Neuroimaging Laboratory, University of Campinas, Campinas, Brazil.
Department of Ophthalmology, University of Campinas, Campinas, Brazil.
Epilepsia. 2021 Feb;62(2):439-449. doi: 10.1111/epi.16816. Epub 2021 Jan 15.
This study's objective was to compare the transinsular (TI-AH), transuncus (TU-AH), and temporopolar (TP-AH) amygdalohippocampectomy approaches regarding seizure control, temporal stem (TS) damage, and neurocognitive decline.
We included 114 consecutive patients with unilateral hippocampal sclerosis (HS) who underwent TI-AH, TU-AH, or TP-AH between 2002 and 2017. We evaluated seizure control using Engel classification. We used diffusion tensor imaging and postoperative Humphrey perimetry to assess the damage of the TS. We also performed pre- and postoperative memory performance and intelligence quotient (IQ).
There were no significant differences in the proportion of patients free of disabling seizures (Engel IA+IB) among the three surgical approaches in the survival analysis. However, more patients were free of disabling seizures (Engel IA+IB) at 2 years of postsurgical follow-up with TP-AH (69.5%) and TI-AH (76.7%) as compared to the TU-AH (43.5%) approach (p = .03). The number of fibers of the inferior fronto-occipital fasciculus postoperatively was reduced in the TI-AH group compared with the TU-AH and TP-AH groups (p = .001). The rate of visual field defects was significantly higher with TI-AH (14/19, 74%) in comparison to the TU-AH (5/15, 33%) and TP-AH (13/40, 32.5%) approaches (p = .008). Finally, there was a significant postoperative decline in verbal memory in left-sided surgeries (p = .019) and delayed recall for both sides (p < .001) regardless of the surgical approach. However, TP-AH was the only group that showed a significant improvement in visual memory (p < .001) and IQ (p < .001) for both right- and left-sided surgeries.
The TP-AH group had better short-term seizure control than TU-AH, a lower rate of visual field defects than TI-AH, and improved visual memory and IQ compared to the other groups. Our findings suggest that TP-AH is a better surgical approach for temporal lobe epilepsy with HS than TI-AH and TU-AH.
本研究旨在比较经岛叶（TI-AH）、经穹窿（TU-AH）和经颞极（TP-AH）杏仁核海马切除术在控制癫痫发作、颞干（TS）损伤和神经认知下降方面的效果。
我们纳入了 2002 年至 2017 年间接受 TI-AH、TU-AH 或 TP-AH 手术的 114 例单侧海马硬化（HS）患者。我们使用 Engel 分级评估癫痫发作的控制情况。我们使用弥散张量成像和术后 Humphrey 视野计评估 TS 的损伤情况。我们还在术前和术后评估了记忆表现和智商（IQ）。
在生存分析中，三组手术方式的无致残性癫痫发作（Engel IA+IB）患者比例之间没有显著差异。然而，与 TU-AH 组（43.5%）相比，TP-AH（69.5%）和 TI-AH（76.7%）组在术后 2 年的随访中，无致残性癫痫发作（Engel IA+IB）的患者更多（p=0.03）。与 TU-AH 和 TP-AH 组相比，TI-AH 组术后下额枕束的纤维数量减少（p=0.001）。与 TU-AH（5/15，33%）和 TP-AH（13/40，32.5%）相比，TI-AH 组（14/19，74%）视野缺损的发生率显著更高（p=0.008）。最后，无论手术方式如何，左侧手术的言语记忆在术后均显著下降（p=0.019），双侧的延迟回忆也显著下降（p<0.001）。然而，只有 TP-AH 组在右侧和左侧手术中都显示出明显的视觉记忆（p<0.001）和智商（p<0.001）的改善。
与 TU-AH 相比，TP-AH 组的短期癫痫发作控制效果更好，与 TI-AH 相比，视野缺损的发生率更低，与其他组相比，视觉记忆和智商也有所提高。我们的研究结果表明，与 TI-AH 和 TU-AH 相比，TP-AH 是治疗颞叶癫痫伴 HS 的更好手术方式。
