Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts, USA.
Harvard Medical School, Boston, Massachusetts, USA.
Oper Neurosurg (Hagerstown). 2021 Oct 13;21(5):312-323. doi: 10.1093/ons/opab262.
Anterior temporal lobectomy (ATL) is the most effective treatment for drug-resistant mesial temporal lobe epilepsy. Extrapial en bloc hippocampal resection facilitates complete removal of the hippocampus. With increasing use of minimally invasive treatments, considering open resection techniques that optimize the integrity of tissue specimens is important both for obtaining the correct histopathological diagnosis and for further study.
To describe the operative strategy and clinical outcomes associated with an extrapial approach to hippocampal resection during ATL.
A database of epilepsy surgeries performed by a single surgeon between October 2011 and February 2019 was reviewed to identify all patients who underwent ATL using an extrapial approach to hippocampal resection. To reduce confounding variables for outcome analysis, subjects with prior resections, tumors, and cavernous malformations were excluded. Seizure outcomes were classified using the Engel scale.
The surgical technique is described and illustrated with intraoperative images. A total of 62 patients met inclusion criteria (31 females) for outcome analysis. Patients with most recent follow-up <3 yr (n = 33) and >3 yr (n = 29) exhibited 79% and 52% class I outcomes, respectively. An infarct was observed on postoperative magnetic resonance imaging in 3 patients (1 asymptomatic and 2 temporarily symptomatic). An en bloc specimen in which the subiculum and all hippocampal subfields were preserved was obtained in each case. Examples of innovative research opportunities resulting from this approach are presented.
Extrapial resection of the hippocampus can be performed safely with seizure freedom and complication rates at least as good as those reported with the use of subpial techniques.
前颞叶切除术（ATL）是治疗耐药性内侧颞叶癫痫最有效的方法。额外皮质整块海马切除术有助于完全切除海马。随着微创治疗的应用越来越广泛，考虑到优化组织标本完整性的开放切除技术，对于获得正确的组织病理学诊断和进一步研究都很重要。
描述在 ATL 期间进行额外皮质海马切除术的手术策略和临床结果。
回顾了 2011 年 10 月至 2019 年 2 月期间由一位外科医生进行的癫痫手术数据库，以确定所有使用额外皮质海马切除术进行 ATL 的患者。为了减少结果分析的混杂变量，排除了有既往切除术、肿瘤和海绵状血管畸形的患者。采用 Engel 量表对癫痫发作结果进行分类。
描述了手术技术并结合术中图像进行了说明。共有 62 名患者符合纳入标准（31 名女性）进行结果分析。最近随访<3 年（n=33）和>3 年（n=29）的患者分别有 79%和 52%的 I 级结果。3 名患者（1 名无症状，2 名暂时有症状）术后磁共振成像显示有梗死。在每个病例中均获得了保留下托和所有海马亚区的整块标本。展示了从这种方法中获得的创新研究机会的示例。
额外皮质海马切除术可以安全进行，其癫痫发作无发作率和并发症发生率至少与使用皮质下技术一样好。
