFD, 0.5 = complete superior quadrantanopsia) quantified VFD. Regressions of VFDR were evaluated against treatment arm and covariates. MRI evaluated effects of volume changes on VFDR. The relationships of VFDR with seizure remission and driving status 3 years after surgery were evaluated.
No patients reported visual changes or had abnormal bedside examinations, but 49 of 54 (91%) of patients experienced VFD on formal perimetry. Neither incidence nor severity of VFDR differed significantly by treatment arm. VFDR severity was not associated with seizure remission or driving status.
The nature of VFD was consistent with lesions of the optic radiations. Effective surgery (defined by seizure remission) of the mesial temporal lobe results in about a 90% incidence of typical VFD regardless of method.
立体定向放射外科（SRS）可能是内侧颞叶癫痫（MTLE）的替代治疗方法。对于 MTLE 的开放性手术，有 9-100%的患者会出现视野缺损（VFD）。微创与开放性手术的术后 VFD 可能不同。
本前瞻性试验将单侧海马硬化症和视频脑电图结果一致的患者随机分为 SRS 与 ATL 治疗组。术后 24 个月进行 Humphries 视野检查。视野缺损比（VFDR=缺失同形同侧视野的比例，0=无 VFD，0.5=完全上象限盲）量化 VFD。VFDR 的回归分析针对治疗组和协变量进行评估。MRI 评估了体积变化对 VFDR 的影响。术后 3 年，评估 VFDR 与癫痫缓解和驾驶状态的关系。
没有患者报告视觉变化或出现异常床边检查，但 54 例患者中有 49 例（91%）在正式视野检查中出现 VFD。治疗组之间 VFDR 的发生率和严重程度无显著差异。VFDR 的严重程度与癫痫缓解或驾驶状态无关。
VFD 的性质与视辐射病变一致。内侧颞叶的有效手术（定义为癫痫缓解）会导致约 90%的典型 VFD 发生，无论手术方式如何。
