Goldstein Hannah E, Poliakov Andrew, Shaw Dennis W, Barry Dwight, Tran Kieu, Novotny Edward J, Saneto Russell P, Marashly Ahmad, Warner Molly H, Wright Jason N, Hauptman Jason S, Ojemann Jeffrey G, Shurtleff Hillary A
1Neurosciences Center, Seattle Children's Hospital, Seattle.
2Department of Neurological Surgery, University of Washington School of Medicine, Seattle.
J Neurosurg Pediatr. 2022 Jul 1;30(3):272-283. doi: 10.3171/2022.5.PEDS22148. Print 2022 Sep 1.
The goal of epilepsy surgery is both seizure cessation and maximal preservation of function. In temporal lobe (TL) cases, the lack of functional MRI (fMRI) tasks that effectively activate mesial temporal structures hampers preoperative memory risk assessment, especially in children. This study evaluated pediatric TL surgery outcome optimization associated with tailored resection informed by an fMRI memory task.
The authors identified focal onset TL epilepsy patients with 1) TL resections; 2) viable fMRI memory scans; and 3) pre- and postoperative neuropsychological (NP) evaluations. They retrospectively evaluated preoperative fMRI memory scans, available Wada tests, pre- and postoperative NP scores, postoperative MRI scans, and postoperative Engel class outcomes. To assess fMRI memory task outcome prediction, the authors 1) overlaid preoperative fMRI activation onto postoperative structural images; 2) classified patients as having "overlap" or "no overlap" of activation and resection cavities; and 3) compared these findings with memory improvement, stability, or decline, based on Reliable Change Index calculations.
Twenty patients met the inclusion criteria. At a median of 2.1 postoperative years, 16 patients had Engel class IA outcomes and 1 each had Engel class IB, ID, IIA, and IID outcomes. Functional MRI activation was linked to NP memory outcome in 19 of 20 cases (95%). Otherwise, heterogeneity characterized the cohort.
Functional MRI memory task activation effectively predicted individual NP outcomes in the context of tailored TL resections. Patients had excellent seizure and overall good NP outcomes. This small study adds to extant literature indicating that pediatric TL epilepsy does not represent a single clinical syndrome. Findings support individualized surgical intervention using fMRI memory activation to help guide this precision medicine approach.
癫痫手术的目标是实现癫痫发作停止并最大程度保留功能。在颞叶（TL）病例中，缺乏能有效激活颞叶内侧结构的功能磁共振成像（fMRI）任务妨碍了术前记忆风险评估，尤其是在儿童中。本研究评估了由fMRI记忆任务指导的量身定制切除术对小儿TL手术结果优化的影响。
作者确定了符合以下条件的局灶性发作性TL癫痫患者：1）进行了TL切除术；2）有可用的fMRI记忆扫描；3）有术前和术后神经心理学（NP）评估。他们回顾性评估了术前fMRI记忆扫描、可用的Wada试验、术前和术后NP评分、术后MRI扫描以及术后Engel分级结果。为了评估fMRI记忆任务结果预测，作者：1）将术前fMRI激活叠加到术后结构图像上；2）将患者分类为激活区域与切除腔有“重叠”或“无重叠”；3）根据可靠变化指数计算，将这些结果与记忆改善、稳定或下降情况进行比较。
20名患者符合纳入标准。术后中位时间为2.1年时，16名患者达到Engel I级A结局，各有1名患者达到Engel I级B、D、II级A和II级D结局。20例中的19例（95%）中，fMRI激活与NP记忆结果相关。否则，该队列具有异质性。
在量身定制的TL切除术中，fMRI记忆任务激活有效地预测了个体NP结果。患者癫痫发作控制良好，总体NP结果良好。这项小型研究补充了现有文献，表明小儿TL癫痫并不代表单一临床综合征。研究结果支持使用fMRI记忆激活进行个体化手术干预，以帮助指导这种精准医疗方法。
